|
HC CROSSMATCH ELECTRONIC
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT 86923
|
| Hospital Charge Code |
30200380
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$39.32 |
| Max. Negotiated Rate |
$470.43 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna Medicare |
$173.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$208.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$208.90
|
| Rate for Payer: BCBS Complete |
$94.06
|
| Rate for Payer: BCBS MAPPO |
$167.12
|
| Rate for Payer: BCN Medicare Advantage |
$167.12
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Cofinity Commercial |
$43.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.12
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Mclaren Medicaid |
$89.58
|
| Rate for Payer: Mclaren Medicare |
$167.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.48
|
| Rate for Payer: Meridian Medicaid |
$94.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: PACE Medicare |
$158.76
|
| Rate for Payer: PACE SWMI |
$167.12
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: PHP Medicare Advantage |
$167.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health Medicare |
$167.12
|
| Rate for Payer: Priority Health SBD |
$39.32
|
| Rate for Payer: Railroad Medicare Medicare |
$167.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$470.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.12
|
| Rate for Payer: UHC Medicare Advantage |
$167.12
|
| Rate for Payer: UHCCP Medicaid |
$94.09
|
| Rate for Payer: VA VA |
$167.12
|
|
|
HC CROSSMATCH IMMED SPIN
|
Facility
|
OP
|
$91.87
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
30200351
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$57.88 |
| Max. Negotiated Rate |
$470.43 |
| Rate for Payer: Aetna Commercial |
$78.09
|
| Rate for Payer: Aetna Medicare |
$173.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$208.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$208.90
|
| Rate for Payer: BCBS Complete |
$94.06
|
| Rate for Payer: BCBS MAPPO |
$167.12
|
| Rate for Payer: BCN Medicare Advantage |
$167.12
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cofinity Commercial |
$79.01
|
| Rate for Payer: Cofinity Commercial |
$64.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.12
|
| Rate for Payer: Healthscope Commercial |
$82.68
|
| Rate for Payer: Mclaren Medicaid |
$89.58
|
| Rate for Payer: Mclaren Medicare |
$167.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.48
|
| Rate for Payer: Meridian Medicaid |
$94.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.09
|
| Rate for Payer: PACE Medicare |
$158.76
|
| Rate for Payer: PACE SWMI |
$167.12
|
| Rate for Payer: PHP Commercial |
$78.09
|
| Rate for Payer: PHP Medicare Advantage |
$167.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.72
|
| Rate for Payer: Priority Health Medicare |
$167.12
|
| Rate for Payer: Priority Health SBD |
$57.88
|
| Rate for Payer: Railroad Medicare Medicare |
$167.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$470.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.12
|
| Rate for Payer: UHC Medicare Advantage |
$167.12
|
| Rate for Payer: UHCCP Medicaid |
$94.09
|
| Rate for Payer: VA VA |
$167.12
|
|
|
HC CROSSMATCH IMMED SPIN
|
Facility
|
IP
|
$91.87
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
30200351
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$57.88 |
| Max. Negotiated Rate |
$82.68 |
| Rate for Payer: Aetna Commercial |
$78.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.72
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cofinity Commercial |
$64.31
|
| Rate for Payer: Cofinity Commercial |
$79.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.50
|
| Rate for Payer: Healthscope Commercial |
$82.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.09
|
| Rate for Payer: PHP Commercial |
$78.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.72
|
| Rate for Payer: Priority Health SBD |
$57.88
|
|
|
HC CROSSMATCH PREWARM
|
Facility
|
IP
|
$233.07
|
|
|
Service Code
|
CPT 86921
|
| Hospital Charge Code |
30200491
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$146.83 |
| Max. Negotiated Rate |
$209.76 |
| Rate for Payer: Aetna Commercial |
$198.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.50
|
| Rate for Payer: Cash Price |
$186.46
|
| Rate for Payer: Cofinity Commercial |
$163.15
|
| Rate for Payer: Cofinity Commercial |
$200.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$163.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.46
|
| Rate for Payer: Healthscope Commercial |
$209.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.11
