|
HC INSERT PICC LESS THAN 5 YRS W IMAGING
|
Facility
|
OP
|
$1,947.18
|
|
|
Service Code
|
CPT 36572
|
| Hospital Charge Code |
36100552
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$77.93 |
| Max. Negotiated Rate |
$1,752.46 |
| Rate for Payer: Aetna Commercial |
$1,655.10
|
| Rate for Payer: Aetna Medicare |
$581.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,265.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$698.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$698.71
|
| Rate for Payer: BCBS Complete |
$321.07
|
| Rate for Payer: BCBS MAPPO |
$558.97
|
| Rate for Payer: BCBS Trust/PPO |
$316.63
|
| Rate for Payer: BCN Medicare Advantage |
$558.97
|
| Rate for Payer: Cash Price |
$1,557.74
|
| Rate for Payer: Cash Price |
$1,557.74
|
| Rate for Payer: Cofinity Commercial |
$1,674.57
|
| Rate for Payer: Cofinity Commercial |
$1,363.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.97
|
| Rate for Payer: Healthscope Commercial |
$1,752.46
|
| Rate for Payer: Mclaren Medicaid |
$305.76
|
| Rate for Payer: Mclaren Medicare |
$558.97
|
| Rate for Payer: Meridian Medicaid |
$321.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,655.10
|
| Rate for Payer: PACE Medicare |
$531.02
|
| Rate for Payer: PACE SWMI |
$558.97
|
| Rate for Payer: PHP Commercial |
$1,655.10
|
| Rate for Payer: PHP Medicare Advantage |
$558.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,363.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,683.01
|
| Rate for Payer: Priority Health Medicare |
$558.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,346.40
|
| Rate for Payer: Priority Health SBD |
$1,226.72
|
| Rate for Payer: Railroad Medicare Medicare |
$558.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.72
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.97
|
| Rate for Payer: UHC Exchange |
$77.93
|
| Rate for Payer: UHC Medicare Advantage |
$575.74
|
| Rate for Payer: VA VA |
$558.97
|
|
|
HC INSERT PICC LESS THAN 5 YRS W IMAGING
|
Facility
|
IP
|
$1,947.18
|
|
|
Service Code
|
CPT 36572
|
| Hospital Charge Code |
36100552
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,226.72 |
| Max. Negotiated Rate |
$1,752.46 |
| Rate for Payer: Aetna Commercial |
$1,655.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,265.67
|
| Rate for Payer: Cash Price |
$1,557.74
|
| Rate for Payer: Cofinity Commercial |
$1,363.03
|
| Rate for Payer: Cofinity Commercial |
$1,674.57
|
| Rate for Payer: Healthscope Commercial |
$1,752.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,655.10
|
| Rate for Payer: PHP Commercial |
$1,655.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,363.03
|
| Rate for Payer: Priority Health SBD |
$1,226.72
|
|
|
HC INSERT/REPLACE SQ ICD W ELECTRODES
|
Facility
|
IP
|
$83,233.86
|
|
|
Service Code
|
CPT 33270
|
| Hospital Charge Code |
48100113
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$52,437.33 |
| Max. Negotiated Rate |
$74,910.47 |
| Rate for Payer: Aetna Commercial |
$70,748.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54,102.01
|
| Rate for Payer: Cash Price |
$66,587.09
|
| Rate for Payer: Cofinity Commercial |
$58,263.70
|
| Rate for Payer: Cofinity Commercial |
$71,581.12
|
| Rate for Payer: Healthscope Commercial |
$74,910.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70,748.78
|
| Rate for Payer: PHP Commercial |
$70,748.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58,263.70
|
| Rate for Payer: Priority Health SBD |
$52,437.33
|
|
|
HC INSERT/REPLACE SQ ICD W ELECTRODES
|
Facility
|
OP
|
$83,233.86
|
|
|
Service Code
|
CPT 33270
|
| Hospital Charge Code |
48100113
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$540.28 |
| Max. Negotiated Rate |
$74,910.47 |
| Rate for Payer: Aetna Commercial |
$70,748.78
|
| Rate for Payer: Aetna Medicare |
$30,444.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54,102.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36,591.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36,591.72
|
| Rate for Payer: BCBS Complete |
$16,814.63
|
| Rate for Payer: BCBS MAPPO |
$29,273.38
|
| Rate for Payer: BCBS Trust/PPO |
$26,932.29
|
| Rate for Payer: BCN Medicare Advantage |
$29,273.38
|
| Rate for Payer: Cash Price |
$66,587.09
|
| Rate for Payer: Cash Price |
