|
HC CONTRAST BATHS EACH 15 MIN
|
Facility
|
IP
|
$105.77
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
42000017
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$66.64 |
| Max. Negotiated Rate |
$95.19 |
| Rate for Payer: Aetna Commercial |
$89.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.75
|
| Rate for Payer: Cash Price |
$84.62
|
| Rate for Payer: Cofinity Commercial |
$74.04
|
| Rate for Payer: Cofinity Commercial |
$90.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.62
|
| Rate for Payer: Healthscope Commercial |
$95.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.90
|
| Rate for Payer: PHP Commercial |
$89.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.75
|
| Rate for Payer: Priority Health SBD |
$66.64
|
|
|
HC CONTROL NOSEBLEED ANTERIOR SIMPLE
|
Facility
|
IP
|
$414.64
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
45000011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$261.22 |
| Max. Negotiated Rate |
$373.18 |
| Rate for Payer: Aetna Commercial |
$352.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.52
|
| Rate for Payer: Cash Price |
$331.71
|
| Rate for Payer: Cofinity Commercial |
$290.25
|
| Rate for Payer: Cofinity Commercial |
$356.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$290.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.71
|
| Rate for Payer: Healthscope Commercial |
$373.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.44
|
| Rate for Payer: PHP Commercial |
$352.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.52
|
| Rate for Payer: Priority Health SBD |
$261.22
|
|
|
HC CONTROL NOSEBLEED ANTERIOR SIMPLE
|
Facility
|
OP
|
$414.64
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
45000011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.78 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$352.44
|
| Rate for Payer: Aetna Medicare |
$131.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$103.06
|
| Rate for Payer: BCN Commercial |
$103.06
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Cash Price |
$331.71
|
| Rate for Payer: Cash Price |
$331.71
|
| Rate for Payer: Cash Price |
$331.71
|
| Rate for Payer: Cofinity Commercial |
$290.25
|
| Rate for Payer: Cofinity Commercial |
$356.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$290.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Healthscope Commercial |
$373.18
|
| Rate for Payer: Mclaren Medicaid |
$67.69
|
| Rate for Payer: Mclaren Medicare |
$126.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.44
|
| Rate for Payer: Nomi Health Commercial |
$378.87
|
| Rate for Payer: PACE Medicare |
$119.98
|
| Rate for Payer: PACE SWMI |
$126.29
|
| Rate for Payer: PHP Commercial |
$352.44
|
| Rate for Payer: PHP Medicare Advantage |
$126.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$396.95
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$317.56
|
| Rate for Payer: Priority Health SBD |
$261.22
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.78
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$71.10
|
| Rate for Payer: VA VA |
$126.29
|
|
|
HC CONTROL OROPHARYNGEAL HEM SIMPLE
|
Facility
|
IP
|
$753.77
|
|
|
Service Code
|
CPT 42960
|
| Hospital Charge Code |
45000100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$474.88 |
| Max. Negotiated Rate |
$678.39 |
| Rate for Payer: Aetna Commercial |
$640.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$489.95
|
| Rate for Payer: Cash Price |
$603.02
|
| Rate for Payer: Cofinity Commercial |
$527.64
|
| Rate for Payer: Cofinity Commercial |
$648.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$527.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$603.02
|
| Rate for Payer: Healthscope Commercial |
$678.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$640.70
|
| Rate for Payer: PHP Commercial |
$640.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$489.95
|
| Rate for Payer: Priority Health SBD |
$474.88
|
|
|
HC CONTROL OROPHARYNGEAL HEM SIMPLE
|
Facility
|
OP
|
$753.77
|
|
|
Service Code
|
CPT 42960
|
| Hospital Charge Code |
45000100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$170.83 |
| Max. Negotiated Rate |
$1,568.21 |
| Rate for Payer: Aetna Commercial |
$640.70
|
| Rate for Payer: Aetna Medicare |
