|
HC INJ SELECT R VENT/ATRIAL ANGIO HRT CATH
|
Facility
|
IP
|
$670.14
|
|
|
Service Code
|
CPT 93566
|
| Hospital Charge Code |
36000110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$422.19 |
| Max. Negotiated Rate |
$603.13 |
| Rate for Payer: Aetna Commercial |
$569.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$435.59
|
| Rate for Payer: Cash Price |
$536.11
|
| Rate for Payer: Cofinity Commercial |
$469.10
|
| Rate for Payer: Cofinity Commercial |
$576.32
|
| Rate for Payer: Healthscope Commercial |
$603.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$569.62
|
| Rate for Payer: PHP Commercial |
$569.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$469.10
|
| Rate for Payer: Priority Health SBD |
$422.19
|
|
|
HC INJ SELECT R VENT/ATRIAL ANGIO HRT CATH
|
Facility
|
OP
|
$670.14
|
|
|
Service Code
|
CPT 93566
|
| Hospital Charge Code |
36000110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$24.89 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$569.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$435.59
|
| Rate for Payer: BCBS Complete |
$268.06
|
| Rate for Payer: BCBS Trust/PPO |
$27.63
|
| Rate for Payer: Cash Price |
$536.11
|
| Rate for Payer: Cash Price |
$536.11
|
| Rate for Payer: Cofinity Commercial |
$576.32
|
| Rate for Payer: Cofinity Commercial |
$469.10
|
| Rate for Payer: Healthscope Commercial |
$603.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$569.62
|
| Rate for Payer: PHP Commercial |
$569.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$469.10
|
| Rate for Payer: Priority Health SBD |
$422.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.38
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$24.89
|
|
|
HC INJ TIXAGEVIMAB AND CILGAVIMAB
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
HCPCS M0220
|
| Hospital Charge Code |
77100033
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$128.52 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Aetna Commercial |
$173.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.60
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$142.80
|
| Rate for Payer: Cofinity Commercial |
$175.44
|
| Rate for Payer: Healthscope Commercial |
$183.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$173.40
|
| Rate for Payer: PHP Commercial |
$173.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.80
|
| Rate for Payer: Priority Health SBD |
$128.52
|
|
|
HC INJ TIXAGEVIMAB AND CILGAVIMAB
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
HCPCS M0220
|
| Hospital Charge Code |
77100033
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$76.88 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Aetna Commercial |
$173.40
|
| Rate for Payer: Aetna Medicare |
$146.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$175.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$175.69
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS MAPPO |
$140.55
|
| Rate for Payer: BCN Medicare Advantage |
$140.55
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$142.80
|
| Rate for Payer: Cofinity Commercial |
$175.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.55
|
| Rate for Payer: Healthscope Commercial |
$183.60
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Mclaren Medicare |
$140.55
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$147.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$161.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$173.40
|
| Rate for Payer: PACE Medicare |
$133.52
|
| Rate for Payer: PACE SWMI |
$140.55
|
| Rate for Payer: PHP Commercial |
$173.40
|
| Rate for Payer: PHP Medicare Advantage |
$140.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.80
|
| Rate for Payer: Priority Health Medicare |
$140.55
|
| Rate for Payer: Priority Health SBD |
$128.52
|
| Rate for Payer: Railroad Medicare Medicare |
$140.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.55
|
| Rate for Payer: UHC Medicare Advantage |
$144.77
|
| Rate for Payer: VA VA |
$140.55
|
|
|
HC INJ, TRIAMCINOLONE ACETONIDE, NOT SPECIFIED, 10 MG
|
Facility
|
IP
|
$10.20
|
|
|
Service Code
|
CPT J3301
|
| Hospital Charge Code |
63600103