|
| Rate for Payer: PHP Commercial |
$198.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.50
|
| Rate for Payer: Priority Health SBD |
$146.83
|
|
|
HC CROSSMATCH PREWARM
|
Facility
|
OP
|
$233.07
|
|
|
Service Code
|
CPT 86921
|
| Hospital Charge Code |
30200491
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$89.58 |
| Max. Negotiated Rate |
$470.43 |
| Rate for Payer: Aetna Commercial |
$198.11
|
| Rate for Payer: Aetna Medicare |
$173.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$208.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$208.90
|
| Rate for Payer: BCBS Complete |
$94.06
|
| Rate for Payer: BCBS MAPPO |
$167.12
|
| Rate for Payer: BCN Medicare Advantage |
$167.12
|
| Rate for Payer: Cash Price |
$186.46
|
| Rate for Payer: Cash Price |
$186.46
|
| Rate for Payer: Cofinity Commercial |
$200.44
|
| Rate for Payer: Cofinity Commercial |
$163.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$163.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.12
|
| Rate for Payer: Healthscope Commercial |
$209.76
|
| Rate for Payer: Mclaren Medicaid |
$89.58
|
| Rate for Payer: Mclaren Medicare |
$167.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.48
|
| Rate for Payer: Meridian Medicaid |
$94.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.11
|
| Rate for Payer: PACE Medicare |
$158.76
|
| Rate for Payer: PACE SWMI |
$167.12
|
| Rate for Payer: PHP Commercial |
$198.11
|
| Rate for Payer: PHP Medicare Advantage |
$167.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.50
|
| Rate for Payer: Priority Health Medicare |
$167.12
|
| Rate for Payer: Priority Health SBD |
$146.83
|
| Rate for Payer: Railroad Medicare Medicare |
$167.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$470.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.12
|
| Rate for Payer: UHC Medicare Advantage |
$167.12
|
| Rate for Payer: UHCCP Medicaid |
$94.09
|
| Rate for Payer: VA VA |
$167.12
|
|
|
HC CRP HIGH SENSITIVITY CARDIAC RISK
|
Facility
|
OP
|
$92.21
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
30200138
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$82.99 |
| Rate for Payer: Aetna Commercial |
$78.38
|
| Rate for Payer: Aetna Medicare |
$13.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.19
|
| Rate for Payer: BCBS Complete |
$7.29
|
| Rate for Payer: BCBS MAPPO |
$12.95
|
| Rate for Payer: BCN Medicare Advantage |
$12.95
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cofinity Commercial |
$79.30
|
| Rate for Payer: Cofinity Commercial |
$64.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.95
|
| Rate for Payer: Healthscope Commercial |
$82.99
|
| Rate for Payer: Mclaren Medicaid |
$6.94
|
| Rate for Payer: Mclaren Medicare |
$12.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.60
|
| Rate for Payer: Meridian Medicaid |
$7.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.38
|
| Rate for Payer: PACE Medicare |
$12.30
|
| Rate for Payer: PACE SWMI |
$12.95
|
| Rate for Payer: PHP Commercial |
$78.38
|
| Rate for Payer: PHP Medicare Advantage |
$12.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.94
|
| Rate for Payer: Priority Health Medicare |
$12.95
|
| Rate for Payer: Priority Health SBD |
$58.09
|
| Rate for Payer: Railroad Medicare Medicare |
$12.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.95
|
| Rate for Payer: UHC Medicare Advantage |
$12.95
|
| Rate for Payer: UHCCP Medicaid |
$7.29
|
| Rate for Payer: VA VA |
$12.95
|
|
|
HC CRP HIGH SENSITIVITY CARDIAC RISK
|
Facility
|
IP
|
$92.21
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
30200138
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.09 |
| Max. Negotiated Rate |
$82.99 |
| Rate for Payer: Aetna Commercial |
$78.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.94
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cofinity Commercial |
$64.55
|
| Rate for Payer: Cofinity Commercial |
$79.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.77
|
| Rate for Payer: Healthscope Commercial |
$82.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.38
|
| Rate for Payer: PHP Commercial |
$78.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.94
|
| Rate for Payer: Priority Health SBD |
$58.09
|
|
|
HC CRP-SF
|
Facility
|
OP
|
$29.97
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
30200407
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$26.97 |
| Rate for Payer: Aetna Commercial |
$25.47
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.47
|
| Rate for Payer: BCBS Complete |
$2.92
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$23.98
|