$66,587.09
|
| Rate for Payer: Cofinity Commercial |
$71,581.12
|
| Rate for Payer: Cofinity Commercial |
$58,263.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29,273.38
|
| Rate for Payer: Healthscope Commercial |
$74,910.47
|
| Rate for Payer: Mclaren Medicaid |
$16,012.54
|
| Rate for Payer: Mclaren Medicare |
$29,273.38
|
| Rate for Payer: Meridian Medicaid |
$16,814.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30,737.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33,664.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70,748.78
|
| Rate for Payer: PACE Medicare |
$27,809.71
|
| Rate for Payer: PACE SWMI |
$29,273.38
|
| Rate for Payer: PHP Commercial |
$70,748.78
|
| Rate for Payer: PHP Medicare Advantage |
$29,273.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,012.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58,263.70
|
| Rate for Payer: Priority Health Medicare |
$29,273.38
|
| Rate for Payer: Priority Health SBD |
$52,437.33
|
| Rate for Payer: Railroad Medicare Medicare |
$29,273.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$594.31
|
| Rate for Payer: UHC Core |
$15,010.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$29,273.38
|
| Rate for Payer: UHC Exchange |
$540.28
|
| Rate for Payer: UHC Medicare Advantage |
$30,151.58
|
| Rate for Payer: VA VA |
$29,273.38
|
|
|
HC INSERT STRAIGHT CATH
|
Facility
|
IP
|
$181.67
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
45000003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.45 |
| Max. Negotiated Rate |
$163.50 |
| Rate for Payer: Aetna Commercial |
$154.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.09
|
| Rate for Payer: Cash Price |
$145.34
|
| Rate for Payer: Cofinity Commercial |
$156.24
|
| Rate for Payer: Cofinity Commercial |
$127.17
|
| Rate for Payer: Healthscope Commercial |
$163.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$154.42
|
| Rate for Payer: PHP Commercial |
$154.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.17
|
| Rate for Payer: Priority Health SBD |
$114.45
|
|
|
HC INSERT STRAIGHT CATH
|
Facility
|
OP
|
$181.67
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
45000003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.89 |
| Max. Negotiated Rate |
$351.10 |
| Rate for Payer: Aetna Commercial |
$154.42
|
| Rate for Payer: Aetna Medicare |
$118.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.09
|
| 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 |
$72.58
|
| Rate for Payer: BCN Medicare Advantage |
$113.66
|
| Rate for Payer: Cash Price |
$145.34
|
| Rate for Payer: Cash Price |
$145.34
|
| Rate for Payer: Cofinity Commercial |
$156.24
|
| Rate for Payer: Cofinity Commercial |
$127.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.66
|
| Rate for Payer: Healthscope Commercial |
$163.50
|
| 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 |
$154.42
|
| Rate for Payer: PACE Medicare |
$107.98
|
| Rate for Payer: PACE SWMI |
$113.66
|
| Rate for Payer: PHP Commercial |
$154.42
|
| 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 |
$127.17
|
| 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 |
$114.45
|
| Rate for Payer: Railroad Medicare Medicare |
$113.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.66
|
| Rate for Payer: UHC Exchange |
$24.89
|
| Rate for Payer: UHC Medicare Advantage |
$117.07
|
| Rate for Payer: VA VA |
$113.66
|
|
|
HC INSERT TUNNELED CENTRAL LINE WO PORT OR PUMP ABOVE 5 YRS AGE
|
Facility
|
IP
|
$3,997.05
|
|
|
Service Code
|
CPT 36558
|
| Hospital Charge Code |
36100123
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,518.14 |
| Max. Negotiated Rate |
$3,597.34 |
| Rate for Payer: Aetna Commercial |
$3,397.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,598.08
|
| Rate for Payer: Cash Price |
$3,197.64
|
| Rate for Payer: Cofinity Commercial |
$2,797.94
|
| Rate for Payer: Cofinity Commercial |
$3,437.46
|
| Rate for Payer: Healthscope Commercial |
$3,597.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,397.49
|
| Rate for Payer: PHP Commercial |
$3,397.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,797.94
|
| Rate for Payer: Priority Health SBD |
$2,518.14
|
|
|
HC INSERT TUNNELED CENTRAL LINE WO PORT OR PUMP ABOVE 5 YRS AGE
|
Facility