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Aetna Commercial |
$8.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.63
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cofinity Commercial |
$8.77
|
| Rate for Payer: Cofinity Commercial |
$7.14
|
| Rate for Payer: Healthscope Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.67
|
| Rate for Payer: PHP Commercial |
$8.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.14
|
| Rate for Payer: Priority Health SBD |
$6.43
|
|
|
HC INJ, TRIAMCINOLONE ACETONIDE, NOT SPECIFIED, 10 MG
|
Facility
|
OP
|
$10.20
|
|
|
Service Code
|
CPT J3301
|
| Hospital Charge Code |
63600103
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Aetna Commercial |
$8.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.63
|
| Rate for Payer: BCBS Complete |
$4.08
|
| Rate for Payer: BCBS Trust/PPO |
$2.79
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cofinity Commercial |
$7.14
|
| Rate for Payer: Cofinity Commercial |
$8.77
|
| Rate for Payer: Healthscope Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.67
|
| Rate for Payer: PHP Commercial |
$8.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.14
|
| Rate for Payer: Priority Health SBD |
$6.43
|
|
|
HC INJ, VIT B12 CYANCOBALAMIN, UP TO 1000MCG
|
Facility
|
IP
|
$5.10
|
|
|
Service Code
|
CPT J3420
|
| Hospital Charge Code |
63600104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna Commercial |
$4.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.32
|
| Rate for Payer: Cash Price |
$4.08
|
| Rate for Payer: Cofinity Commercial |
$4.39
|
| Rate for Payer: Cofinity Commercial |
$3.57
|
| Rate for Payer: Healthscope Commercial |
$4.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.34
|
| Rate for Payer: PHP Commercial |
$4.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.57
|
| Rate for Payer: Priority Health SBD |
$3.21
|
|
|
HC INJ, VIT B12 CYANCOBALAMIN, UP TO 1000MCG
|
Facility
|
OP
|
$5.10
|
|
|
Service Code
|
CPT J3420
|
| Hospital Charge Code |
63600104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna Commercial |
$4.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.32
|
| Rate for Payer: BCBS Complete |
$2.04
|
| Rate for Payer: BCBS Trust/PPO |
$4.27
|
| Rate for Payer: Cash Price |
$4.08
|
| Rate for Payer: Cash Price |
$4.08
|
| Rate for Payer: Cofinity Commercial |
$3.57
|
| Rate for Payer: Cofinity Commercial |
$4.39
|
| Rate for Payer: Healthscope Commercial |
$4.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.34
|
| Rate for Payer: PHP Commercial |
$4.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.57
|
| Rate for Payer: Priority Health SBD |
$3.21
|
|
|
HC INSECT VENOM ALLERGY PANEL
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200115
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.09
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC INSECT VENOM ALLERGY PANEL
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200115
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
|
|
HC INSERT CATH COMPLICATED
|
Facility
|
IP
|
$490.51
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
45000005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$309.02 |
| Max. Negotiated Rate |
$441.46 |
| Rate for Payer: Aetna Commercial |
$416.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.83
|
| Rate for Payer: Cash Price |
$392.41
|
| Rate for Payer: Cofinity Commercial |
$343.36
|
| Rate for Payer: Cofinity Commercial |
$421.84
|
| Rate for Payer: Healthscope Commercial |
$441.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$416.93
|
| Rate for Payer: PHP Commercial |
$416.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.36
|
| Rate for Payer: Priority Health SBD |
$309.02
|
|
|
HC INSERT CATH COMPLICATED
|
Facility
|
OP
|
$490.51
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
45000005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.67 |
| Max. Negotiated Rate |
$441.46 |
| Rate for Payer: Aetna Commercial |
$416.93
|
| Rate for Payer: Aetna Medicare |
$144.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.74
|
| Rate for Payer: BCBS Complete |
$79.84
|
| Rate for Payer: BCBS MAPPO |
$138.99
|
| Rate for Payer: BCBS Trust/PPO |
$50.67
|