| Rate for Payer: Cash Price |
$23.98
|
| Rate for Payer: Cofinity Commercial |
$25.77
|
| Rate for Payer: Cofinity Commercial |
$20.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$26.97
|
| Rate for Payer: Mclaren Medicaid |
$2.78
|
| Rate for Payer: Mclaren Medicare |
$5.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: Meridian Medicaid |
$2.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.47
|
| Rate for Payer: PACE Medicare |
$4.92
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$25.47
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.48
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: Priority Health SBD |
$18.88
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.18
|
| Rate for Payer: UHC Medicare Advantage |
$5.18
|
| Rate for Payer: UHCCP Medicaid |
$2.92
|
| Rate for Payer: VA VA |
$5.18
|
|
|
HC CRP-SF
|
Facility
|
IP
|
$29.97
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
30200407
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.88 |
| Max. Negotiated Rate |
$26.97 |
| Rate for Payer: Aetna Commercial |
$25.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.48
|
| Rate for Payer: Cash Price |
$23.98
|
| Rate for Payer: Cofinity Commercial |
$20.98
|
| Rate for Payer: Cofinity Commercial |
$25.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.98
|
| Rate for Payer: Healthscope Commercial |
$26.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.47
|
| Rate for Payer: PHP Commercial |
$25.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.48
|
| Rate for Payer: Priority Health SBD |
$18.88
|
|
|
HC CRRT INITIAL
|
Facility
|
IP
|
$714.00
|
|
| Hospital Charge Code |
27000607
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$449.82 |
| Max. Negotiated Rate |
$642.60 |
| Rate for Payer: Aetna Commercial |
$606.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.10
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cofinity Commercial |
$499.80
|
| Rate for Payer: Cofinity Commercial |
$614.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$499.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.20
|
| Rate for Payer: Healthscope Commercial |
$642.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$606.90
|
| Rate for Payer: PHP Commercial |
$606.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: Priority Health SBD |
$449.82
|
|
|
HC CRRT INITIAL
|
Facility
|
OP
|
$714.00
|
|
| Hospital Charge Code |
27000607
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$642.60 |
| Rate for Payer: Aetna Commercial |
$606.90
|
| Rate for Payer: Aetna Medicare |
$357.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.10
|
| Rate for Payer: BCBS Complete |
$285.60
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cofinity Commercial |
$499.80
|
| Rate for Payer: Cofinity Commercial |
$614.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$499.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.20
|
| Rate for Payer: Healthscope Commercial |
$642.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$606.90
|
| Rate for Payer: PHP Commercial |
$606.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: Priority Health SBD |
$449.82
|
|
|
HC CRRT INITIATION/REINITIATION
|
Facility
|
OP
|
$1,135.08
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
88000001
|
|
Hospital Revenue Code
|
809
|
| Min. Negotiated Rate |
$222.60 |
| Max. Negotiated Rate |
$1,169.00 |
| Rate for Payer: Aetna Commercial |
$964.82
|
| Rate for Payer: Aetna Medicare |
$431.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$737.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$519.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$519.11
|
| Rate for Payer: BCBS Complete |
$233.73
|
| Rate for Payer: BCBS MAPPO |
$415.29
|
| Rate for Payer: BCN Medicare Advantage |
$415.29
|
| Rate for Payer: Cash Price |
$908.06
|
| Rate for Payer: Cash Price |
$908.06
|
| Rate for Payer: Cofinity Commercial |
$976.17
|
| Rate for Payer: Cofinity Commercial |
$794.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$794.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$908.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$415.29
|
| Rate for Payer: Healthscope Commercial |
$1,021.57
|
| Rate for Payer: Mclaren Medicaid |
$222.60
|
| Rate for Payer: Mclaren Medicare |
$415.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$436.05
|
| Rate for Payer: Meridian Medicaid |
$233.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$477.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$964.82
|
| Rate for Payer: PACE Medicare |
$394.53
|
| Rate for Payer: PACE SWMI |
$415.29
|
| Rate for Payer: PHP Commercial |