|
OP
|
$3,997.05
|
|
|
Service Code
|
CPT 36558
|
| Hospital Charge Code |
36100123
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$249.84 |
| Max. Negotiated Rate |
$8,913.25 |
| Rate for Payer: Aetna Commercial |
$3,397.49
|
| Rate for Payer: Aetna Medicare |
$2,949.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,598.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,545.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,545.25
|
| Rate for Payer: BCBS Complete |
$1,629.11
|
| Rate for Payer: BCBS MAPPO |
$2,836.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,230.92
|
| Rate for Payer: BCN Medicare Advantage |
$2,836.20
|
| Rate for Payer: Cash Price |
$3,197.64
|
| Rate for Payer: Cash Price |
$3,197.64
|
| Rate for Payer: Cofinity Commercial |
$2,797.94
|
| Rate for Payer: Cofinity Commercial |
$3,437.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,836.20
|
| Rate for Payer: Healthscope Commercial |
$3,597.34
|
| Rate for Payer: Mclaren Medicaid |
$1,551.40
|
| Rate for Payer: Mclaren Medicare |
$2,836.20
|
| Rate for Payer: Meridian Medicaid |
$1,629.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,978.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,261.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,397.49
|
| Rate for Payer: PACE Medicare |
$2,694.39
|
| Rate for Payer: PACE SWMI |
$2,836.20
|
| Rate for Payer: PHP Commercial |
$3,397.49
|
| Rate for Payer: PHP Medicare Advantage |
$2,836.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,551.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,797.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,913.25
|
| Rate for Payer: Priority Health Medicare |
$2,836.20
|
| Rate for Payer: Priority Health Narrow Network |
$7,130.60
|
| Rate for Payer: Priority Health SBD |
$2,518.14
|
| Rate for Payer: Railroad Medicare Medicare |
$2,836.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.82
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,836.20
|
| Rate for Payer: UHC Exchange |
$249.84
|
| Rate for Payer: UHC Medicare Advantage |
$2,921.29
|
| Rate for Payer: VA VA |
$2,836.20
|
|
|
HC INSERT TUNNELED CENTRAL LINE WO PORT OR PUMP LESS THAN 5 YRS AGE
|
Facility
|
IP
|
$4,058.39
|
|
|
Service Code
|
CPT 36557
|
| Hospital Charge Code |
36100122
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,556.79 |
| Max. Negotiated Rate |
$3,652.55 |
| Rate for Payer: Aetna Commercial |
$3,449.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,637.95
|
| Rate for Payer: Cash Price |
$3,246.71
|
| Rate for Payer: Cofinity Commercial |
$2,840.87
|
| Rate for Payer: Cofinity Commercial |
$3,490.22
|
| Rate for Payer: Healthscope Commercial |
$3,652.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,449.63
|
| Rate for Payer: PHP Commercial |
$3,449.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,840.87
|
| Rate for Payer: Priority Health SBD |
$2,556.79
|
|
|
HC INSERT TUNNELED CENTRAL LINE WO PORT OR PUMP LESS THAN 5 YRS AGE
|
Facility
|
OP
|
$4,058.39
|
|
|
Service Code
|
CPT 36557
|
| Hospital Charge Code |
36100122
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$314.34 |
| Max. Negotiated Rate |
$15,411.76 |
| Rate for Payer: Aetna Commercial |
$3,449.63
|
| Rate for Payer: Aetna Medicare |
$5,085.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,637.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,112.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,112.15
|
| Rate for Payer: BCBS Complete |
$2,808.66
|
| Rate for Payer: BCBS MAPPO |
$4,889.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,840.79
|
| Rate for Payer: BCN Medicare Advantage |
$4,889.72
|
| Rate for Payer: Cash Price |
$3,246.71
|
| Rate for Payer: Cash Price |
$3,246.71
|
| Rate for Payer: Cofinity Commercial |
$2,840.87
|
| Rate for Payer: Cofinity Commercial |
$3,490.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,889.72
|
| Rate for Payer: Healthscope Commercial |
$3,652.55
|
| Rate for Payer: Mclaren Medicaid |
$2,674.68
|
| Rate for Payer: Mclaren Medicare |
$4,889.72
|
| Rate for Payer: Meridian Medicaid |
$2,808.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,134.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,623.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,449.63