| Rate for Payer: BCN Medicare Advantage |
$138.99
|
| Rate for Payer: Cash Price |
$392.41
|
| Rate for Payer: Cash Price |
$392.41
|
| Rate for Payer: Cofinity Commercial |
$421.84
|
| Rate for Payer: Cofinity Commercial |
$343.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.99
|
| Rate for Payer: Healthscope Commercial |
$441.46
|
| Rate for Payer: Mclaren Medicaid |
$76.03
|
| Rate for Payer: Mclaren Medicare |
$138.99
|
| Rate for Payer: Meridian Medicaid |
$79.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$416.93
|
| Rate for Payer: PACE Medicare |
$132.04
|
| Rate for Payer: PACE SWMI |
$138.99
|
| Rate for Payer: PHP Commercial |
$416.93
|
| Rate for Payer: PHP Medicare Advantage |
$138.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$436.07
|
| Rate for Payer: Priority Health Medicare |
$138.99
|
| Rate for Payer: Priority Health Narrow Network |
$348.85
|
| Rate for Payer: Priority Health SBD |
$309.02
|
| Rate for Payer: Railroad Medicare Medicare |
$138.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.99
|
| Rate for Payer: UHC Exchange |
$74.00
|
| Rate for Payer: UHC Medicare Advantage |
$143.16
|
| Rate for Payer: VA VA |
$138.99
|
|
|
HC INSERT CERVICAL DILATOR
|
Facility
|
OP
|
$414.94
|
|
|
Service Code
|
CPT 59200
|
| Hospital Charge Code |
36100397
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$875.44 |
| Rate for Payer: Aetna Commercial |
$352.70
|
| Rate for Payer: Aetna Medicare |
$296.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$356.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$356.81
|
| Rate for Payer: BCBS Complete |
$163.96
|
| Rate for Payer: BCBS MAPPO |
$285.45
|
| Rate for Payer: BCBS Trust/PPO |
$182.50
|
| Rate for Payer: BCN Medicare Advantage |
$285.45
|
| Rate for Payer: Cash Price |
$331.95
|
| Rate for Payer: Cash Price |
$331.95
|
| Rate for Payer: Cofinity Commercial |
$356.85
|
| Rate for Payer: Cofinity Commercial |
$290.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.45
|
| Rate for Payer: Healthscope Commercial |
$373.45
|
| Rate for Payer: Mclaren Medicaid |
$156.14
|
| Rate for Payer: Mclaren Medicare |
$285.45
|
| Rate for Payer: Meridian Medicaid |
$163.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$299.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$328.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$352.70
|
| Rate for Payer: PACE Medicare |
$271.18
|
| Rate for Payer: PACE SWMI |
$285.45
|
| Rate for Payer: PHP Commercial |
$352.70
|
| Rate for Payer: PHP Medicare Advantage |
$285.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$875.44
|
| Rate for Payer: Priority Health Medicare |
$285.45
|
| Rate for Payer: Priority Health Narrow Network |
$700.35
|
| Rate for Payer: Priority Health SBD |
$261.41
|
| Rate for Payer: Railroad Medicare Medicare |
$285.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$285.45
|
| Rate for Payer: UHC Exchange |
$43.55
|
| Rate for Payer: UHC Medicare Advantage |
$294.01
|
| Rate for Payer: VA VA |
$285.45
|
|
|
HC INSERT CERVICAL DILATOR
|
Facility
|
IP
|
$414.94
|
|
|
Service Code
|
CPT 59200
|
| Hospital Charge Code |
36100397
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$261.41 |
| Max. Negotiated Rate |
$373.45 |
| Rate for Payer: Aetna Commercial |
$352.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.71
|
| Rate for Payer: Cash Price |
$331.95
|
| Rate for Payer: Cofinity Commercial |
$290.46
|
| Rate for Payer: Cofinity Commercial |
$356.85
|
| Rate for Payer: Healthscope Commercial |
$373.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$352.70
|
| Rate for Payer: PHP Commercial |
$352.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.46
|
| Rate for Payer: Priority Health SBD |
$261.41
|
|
|
HC INSERT EMERGENCY AIRWAY
|
Facility
|
OP
|
$565.01
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
45000012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$118.88 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$480.26
|
| Rate for Payer: Aetna Medicare |
$226.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$271.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$271.68
|
| Rate for Payer: BCBS Complete |
$124.84