$964.82
|
| Rate for Payer: PHP Medicare Advantage |
$415.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$222.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$737.80
|
| Rate for Payer: Priority Health Medicare |
$415.29
|
| Rate for Payer: Priority Health SBD |
$715.10
|
| Rate for Payer: Railroad Medicare Medicare |
$415.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,169.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$415.29
|
| Rate for Payer: UHC Medicare Advantage |
$415.29
|
| Rate for Payer: UHCCP Medicaid |
$233.81
|
| Rate for Payer: VA VA |
$415.29
|
|
|
HC CRRT INITIATION/REINITIATION
|
Facility
|
IP
|
$1,135.08
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
88000001
|
|
Hospital Revenue Code
|
809
|
| Min. Negotiated Rate |
$715.10 |
| Max. Negotiated Rate |
$1,021.57 |
| Rate for Payer: Aetna Commercial |
$964.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$737.80
|
| Rate for Payer: Cash Price |
$908.06
|
| Rate for Payer: Cofinity Commercial |
$794.56
|
| Rate for Payer: Cofinity Commercial |
$976.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$794.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$908.06
|
| Rate for Payer: Healthscope Commercial |
$1,021.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$964.82
|
| Rate for Payer: PHP Commercial |
$964.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$737.80
|
| Rate for Payer: Priority Health SBD |
$715.10
|
|
|
HC CRRT MONITOR FEE
|
Facility
|
OP
|
$127.50
|
|
| Hospital Charge Code |
27000609
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Aetna Commercial |
$108.38
|
| Rate for Payer: Aetna Medicare |
$63.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.88
|
| Rate for Payer: BCBS Complete |
$51.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cofinity Commercial |
$109.65
|
| Rate for Payer: Cofinity Commercial |
$89.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$89.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.00
|
| Rate for Payer: Healthscope Commercial |
$114.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.38
|
| Rate for Payer: PHP Commercial |
$108.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.88
|
| Rate for Payer: Priority Health SBD |
$80.33
|
|
|
HC CRRT MONITOR FEE
|
Facility
|
IP
|
$127.50
|
|
| Hospital Charge Code |
27000609
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$80.33 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Aetna Commercial |
$108.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.88
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cofinity Commercial |
$109.65
|
| Rate for Payer: Cofinity Commercial |
$89.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$89.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.00
|
| Rate for Payer: Healthscope Commercial |
$114.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.38
|
| Rate for Payer: PHP Commercial |
$108.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.88
|
| Rate for Payer: Priority Health SBD |
$80.33
|
|
|
HC CRRT MONITORING PER HOUR
|
Facility
|
IP
|
$416.84
|
|
| Hospital Charge Code |
88000002
|
|
Hospital Revenue Code
|
809
|
| Min. Negotiated Rate |
$262.61 |
| Max. Negotiated Rate |
$375.16 |
| Rate for Payer: Aetna Commercial |
$354.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.95
|
| Rate for Payer: Cash Price |
$333.47
|
| Rate for Payer: Cofinity Commercial |
$291.79
|
| Rate for Payer: Cofinity Commercial |
$358.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$291.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.47
|
| Rate for Payer: Healthscope Commercial |
$375.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.31
|
| Rate for Payer: PHP Commercial |
$354.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.95
|
| Rate for Payer: Priority Health SBD |
$262.61
|
|
|
HC CRRT MONITORING PER HOUR
|
Facility
|
OP
|
$416.84
|
|
| Hospital Charge Code |
88000002
|
|
Hospital Revenue Code
|
809
|
| Min. Negotiated Rate |
$166.74 |
| Max. Negotiated Rate |
$375.16 |
| Rate for Payer: Aetna Commercial |
$354.31
|
| Rate for Payer: Aetna Medicare |
$208.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.95
|
| Rate for Payer: BCBS Complete |
$166.74
|
| Rate for Payer: Cash Price |
$333.47
|
| Rate for Payer: Cofinity Commercial |
$291.79
|
| Rate for Payer: Cofinity Commercial |
$358.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$291.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.47
|
| Rate for Payer: Healthscope Commercial |
$375.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.31
|
| Rate for Payer: PHP Commercial |