|
| Rate for Payer: PACE Medicare |
$4,645.23
|
| Rate for Payer: PACE SWMI |
$4,889.72
|
| Rate for Payer: PHP Commercial |
$3,449.63
|
| Rate for Payer: PHP Medicare Advantage |
$4,889.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,674.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,840.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,411.76
|
| Rate for Payer: Priority Health Medicare |
$4,889.72
|
| Rate for Payer: Priority Health Narrow Network |
$12,329.41
|
| Rate for Payer: Priority Health SBD |
$2,556.79
|
| Rate for Payer: Railroad Medicare Medicare |
$4,889.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$345.77
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,889.72
|
| Rate for Payer: UHC Exchange |
$314.34
|
| Rate for Payer: UHC Medicare Advantage |
$5,036.41
|
| Rate for Payer: VA VA |
$4,889.72
|
|
|
HC IN SITU HYBRID EA ADDL PROBE STAIN PER SPECIMEN
|
Facility
|
IP
|
$259.90
|
|
|
Service Code
|
CPT 88364
|
| Hospital Charge Code |
31000120
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$163.74 |
| Max. Negotiated Rate |
$233.91 |
| Rate for Payer: Aetna Commercial |
$220.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.94
|
| Rate for Payer: Cash Price |
$207.92
|
| Rate for Payer: Cofinity Commercial |
$181.93
|
| Rate for Payer: Cofinity Commercial |
$223.51
|
| Rate for Payer: Healthscope Commercial |
$233.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$220.92
|
| Rate for Payer: PHP Commercial |
$220.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.93
|
| Rate for Payer: Priority Health SBD |
$163.74
|
|
|
HC IN SITU HYBRID EA ADDL PROBE STAIN PER SPECIMEN
|
Facility
|
OP
|
$259.90
|
|
|
Service Code
|
CPT 88364
|
| Hospital Charge Code |
31000120
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$84.20 |
| Max. Negotiated Rate |
$233.91 |
| Rate for Payer: Aetna Commercial |
$220.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.94
|
| Rate for Payer: BCBS Complete |
$103.96
|
| Rate for Payer: BCBS Trust/PPO |
$127.42
|
| Rate for Payer: BCCCP Commercial |
$137.47
|
| Rate for Payer: Cash Price |
$207.92
|
| Rate for Payer: Cash Price |
$207.92
|
| Rate for Payer: Cofinity Commercial |
$223.51
|
| Rate for Payer: Cofinity Commercial |
$181.93
|
| Rate for Payer: Healthscope Commercial |
$233.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$220.92
|
| Rate for Payer: PHP Commercial |
$220.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.93
|
| Rate for Payer: Priority Health SBD |
$163.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.08
|
| Rate for Payer: UHC Core |
$84.20
|
| Rate for Payer: UHC Exchange |
$130.98
|
|
|
HC IN SITU HYBRID MULTIPLX MRPH QUANT OR SEMI-QUANT
|
Facility
|
IP
|
$642.60
|
|
|
Service Code
|
CPT 88377
|
| Hospital Charge Code |
31000119
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$404.84 |
| Max. Negotiated Rate |
$578.34 |
| Rate for Payer: Aetna Commercial |
$546.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$417.69
|
| Rate for Payer: Cash Price |
$514.08
|
| Rate for Payer: Cofinity Commercial |
$449.82
|
| Rate for Payer: Cofinity Commercial |
$552.64
|
| Rate for Payer: Healthscope Commercial |
$578.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$546.21
|
| Rate for Payer: PHP Commercial |
$546.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.82
|
| Rate for Payer: Priority Health SBD |
$404.84
|
|
|
HC IN SITU HYBRID MULTIPLX MRPH QUANT OR SEMI-QUANT
|
Facility
|
OP
|
$642.60
|
|
|
Service Code
|
CPT 88377
|
| Hospital Charge Code |
31000119
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$83.13 |
| Max. Negotiated Rate |
$578.34 |
| Rate for Payer: Aetna Commercial |
$546.21
|
| Rate for Payer: Aetna Medicare |
$158.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$417.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.98
|
| Rate for Payer: BCBS Complete |
$87.30
|
| Rate for Payer: BCBS MAPPO |
$151.98
|
| Rate for Payer: BCBS Trust/PPO |
$412.04
|
| Rate for Payer: BCCCP Commercial |
$398.07
|
| Rate for Payer: BCN Medicare Advantage |
$151.98
|
| Rate for Payer: Cash Price |
$514.08
|
| Rate for Payer: Cash Price |
$514.08
|
| Rate for Payer: Cofinity Commercial |
$449.82
|
| Rate for Payer: Cofinity Commercial |