|
| Rate for Payer: BCBS MAPPO |
$217.34
|
| Rate for Payer: BCBS Trust/PPO |
$129.91
|
| Rate for Payer: BCN Medicare Advantage |
$217.34
|
| Rate for Payer: Cash Price |
$452.01
|
| Rate for Payer: Cash Price |
$452.01
|
| Rate for Payer: Cofinity Commercial |
$395.51
|
| Rate for Payer: Cofinity Commercial |
$485.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.34
|
| Rate for Payer: Healthscope Commercial |
$508.51
|
| Rate for Payer: Mclaren Medicaid |
$118.88
|
| Rate for Payer: Mclaren Medicare |
$217.34
|
| Rate for Payer: Meridian Medicaid |
$124.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$249.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$480.26
|
| Rate for Payer: PACE Medicare |
$206.47
|
| Rate for Payer: PACE SWMI |
$217.34
|
| Rate for Payer: PHP Commercial |
$480.26
|
| Rate for Payer: PHP Medicare Advantage |
$217.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$118.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$623.17
|
| Rate for Payer: Priority Health Medicare |
$217.34
|
| Rate for Payer: Priority Health Narrow Network |
$498.54
|
| Rate for Payer: Priority Health SBD |
$355.96
|
| Rate for Payer: Railroad Medicare Medicare |
$217.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.19
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$217.34
|
| Rate for Payer: UHC Exchange |
$136.54
|
| Rate for Payer: UHC Medicare Advantage |
$223.86
|
| Rate for Payer: VA VA |
$217.34
|
|
|
HC INSERT EMERGENCY AIRWAY
|
Facility
|
IP
|
$565.01
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
45000012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$355.96 |
| Max. Negotiated Rate |
$508.51 |
| Rate for Payer: Aetna Commercial |
$480.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.26
|
| Rate for Payer: Cash Price |
$452.01
|
| Rate for Payer: Cofinity Commercial |
$395.51
|
| Rate for Payer: Cofinity Commercial |
$485.91
|
| Rate for Payer: Healthscope Commercial |
$508.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$480.26
|
| Rate for Payer: PHP Commercial |
$480.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.51
|
| Rate for Payer: Priority Health SBD |
$355.96
|
|
|
HC INSERT INDWELLING CATH
|
Facility
|
IP
|
$195.34
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
45000004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.06 |
| Max. Negotiated Rate |
$175.81 |
| Rate for Payer: Aetna Commercial |
$166.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.97
|
| Rate for Payer: Cash Price |
$156.27
|
| Rate for Payer: Cofinity Commercial |
$136.74
|
| Rate for Payer: Cofinity Commercial |
$167.99
|
| Rate for Payer: Healthscope Commercial |
$175.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$166.04
|
| Rate for Payer: PHP Commercial |
$166.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.74
|
| Rate for Payer: Priority Health SBD |
$123.06
|
|
|
HC INSERT INDWELLING CATH
|
Facility
|
OP
|
$195.34
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
45000004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.56 |
| Max. Negotiated Rate |
$351.10 |
| Rate for Payer: Aetna Commercial |
$166.04
|
| Rate for Payer: Aetna Medicare |
$118.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$142.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$142.08
|
| Rate for Payer: BCBS Complete |
$65.29
|
| Rate for Payer: BCBS MAPPO |
$113.66
|
| Rate for Payer: BCBS Trust/PPO |
$141.54
|
| Rate for Payer: BCN Medicare Advantage |
$113.66
|
| Rate for Payer: Cash Price |
$156.27
|
| Rate for Payer: Cash Price |
$156.27
|
| Rate for Payer: Cofinity Commercial |
$136.74
|
| Rate for Payer: Cofinity Commercial |
$167.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.66
|
| Rate for Payer: Healthscope Commercial |
$175.81
|
| Rate for Payer: Mclaren Medicaid |
$62.17
|
| Rate for Payer: Mclaren Medicare |
$113.66
|
| Rate for Payer: Meridian Medicaid |
$65.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$166.04
|
| Rate for Payer: PACE Medicare |
$107.98
|
| Rate for Payer: PACE SWMI |
$113.66
|
| Rate for Payer: PHP Commercial |
$166.04
|
| Rate for Payer: PHP Medicare Advantage |
$113.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$351.10