$518.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$489.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$623.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$623.69
|
| Rate for Payer: BCBS Complete |
$280.81
|
| Rate for Payer: BCBS MAPPO |
$498.95
|
| Rate for Payer: BCBS Trust/PPO |
$294.06
|
| Rate for Payer: BCN Commercial |
$294.06
|
| Rate for Payer: BCN Medicare Advantage |
$498.95
|
| Rate for Payer: Cash Price |
$603.02
|
| Rate for Payer: Cash Price |
$603.02
|
| Rate for Payer: Cash Price |
$603.02
|
| Rate for Payer: Cofinity Commercial |
$648.24
|
| Rate for Payer: Cofinity Commercial |
$527.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$527.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$603.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$498.95
|
| Rate for Payer: Healthscope Commercial |
$678.39
|
| Rate for Payer: Mclaren Medicaid |
$267.44
|
| Rate for Payer: Mclaren Medicare |
$498.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$523.90
|
| Rate for Payer: Meridian Medicaid |
$280.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$573.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$640.70
|
| Rate for Payer: Nomi Health Commercial |
$1,047.80
|
| Rate for Payer: PACE Medicare |
$474.00
|
| Rate for Payer: PACE SWMI |
$498.95
|
| Rate for Payer: PHP Commercial |
$640.70
|
| Rate for Payer: PHP Medicare Advantage |
$498.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$489.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,568.21
|
| Rate for Payer: Priority Health Medicare |
$498.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,254.57
|
| Rate for Payer: Priority Health SBD |
$474.88
|
| Rate for Payer: Railroad Medicare Medicare |
$498.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.83
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$498.95
|
| Rate for Payer: UHC Medicare Advantage |
$498.95
|
| Rate for Payer: UHCCP Medicaid |
$280.91
|
| Rate for Payer: VA VA |
$498.95
|
|
|
HC CONTROL OROPHARYNG HEMORRHAGE SIMPLE
|
Facility
|
OP
|
$1,342.32
|
|
|
Service Code
|
CPT 42960
|
| Hospital Charge Code |
76100478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$170.83 |
| Max. Negotiated Rate |
$1,568.21 |
| Rate for Payer: Aetna Commercial |
$1,140.97
|
| Rate for Payer: Aetna Medicare |
$518.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$872.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$623.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$623.69
|
| Rate for Payer: BCBS Complete |
$280.81
|
| Rate for Payer: BCBS MAPPO |
$498.95
|
| Rate for Payer: BCBS Trust/PPO |
$294.06
|
| Rate for Payer: BCN Commercial |
$294.06
|
| Rate for Payer: BCN Medicare Advantage |
$498.95
|
| Rate for Payer: Cash Price |
$1,073.86
|
| Rate for Payer: Cash Price |
$1,073.86
|
| Rate for Payer: Cash Price |
$1,073.86
|
| Rate for Payer: Cofinity Commercial |
$939.62
|
| Rate for Payer: Cofinity Commercial |
$1,154.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$939.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,073.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$498.95
|
| Rate for Payer: Healthscope Commercial |
$1,208.09
|
| Rate for Payer: Mclaren Medicaid |
$267.44
|
| Rate for Payer: Mclaren Medicare |
$498.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$523.90
|
| Rate for Payer: Meridian Medicaid |
$280.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$573.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,140.97
|
| Rate for Payer: Nomi Health Commercial |
$1,047.80
|
| Rate for Payer: PACE Medicare |
$474.00
|
| Rate for Payer: PACE SWMI |
$498.95
|
| Rate for Payer: PHP Commercial |
$1,140.97
|
| Rate for Payer: PHP Medicare Advantage |
$498.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$872.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,568.21
|
| Rate for Payer: Priority Health Medicare |
$498.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,254.57
|
| Rate for Payer: Priority Health SBD |
$845.66
|
| Rate for Payer: Railroad Medicare Medicare |
$498.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.83
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$498.95
|
| Rate for Payer: UHC Medicare Advantage |
$498.95
|
| Rate for Payer: UHCCP Medicaid |
$280.91
|
| Rate for Payer: VA VA |
$498.95
|
|
|
HC CONTROL OROPHARYNG HEMORRHAGE SIMPLE
|
Facility
|
IP