$552.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.98
|
| Rate for Payer: Healthscope Commercial |
$578.34
|
| Rate for Payer: Mclaren Medicaid |
$83.13
|
| Rate for Payer: Mclaren Medicare |
$151.98
|
| Rate for Payer: Meridian Medicaid |
$87.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$159.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$546.21
|
| Rate for Payer: PACE Medicare |
$144.38
|
| Rate for Payer: PACE SWMI |
$151.98
|
| Rate for Payer: PHP Commercial |
$546.21
|
| Rate for Payer: PHP Medicare Advantage |
$151.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.82
|
| Rate for Payer: Priority Health Medicare |
$151.98
|
| Rate for Payer: Priority Health SBD |
$404.84
|
| Rate for Payer: Railroad Medicare Medicare |
$151.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$427.18
|
| Rate for Payer: UHC Core |
$220.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.98
|
| Rate for Payer: UHC Exchange |
$388.35
|
| Rate for Payer: UHC Medicare Advantage |
$156.54
|
| Rate for Payer: VA VA |
$151.98
|
|
|
HC INSTILL ANTICARCIN BLADDER
|
Facility
|
IP
|
$731.89
|
|
|
Service Code
|
CPT 51720
|
| Hospital Charge Code |
36100449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$461.09 |
| Max. Negotiated Rate |
$658.70 |
| Rate for Payer: Aetna Commercial |
$622.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$475.73
|
| Rate for Payer: Cash Price |
$585.51
|
| Rate for Payer: Cofinity Commercial |
$512.32
|
| Rate for Payer: Cofinity Commercial |
$629.43
|
| Rate for Payer: Healthscope Commercial |
$658.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$622.11
|
| Rate for Payer: PHP Commercial |
$622.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.32
|
| Rate for Payer: Priority Health SBD |
$461.09
|
|
|
HC INSTILL ANTICARCIN BLADDER
|
Facility
|
OP
|
$731.89
|
|
|
Service Code
|
CPT 51720
|
| Hospital Charge Code |
36100449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.24 |
| Max. Negotiated Rate |
$759.79 |
| Rate for Payer: Aetna Commercial |
$622.11
|
| Rate for Payer: Aetna Medicare |
$632.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$475.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$759.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$759.79
|
| Rate for Payer: BCBS Complete |
$349.14
|
| Rate for Payer: BCBS MAPPO |
$607.83
|
| Rate for Payer: BCBS Trust/PPO |
$390.90
|
| Rate for Payer: BCN Medicare Advantage |
$607.83
|
| Rate for Payer: Cash Price |
$585.51
|
| Rate for Payer: Cash Price |
$585.51
|
| Rate for Payer: Cofinity Commercial |
$512.32
|
| Rate for Payer: Cofinity Commercial |
$629.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$607.83
|
| Rate for Payer: Healthscope Commercial |
$658.70
|
| Rate for Payer: Mclaren Medicaid |
$332.48
|
| Rate for Payer: Mclaren Medicare |
$607.83
|
| Rate for Payer: Meridian Medicaid |
$349.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$638.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$699.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$622.11
|
| Rate for Payer: PACE Medicare |
$577.44
|
| Rate for Payer: PACE SWMI |
$607.83
|
| Rate for Payer: PHP Commercial |
$622.11
|
| Rate for Payer: PHP Medicare Advantage |
$607.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$332.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.32
|
| Rate for Payer: Priority Health Medicare |
$607.83
|
| Rate for Payer: Priority Health SBD |
$461.09
|
| Rate for Payer: Railroad Medicare Medicare |
$607.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$607.83
|
| Rate for Payer: UHC Exchange |
$42.24
|
| Rate for Payer: UHC Medicare Advantage |
$626.06
|
| Rate for Payer: VA VA |
$607.83
|
|
|
HC INST THER AGENT RENAL PELVIS/URETER VIA TUB
|
Facility
|
OP
|
$653.82
|
|
|
Service Code
|
CPT 50391
|
| Hospital Charge Code |
36100571
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$35.46 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$555.75
|
| Rate for Payer: Aetna Medicare |
$228.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$424.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$274.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$274.89
|
| Rate for Payer: BCBS Complete |
$126.32
|
| Rate for Payer: BCBS MAPPO |