|
| Rate for Payer: Priority Health Medicare |
$113.66
|
| Rate for Payer: Priority Health Narrow Network |
$280.88
|
| Rate for Payer: Priority Health SBD |
$123.06
|
| Rate for Payer: Railroad Medicare Medicare |
$113.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.66
|
| Rate for Payer: UHC Exchange |
$24.56
|
| Rate for Payer: UHC Medicare Advantage |
$117.07
|
| Rate for Payer: VA VA |
$113.66
|
|
|
HC INSERT INFUSION PUMP
|
Facility
|
OP
|
$1,052.40
|
|
| Hospital Charge Code |
36100438
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$420.96 |
| Max. Negotiated Rate |
$947.16 |
| Rate for Payer: Aetna Commercial |
$894.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$684.06
|
| Rate for Payer: BCBS Complete |
$420.96
|
| Rate for Payer: Cash Price |
$841.92
|
| Rate for Payer: Cofinity Commercial |
$736.68
|
| Rate for Payer: Cofinity Commercial |
$905.06
|
| Rate for Payer: Healthscope Commercial |
$947.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$894.54
|
| Rate for Payer: PHP Commercial |
$894.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$736.68
|
| Rate for Payer: Priority Health SBD |
$663.01
|
|
|
HC INSERT INFUSION PUMP
|
Facility
|
IP
|
$1,052.40
|
|
| Hospital Charge Code |
36100438
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$663.01 |
| Max. Negotiated Rate |
$947.16 |
| Rate for Payer: Aetna Commercial |
$894.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$684.06
|
| Rate for Payer: Cash Price |
$841.92
|
| Rate for Payer: Cofinity Commercial |
$736.68
|
| Rate for Payer: Cofinity Commercial |
$905.06
|
| Rate for Payer: Healthscope Commercial |
$947.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$894.54
|
| Rate for Payer: PHP Commercial |
$894.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$736.68
|
| Rate for Payer: Priority Health SBD |
$663.01
|
|
|
HC INSERTION CECO TUBE W FLUORO
|
Facility
|
OP
|
$1,441.32
|
|
|
Service Code
|
CPT 49442
|
| Hospital Charge Code |
36100227
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$198.43 |
| Max. Negotiated Rate |
$3,247.14 |
| Rate for Payer: Aetna Commercial |
$1,225.12
|
| Rate for Payer: Aetna Medicare |
$1,092.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$936.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,312.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,312.52
|
| Rate for Payer: BCBS Complete |
$603.13
|
| Rate for Payer: BCBS MAPPO |
$1,050.02
|
| Rate for Payer: BCBS Trust/PPO |
$604.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,050.02
|
| Rate for Payer: Cash Price |
$1,153.06
|
| Rate for Payer: Cash Price |
$1,153.06
|
| Rate for Payer: Cofinity Commercial |
$1,239.54
|
| Rate for Payer: Cofinity Commercial |
$1,008.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,050.02
|
| Rate for Payer: Healthscope Commercial |
$1,297.19
|
| Rate for Payer: Mclaren Medicaid |
$574.36
|
| Rate for Payer: Mclaren Medicare |
$1,050.02
|
| Rate for Payer: Meridian Medicaid |
$603.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,102.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,207.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,225.12
|
| Rate for Payer: PACE Medicare |
$997.52
|
| Rate for Payer: PACE SWMI |
$1,050.02
|
| Rate for Payer: PHP Commercial |
$1,225.12
|
| Rate for Payer: PHP Medicare Advantage |
$1,050.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$574.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,247.14
|
| Rate for Payer: Priority Health Medicare |
$1,050.02
|
| Rate for Payer: Priority Health Narrow Network |
$2,597.71
|
| Rate for Payer: Priority Health SBD |
$908.03
|
| Rate for Payer: Railroad Medicare Medicare |
$1,050.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.27
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,050.02
|
| Rate for Payer: UHC Exchange |
$198.43
|
| Rate for Payer: UHC Medicare Advantage |
$1,081.52
|
| Rate for Payer: VA VA |
$1,050.02
|
|
|
HC INSERTION CECO TUBE W FLUORO
|
Facility
|
IP
|
$1,441.32
|
|
|
Service Code
|
CPT 49442
|
| Hospital Charge Code |
36100227
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$908.03 |