|
$1,342.32
|
|
|
Service Code
|
CPT 42960
|
| Hospital Charge Code |
76100478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$845.66 |
| Max. Negotiated Rate |
$1,208.09 |
| Rate for Payer: Aetna Commercial |
$1,140.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$872.51
|
| Rate for Payer: Cash Price |
$1,073.86
|
| Rate for Payer: Cofinity Commercial |
$1,154.40
|
| Rate for Payer: Cofinity Commercial |
$939.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$939.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,073.86
|
| Rate for Payer: Healthscope Commercial |
$1,208.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,140.97
|
| Rate for Payer: PHP Commercial |
$1,140.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$872.51
|
| Rate for Payer: Priority Health SBD |
$845.66
|
|
|
HC CONVERT EXTERNAL BILIARY DRAIN TO INTERNAL EXTERNAL
|
Facility
|
OP
|
$3,683.04
|
|
|
Service Code
|
CPT 47535
|
| Hospital Charge Code |
36100492
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$202.82 |
| Max. Negotiated Rate |
$10,867.50 |
| Rate for Payer: Aetna Commercial |
$3,130.58
|
| Rate for Payer: Aetna Medicare |
$3,596.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,393.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,322.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,322.12
|
| Rate for Payer: BCBS Complete |
$1,945.99
|
| Rate for Payer: BCBS MAPPO |
$3,457.70
|
| Rate for Payer: BCBS Trust/PPO |
$2,383.17
|
| Rate for Payer: BCN Commercial |
$2,383.17
|
| Rate for Payer: BCN Medicare Advantage |
$3,457.70
|
| Rate for Payer: Cash Price |
$2,946.43
|
| Rate for Payer: Cash Price |
$2,946.43
|
| Rate for Payer: Cash Price |
$2,946.43
|
| Rate for Payer: Cofinity Commercial |
$2,578.13
|
| Rate for Payer: Cofinity Commercial |
$3,167.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,578.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,946.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,457.70
|
| Rate for Payer: Healthscope Commercial |
$3,314.74
|
| Rate for Payer: Mclaren Medicaid |
$1,853.33
|
| Rate for Payer: Mclaren Medicare |
$3,457.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,630.58
|
| Rate for Payer: Meridian Medicaid |
$1,945.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,976.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,130.58
|
| Rate for Payer: Nomi Health Commercial |
$7,261.17
|
| Rate for Payer: PACE Medicare |
$3,284.82
|
| Rate for Payer: PACE SWMI |
$3,457.70
|
| Rate for Payer: PHP Commercial |
$3,130.58
|
| Rate for Payer: PHP Medicare Advantage |
$3,457.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,853.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,393.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,867.50
|
| Rate for Payer: Priority Health Medicare |
$3,457.70
|
| Rate for Payer: Priority Health Narrow Network |
$8,694.00
|
| Rate for Payer: Priority Health SBD |
$2,320.32
|
| Rate for Payer: Railroad Medicare Medicare |
$3,457.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.82
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,457.70
|
| Rate for Payer: UHC Exchange |
$5,811.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,457.70
|
| Rate for Payer: UHCCP Medicaid |
$1,946.69
|
| Rate for Payer: VA VA |
$3,457.70
|
|
|
HC CONVERT EXTERNAL BILIARY DRAIN TO INTERNAL EXTERNAL
|
Facility
|
IP
|
$3,683.04
|
|
|
Service Code
|
CPT 47535
|
| Hospital Charge Code |
36100492
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,320.32 |
| Max. Negotiated Rate |
$3,314.74 |
| Rate for Payer: Aetna Commercial |
$3,130.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,393.98
|
| Rate for Payer: Cash Price |
$2,946.43
|
| Rate for Payer: Cofinity Commercial |
$2,578.13
|
| Rate for Payer: Cofinity Commercial |
$3,167.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,578.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,946.43
|
| Rate for Payer: Healthscope Commercial |
$3,314.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,130.58
|
| Rate for Payer: PHP Commercial |
$3,130.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,393.98
|
| Rate for Payer: Priority Health SBD |
$2,320.32
|
|
|
HC CONVERT NEPHROSTOMY TO NEPHROURETERAL CATH
|
Facility
|
OP
|
$1,204.40
|
|
|
Service Code
|
CPT 50434
|