$219.91
|
| Rate for Payer: BCBS Trust/PPO |
$35.46
|
| Rate for Payer: BCN Medicare Advantage |
$219.91
|
| Rate for Payer: Cash Price |
$523.06
|
| Rate for Payer: Cash Price |
$523.06
|
| Rate for Payer: Cofinity Commercial |
$457.67
|
| Rate for Payer: Cofinity Commercial |
$562.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.91
|
| Rate for Payer: Healthscope Commercial |
$588.44
|
| Rate for Payer: Mclaren Medicaid |
$120.29
|
| Rate for Payer: Mclaren Medicare |
$219.91
|
| Rate for Payer: Meridian Medicaid |
$126.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$230.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$555.75
|
| Rate for Payer: PACE Medicare |
$208.91
|
| Rate for Payer: PACE SWMI |
$219.91
|
| Rate for Payer: PHP Commercial |
$555.75
|
| Rate for Payer: PHP Medicare Advantage |
$219.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$457.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$828.53
|
| Rate for Payer: Priority Health Medicare |
$219.91
|
| Rate for Payer: Priority Health Narrow Network |
$662.82
|
| Rate for Payer: Priority Health SBD |
$411.91
|
| Rate for Payer: Railroad Medicare Medicare |
$219.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.46
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.91
|
| Rate for Payer: UHC Exchange |
$94.96
|
| Rate for Payer: UHC Medicare Advantage |
$226.51
|
| Rate for Payer: VA VA |
$219.91
|
|
|
HC INST THER AGENT RENAL PELVIS/URETER VIA TUB
|
Facility
|
IP
|
$653.82
|
|
|
Service Code
|
CPT 50391
|
| Hospital Charge Code |
36100571
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$411.91 |
| Max. Negotiated Rate |
$588.44 |
| Rate for Payer: Aetna Commercial |
$555.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$424.98
|
| Rate for Payer: Cash Price |
$523.06
|
| Rate for Payer: Cofinity Commercial |
$457.67
|
| Rate for Payer: Cofinity Commercial |
$562.29
|
| Rate for Payer: Healthscope Commercial |
$588.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$555.75
|
| Rate for Payer: PHP Commercial |
$555.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$457.67
|
| Rate for Payer: Priority Health SBD |
$411.91
|
|
|
HC INSULIN
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
30100266
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.74 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.70
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cofinity Commercial |
$68.60
|
| Rate for Payer: Cofinity Commercial |
$84.28
|
| Rate for Payer: Healthscope Commercial |
$88.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.30
|
| Rate for Payer: PHP Commercial |
$83.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.60
|
| Rate for Payer: Priority Health SBD |
$61.74
|
|
|
HC INSULIN
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
30100266
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna Medicare |
$11.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.29
|
| Rate for Payer: BCBS Complete |
$6.57
|
| Rate for Payer: BCBS MAPPO |
$11.43
|
| Rate for Payer: BCBS Trust/PPO |
$8.95
|
| Rate for Payer: BCN Medicare Advantage |
$11.43
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cofinity Commercial |
$68.60
|
| Rate for Payer: Cofinity Commercial |
$84.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.43
|
| Rate for Payer: Healthscope Commercial |
$88.20
|
| Rate for Payer: Mclaren Medicaid |
$6.25
|
| Rate for Payer: Mclaren Medicare |
$11.43
|
| Rate for Payer: Meridian Medicaid |
$6.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.30
|
| Rate for Payer: PACE Medicare |
$10.86
|
| Rate for Payer: PACE SWMI |
$11.43
|
| Rate for Payer: PHP Commercial |
$83.30
|
| Rate for Payer: PHP Medicare Advantage |
$11.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.60
|
| Rate for Payer: Priority Health Medicare |
$11.43
|
| Rate for Payer: Priority Health SBD |
$61.74
|
| Rate for Payer: Railroad Medicare Medicare |
$11.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.72
|
| Rate for Payer: UHC Core |
$19.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.43
|
| Rate for Payer: UHC Exchange |
$11.43
|
| Rate for Payer: UHC Medicare Advantage |
$11.77
|
| Rate for Payer: VA VA |
$11.43
|
|
|
HC INSULIN ANTIBODIES