| Max. Negotiated Rate |
$1,297.19 |
| Rate for Payer: Aetna Commercial |
$1,225.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$936.86
|
| Rate for Payer: Cash Price |
$1,153.06
|
| Rate for Payer: Cofinity Commercial |
$1,008.92
|
| Rate for Payer: Cofinity Commercial |
$1,239.54
|
| Rate for Payer: Healthscope Commercial |
$1,297.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,225.12
|
| Rate for Payer: PHP Commercial |
$1,225.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.92
|
| Rate for Payer: Priority Health SBD |
$908.03
|
|
|
HC INSERTION D OR J TUBE W FLUORO
|
Facility
|
OP
|
$1,491.52
|
|
|
Service Code
|
CPT 49441
|
| Hospital Charge Code |
36100226
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$231.50 |
| Max. Negotiated Rate |
$5,222.22 |
| Rate for Payer: Aetna Commercial |
$1,267.79
|
| Rate for Payer: Aetna Medicare |
$1,760.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$969.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,116.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,116.40
|
| Rate for Payer: BCBS Complete |
$972.53
|
| Rate for Payer: BCBS MAPPO |
$1,693.12
|
| Rate for Payer: BCBS Trust/PPO |
$527.94
|
| Rate for Payer: BCN Medicare Advantage |
$1,693.12
|
| Rate for Payer: Cash Price |
$1,193.22
|
| Rate for Payer: Cash Price |
$1,193.22
|
| Rate for Payer: Cofinity Commercial |
$1,044.06
|
| Rate for Payer: Cofinity Commercial |
$1,282.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,693.12
|
| Rate for Payer: Healthscope Commercial |
$1,342.37
|
| Rate for Payer: Mclaren Medicaid |
$926.14
|
| Rate for Payer: Mclaren Medicare |
$1,693.12
|
| Rate for Payer: Meridian Medicaid |
$972.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,777.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,947.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,267.79
|
| Rate for Payer: PACE Medicare |
$1,608.46
|
| Rate for Payer: PACE SWMI |
$1,693.12
|
| Rate for Payer: PHP Commercial |
$1,267.79
|
| Rate for Payer: PHP Medicare Advantage |
$1,693.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$926.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,044.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,222.22
|
| Rate for Payer: Priority Health Medicare |
$1,693.12
|
| Rate for Payer: Priority Health Narrow Network |
$4,177.77
|
| Rate for Payer: Priority Health SBD |
$939.66
|
| Rate for Payer: Railroad Medicare Medicare |
$1,693.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$254.65
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,693.12
|
| Rate for Payer: UHC Exchange |
$231.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,743.91
|
| Rate for Payer: VA VA |
$1,693.12
|
|
|
HC INSERTION D OR J TUBE W FLUORO
|
Facility
|
IP
|
$1,491.52
|
|
|
Service Code
|
CPT 49441
|
| Hospital Charge Code |
36100226
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$939.66 |
| Max. Negotiated Rate |
$1,342.37 |
| Rate for Payer: Aetna Commercial |
$1,267.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$969.49
|
| Rate for Payer: Cash Price |
$1,193.22
|
| Rate for Payer: Cofinity Commercial |
$1,282.71
|
| Rate for Payer: Cofinity Commercial |
$1,044.06
|
| Rate for Payer: Healthscope Commercial |
$1,342.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,267.79
|
| Rate for Payer: PHP Commercial |
$1,267.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,044.06
|
| Rate for Payer: Priority Health SBD |
$939.66
|
|
|
HC INSERTION DRUG IMPLANT DEVICE
|
Facility
|
IP
|
$162.93
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
76100179
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.65 |
| Max. Negotiated Rate |
$146.64 |
| Rate for Payer: Aetna Commercial |
$138.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.90
|
| Rate for Payer: Cash Price |
$130.34
|
| Rate for Payer: Cofinity Commercial |
$114.05
|
| Rate for Payer: Cofinity Commercial |
$140.12
|
| Rate for Payer: Healthscope Commercial |
$146.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.49
|
| Rate for Payer: PHP Commercial |
$138.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.05
|
| Rate for Payer: Priority Health SBD |
$102.65
|
|