| Hospital Charge Code |
36100506
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$198.23 |
| Max. Negotiated Rate |
$6,308.24 |
| Rate for Payer: Aetna Commercial |
$1,023.74
|
| Rate for Payer: Aetna Medicare |
$2,087.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$782.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,508.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,508.86
|
| Rate for Payer: BCBS Complete |
$1,129.59
|
| Rate for Payer: BCBS MAPPO |
$2,007.09
|
| Rate for Payer: BCBS Trust/PPO |
$567.75
|
| Rate for Payer: BCN Commercial |
$567.75
|
| Rate for Payer: BCN Medicare Advantage |
$2,007.09
|
| Rate for Payer: Cash Price |
$963.52
|
| Rate for Payer: Cash Price |
$963.52
|
| Rate for Payer: Cash Price |
$963.52
|
| Rate for Payer: Cofinity Commercial |
$1,035.78
|
| Rate for Payer: Cofinity Commercial |
$843.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$843.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$963.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,007.09
|
| Rate for Payer: Healthscope Commercial |
$1,083.96
|
| Rate for Payer: Mclaren Medicaid |
$1,075.80
|
| Rate for Payer: Mclaren Medicare |
$2,007.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,107.44
|
| Rate for Payer: Meridian Medicaid |
$1,129.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,308.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,023.74
|
| Rate for Payer: Nomi Health Commercial |
$4,214.89
|
| Rate for Payer: PACE Medicare |
$1,906.74
|
| Rate for Payer: PACE SWMI |
$2,007.09
|
| Rate for Payer: PHP Commercial |
$1,023.74
|
| Rate for Payer: PHP Medicare Advantage |
$2,007.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$782.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,308.24
|
| Rate for Payer: Priority Health Medicare |
$2,007.09
|
| Rate for Payer: Priority Health Narrow Network |
$5,046.59
|
| Rate for Payer: Priority Health SBD |
$758.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,007.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.23
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,007.09
|
| Rate for Payer: UHC Exchange |
$1,566.00
|
| Rate for Payer: UHC Medicare Advantage |
$2,007.09
|
| Rate for Payer: UHCCP Medicaid |
$1,129.99
|
| Rate for Payer: VA VA |
$2,007.09
|
|
|
HC CONVERT NEPHROSTOMY TO NEPHROURETERAL CATH
|
Facility
|
IP
|
$1,204.40
|
|
|
Service Code
|
CPT 50434
|
| Hospital Charge Code |
36100506
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$758.77 |
| Max. Negotiated Rate |
$1,083.96 |
| Rate for Payer: Aetna Commercial |
$1,023.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$782.86
|
| Rate for Payer: Cash Price |
$963.52
|
| Rate for Payer: Cofinity Commercial |
$1,035.78
|
| Rate for Payer: Cofinity Commercial |
$843.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$843.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$963.52
|
| Rate for Payer: Healthscope Commercial |
$1,083.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,023.74
|
| Rate for Payer: PHP Commercial |
$1,023.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$782.86
|
| Rate for Payer: Priority Health SBD |
$758.77
|
|
|
HC CONVEX WAFER
|
Facility
|
OP
|
$57.04
|
|
| Hospital Charge Code |
27000049
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.82 |
| Max. Negotiated Rate |
$51.34 |
| Rate for Payer: Aetna Commercial |
$48.48
|
| Rate for Payer: Aetna Medicare |
$28.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.08
|
| Rate for Payer: BCBS Complete |
$22.82
|
| Rate for Payer: Cash Price |
$45.63
|
| Rate for Payer: Cofinity Commercial |
$39.93
|
| Rate for Payer: Cofinity Commercial |
$49.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.63
|
| Rate for Payer: Healthscope Commercial |
$51.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.48
|
| Rate for Payer: PHP Commercial |
$48.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.08
|
| Rate for Payer: Priority Health SBD |
$35.94
|
|
|
HC CONVEX WAFER
|
Facility
|
IP
|
$57.04
|
|
| Hospital Charge Code |
27000049
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.94 |
| Max. Negotiated Rate |
$51.34 |
| Rate for Payer: Aetna Commercial |
$48.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.08
|
| Rate for Payer: Cash Price |
$45.63
|
| Rate for Payer: Cofinity Commercial |