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
30200199
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$57.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.20
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$47.60
|
| Rate for Payer: Cofinity Commercial |
$58.48
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.80
|
| Rate for Payer: PHP Commercial |
$57.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
| Rate for Payer: Priority Health SBD |
$42.84
|
|
|
HC INSULIN ANTIBODIES
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
30200199
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.71 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$57.80
|
| Rate for Payer: Aetna Medicare |
$22.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.76
|
| Rate for Payer: BCBS Complete |
$12.30
|
| Rate for Payer: BCBS MAPPO |
$21.41
|
| Rate for Payer: BCBS Trust/PPO |
$16.77
|
| Rate for Payer: BCN Medicare Advantage |
$21.41
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$58.48
|
| Rate for Payer: Cofinity Commercial |
$47.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Mclaren Medicaid |
$11.71
|
| Rate for Payer: Mclaren Medicare |
$21.41
|
| Rate for Payer: Meridian Medicaid |
$12.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.80
|
| Rate for Payer: PACE Medicare |
$20.34
|
| Rate for Payer: PACE SWMI |
$21.41
|
| Rate for Payer: PHP Commercial |
$57.80
|
| Rate for Payer: PHP Medicare Advantage |
$21.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
| Rate for Payer: Priority Health Medicare |
$21.41
|
| Rate for Payer: Priority Health SBD |
$42.84
|
| Rate for Payer: Railroad Medicare Medicare |
$21.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.69
|
| Rate for Payer: UHC Core |
$36.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.41
|
| Rate for Payer: UHC Exchange |
$21.41
|
| Rate for Payer: UHC Medicare Advantage |
$22.05
|
| Rate for Payer: VA VA |
$21.41
|
|
|
HC INSULIN LIKE GROWTH FACTOR BP3
|
Facility
|
IP
|
$48.96
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.84 |
| Max. Negotiated Rate |
$44.06 |
| Rate for Payer: Aetna Commercial |
$41.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.82
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$42.11
|
| Rate for Payer: Cofinity Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$44.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.62
|
| Rate for Payer: PHP Commercial |
$41.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.27
|
| Rate for Payer: Priority Health SBD |
$30.84
|
|
|
HC INSULIN LIKE GROWTH FACTOR BP3
|
Facility
|
OP
|
$48.96
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$44.06 |
| Rate for Payer: Aetna Commercial |
$41.62
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$13.52
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$42.11
|
| Rate for Payer: Cofinity Commercial |
$34.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$44.06
|
| Rate for Payer: Mclaren Medicaid |
$9.45
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Medicaid |
$9.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.62
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$41.62
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.27
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health SBD |
$30.84
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.72
|
| Rate for Payer: UHC Core |
$22.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Exchange |
$17.27
|
| Rate for Payer: UHC Medicare Advantage |
$17.79
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC INTENSIVE CARE OBS OVERFLOW PER HR
|
Facility
|
IP
|
$186.06
|
|
| Hospital Charge Code |
76900004
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$117.22 |
| Max. Negotiated Rate |
$167.45 |
| Rate for Payer: Aetna Commercial |
$158.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.94
|
| Rate for Payer: Cash Price |
$148.85
|
| Rate for Payer: Cofinity Commercial |
$130.24
|
| Rate for Payer: Cofinity Commercial |
$160.01
|
| Rate for Payer: Healthscope Commercial |
$167.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.15
|
| Rate for Payer: PHP Commercial |
$158.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.24
|
| Rate for Payer: Priority Health SBD |
$117.22
|
|