$354.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.95
|
| Rate for Payer: Priority Health SBD |
$262.61
|
|
|
HC CRRT SUBSEQUENT CARTRIDGE
|
Facility
|
OP
|
$280.50
|
|
| Hospital Charge Code |
27000608
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$112.20 |
| Max. Negotiated Rate |
$252.45 |
| Rate for Payer: Aetna Commercial |
$238.43
|
| Rate for Payer: Aetna Medicare |
$140.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.32
|
| Rate for Payer: BCBS Complete |
$112.20
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$196.35
|
| Rate for Payer: Cofinity Commercial |
$241.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Healthscope Commercial |
$252.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.43
|
| Rate for Payer: PHP Commercial |
$238.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.32
|
| Rate for Payer: Priority Health SBD |
$176.72
|
|
|
HC CRRT SUBSEQUENT CARTRIDGE
|
Facility
|
IP
|
$280.50
|
|
| Hospital Charge Code |
27000608
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$176.72 |
| Max. Negotiated Rate |
$252.45 |
| Rate for Payer: Aetna Commercial |
$238.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.32
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$196.35
|
| Rate for Payer: Cofinity Commercial |
$241.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Healthscope Commercial |
$252.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.43
|
| Rate for Payer: PHP Commercial |
$238.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.32
|
| Rate for Payer: Priority Health SBD |
$176.72
|
|
|
HC CRUTCHES
|
Facility
|
OP
|
$126.70
|
|
| Hospital Charge Code |
96000002
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.68 |
| Max. Negotiated Rate |
$114.03 |
| Rate for Payer: Aetna Commercial |
$107.69
|
| Rate for Payer: Aetna Medicare |
$63.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.36
|
| Rate for Payer: BCBS Complete |
$50.68
|
| Rate for Payer: Cash Price |
$101.36
|
| Rate for Payer: Cofinity Commercial |
$108.96
|
| Rate for Payer: Cofinity Commercial |
$88.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$88.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.36
|
| Rate for Payer: Healthscope Commercial |
$114.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.69
|
| Rate for Payer: PHP Commercial |
$107.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.36
|
| Rate for Payer: Priority Health SBD |
$79.82
|
|
|
HC CRUTCHES
|
Facility
|
IP
|
$126.70
|
|
| Hospital Charge Code |
96000002
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$79.82 |
| Max. Negotiated Rate |
$114.03 |
| Rate for Payer: Aetna Commercial |
$107.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.36
|
| Rate for Payer: Cash Price |
$101.36
|
| Rate for Payer: Cofinity Commercial |
$108.96
|
| Rate for Payer: Cofinity Commercial |
$88.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$88.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.36
|
| Rate for Payer: Healthscope Commercial |
$114.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.69
|
| Rate for Payer: PHP Commercial |
$107.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.36
|
| Rate for Payer: Priority Health SBD |
$79.82
|
|
|
HC CRYOABLATION KIDNEY UNILATERAL
|
Facility
|
IP
|
$12,081.12
|
|
|
Service Code
|
CPT 50593
|
| Hospital Charge Code |
36100572
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,611.11 |
| Max. Negotiated Rate |
$10,873.01 |
| Rate for Payer: Aetna Commercial |
$10,268.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,852.73
|
| Rate for Payer: Cash Price |
$9,664.90
|
| Rate for Payer: Cofinity Commercial |
$10,389.76
|
| Rate for Payer: Cofinity Commercial |
$8,456.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,456.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,664.90
|
| Rate for Payer: Healthscope Commercial |
$10,873.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,268.95
|
| Rate for Payer: PHP Commercial |
$10,268.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,852.73
|
| Rate for Payer: Priority Health SBD |
$7,611.11
|
|
|
HC CRYOABLATION KIDNEY UNILATERAL
|
Facility
|
OP
|
$12,081.12
|
|
|
Service Code
|
CPT 50593
|
| Hospital Charge Code |
36100572
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,442.46 |
| Max. Negotiated Rate |
$28,582.07 |
| Rate for Payer: Aetna Commercial |
$10,268.95
|
| Rate for Payer: Aetna Medicare |
$10,560.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,852.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,692.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,692.31