$39.93
|
| Rate for Payer: Cofinity Commercial |
$49.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.63
|
| Rate for Payer: Healthscope Commercial |
$51.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.48
|
| Rate for Payer: PHP Commercial |
$48.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.08
|
| Rate for Payer: Priority Health SBD |
$35.94
|
|
|
HC COOK GUIDEWIRE
|
Facility
|
IP
|
$47.87
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.16 |
| Max. Negotiated Rate |
$43.08 |
| Rate for Payer: Aetna Commercial |
$40.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.12
|
| Rate for Payer: Cash Price |
$38.30
|
| Rate for Payer: Cofinity Commercial |
$33.51
|
| Rate for Payer: Cofinity Commercial |
$41.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.30
|
| Rate for Payer: Healthscope Commercial |
$43.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.69
|
| Rate for Payer: PHP Commercial |
$40.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.12
|
| Rate for Payer: Priority Health SBD |
$30.16
|
|
|
HC COOK GUIDEWIRE
|
Facility
|
OP
|
$47.87
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.15 |
| Max. Negotiated Rate |
$43.08 |
| Rate for Payer: Aetna Commercial |
$40.69
|
| Rate for Payer: Aetna Medicare |
$23.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.12
|
| Rate for Payer: BCBS Complete |
$19.15
|
| Rate for Payer: Cash Price |
$38.30
|
| Rate for Payer: Cofinity Commercial |
$33.51
|
| Rate for Payer: Cofinity Commercial |
$41.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.30
|
| Rate for Payer: Healthscope Commercial |
$43.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.69
|
| Rate for Payer: PHP Commercial |
$40.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.12
|
| Rate for Payer: Priority Health SBD |
$30.16
|
|
|
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 COOK PIGTAIL
|
Facility
|
IP
|
$468.32
|
|
| Hospital Charge Code |
27200233
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$295.04 |
| Max. Negotiated Rate |
$421.49 |
| Rate for Payer: Aetna Commercial |
$398.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.41
|
| 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
|
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 |
$1,644.75
|
| Rate for Payer: Cofinity Commercial |
$1,338.75
|
| 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
|
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 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 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: BCBS Trust/PPO |
$10.99
|
| Rate for Payer: BCN Commercial |
$10.99
|
| 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 |
$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: 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: Nomi Health Commercial |
$18.62
|
| 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 HMO/PPO/Tiered Network |
$12.77
|
| Rate for Payer: Priority Health Medicare |
$12.41
|
| Rate for Payer: Priority Health Narrow Network |
$10.22
|
| Rate for Payer: Priority Health SBD |
$28.27
|
| Rate for Payer: Railroad Medicare Medicare |
$12.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.89
|
| Rate for Payer: UHC Core |
$9.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.41
|
| Rate for Payer: UHC Exchange |
$9.83
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: UHCCP Medicaid |
$6.99
|
| Rate for Payer: VA VA |
$12.41
|
|
|
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: BCBS Trust/PPO |
$10.99
|
| Rate for Payer: BCN Commercial |
$10.99
|
| 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 |
$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: 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: Nomi Health Commercial |
$18.62
|
| 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 HMO/PPO/Tiered Network |
$12.77
|
| Rate for Payer: Priority Health Medicare |
$12.41
|
| Rate for Payer: Priority Health Narrow Network |
$10.22
|
| Rate for Payer: Priority Health SBD |
$39.84
|
| Rate for Payer: Railroad Medicare Medicare |
$12.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.89
|
| Rate for Payer: UHC Core |
$9.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.41
|
| Rate for Payer: UHC Exchange |
$9.83
|
| 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
|
|