|
| Rate for Payer: BCBS Complete |
$5,714.59
|
| Rate for Payer: BCBS MAPPO |
$10,153.85
|
| Rate for Payer: BCN Medicare Advantage |
$10,153.85
|
| Rate for Payer: Cash Price |
$9,664.90
|
| Rate for Payer: Cash Price |
$9,664.90
|
| Rate for Payer: Cofinity Commercial |
$8,456.78
|
| Rate for Payer: Cofinity Commercial |
$10,389.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,456.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,664.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,153.85
|
| Rate for Payer: Healthscope Commercial |
$10,873.01
|
| Rate for Payer: Mclaren Medicaid |
$5,442.46
|
| Rate for Payer: Mclaren Medicare |
$10,153.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,661.54
|
| Rate for Payer: Meridian Medicaid |
$5,714.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,676.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,268.95
|
| Rate for Payer: PACE Medicare |
$9,646.16
|
| Rate for Payer: PACE SWMI |
$10,153.85
|
| Rate for Payer: PHP Commercial |
$10,268.95
|
| Rate for Payer: PHP Medicare Advantage |
$10,153.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,442.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,852.73
|
| Rate for Payer: Priority Health Medicare |
$10,153.85
|
| Rate for Payer: Priority Health SBD |
$7,611.11
|
| Rate for Payer: Railroad Medicare Medicare |
$10,153.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,582.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,153.85
|
| Rate for Payer: UHC Medicare Advantage |
$10,153.85
|
| Rate for Payer: UHCCP Medicaid |
$5,716.62
|
| Rate for Payer: VA VA |
$10,153.85
|
|
|
HC CRYOABLATION LIVER TUMOR
|
Facility
|
IP
|
$10,529.77
|
|
|
Service Code
|
CPT 47383
|
| Hospital Charge Code |
36100613
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,633.76 |
| Max. Negotiated Rate |
$9,476.79 |
| Rate for Payer: Aetna Commercial |
$8,950.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,844.35
|
| Rate for Payer: Cash Price |
$8,423.82
|
| Rate for Payer: Cofinity Commercial |
$7,370.84
|
| Rate for Payer: Cofinity Commercial |
$9,055.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,370.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,423.82
|
| Rate for Payer: Healthscope Commercial |
$9,476.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,950.30
|
| Rate for Payer: PHP Commercial |
$8,950.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,844.35
|
| Rate for Payer: Priority Health SBD |
$6,633.76
|
|
|
HC CRYOABLATION LIVER TUMOR
|
Facility
|
OP
|
$10,529.77
|
|
|
Service Code
|
CPT 47383
|
| Hospital Charge Code |
36100613
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,442.46 |
| Max. Negotiated Rate |
$28,582.07 |
| Rate for Payer: Aetna Commercial |
$8,950.30
|
| Rate for Payer: Aetna Medicare |
$10,560.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,844.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,692.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,692.31
|
| Rate for Payer: BCBS Complete |
$5,714.59
|
| Rate for Payer: BCBS MAPPO |
$10,153.85
|
| Rate for Payer: BCN Medicare Advantage |
$10,153.85
|
| Rate for Payer: Cash Price |
$8,423.82
|
| Rate for Payer: Cash Price |
$8,423.82
|
| Rate for Payer: Cofinity Commercial |
$9,055.60
|
| Rate for Payer: Cofinity Commercial |
$7,370.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,370.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,423.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,153.85
|
| Rate for Payer: Healthscope Commercial |
$9,476.79
|
| Rate for Payer: Mclaren Medicaid |
$5,442.46
|
| Rate for Payer: Mclaren Medicare |
$10,153.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,661.54
|
| Rate for Payer: Meridian Medicaid |
$5,714.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,676.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,950.30
|
| Rate for Payer: PACE Medicare |
$9,646.16
|
| Rate for Payer: PACE SWMI |
$10,153.85
|
| Rate for Payer: PHP Commercial |
$8,950.30
|
| Rate for Payer: PHP Medicare Advantage |
$10,153.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,442.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,844.35
|
| Rate for Payer: Priority Health Medicare |
$10,153.85
|
| Rate for Payer: Priority Health SBD |
$6,633.76
|
| Rate for Payer: Railroad Medicare Medicare |
$10,153.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,582.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,153.85
|
| Rate for Payer: UHC Medicare Advantage |
$10,153.85
|
| Rate for Payer: UHCCP Medicaid |
$5,716.62
|
| Rate for Payer: VA VA |
$10,153.85
|
|
