|
HC DI GEORGE SYNDROME
|
Facility
|
IP
|
$172.71
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
31000033
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$108.81 |
| Max. Negotiated Rate |
$155.44 |
| Rate for Payer: Aetna Commercial |
$146.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.26
|
| Rate for Payer: Cash Price |
$138.17
|
| Rate for Payer: Cofinity Advantage |
$120.90
|
| Rate for Payer: Cofinity Commercial |
$148.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.17
|
| Rate for Payer: Healthscope Commercial |
$155.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$129.53
|
| Rate for Payer: PHP Commercial |
$146.80
|
| Rate for Payer: Priority Health SBD |
$108.81
|
|
|
HC DI GEORGE SYNDROME
|
Facility
|
OP
|
$172.71
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
31000033
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$18.21 |
| Max. Negotiated Rate |
$155.44 |
| Rate for Payer: Aetna Commercial |
$146.80
|
| Rate for Payer: Aetna Medicare |
$36.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.51
|
| Rate for Payer: BCBS Complete |
$19.12
|
| Rate for Payer: BCBS MAPPO |
$34.81
|
| Rate for Payer: BCBS Trust/PPO |
$37.12
|
| Rate for Payer: BCN Commercial |
$37.12
|
| Rate for Payer: BCN Medicare Advantage |
$34.81
|
| Rate for Payer: Cash Price |
$138.17
|
| Rate for Payer: Cash Price |
$138.17
|
| Rate for Payer: Cofinity Advantage |
$120.90
|
| Rate for Payer: Cofinity Commercial |
$148.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.81
|
| Rate for Payer: Healthscope Commercial |
$155.44
|
| Rate for Payer: Mclaren Medicaid |
$18.21
|
| Rate for Payer: Mclaren Medicare |
$34.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.55
|
| Rate for Payer: Meridian Medicaid |
$36.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.80
|
| Rate for Payer: Nomi Health Commercial |
$52.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$129.53
|
| Rate for Payer: PACE Medicare |
$33.07
|
| Rate for Payer: PACE SWMI |
$34.81
|
| Rate for Payer: PHP Commercial |
$146.80
|
| Rate for Payer: PHP Medicare Advantage |
$34.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$34.81
|
| Rate for Payer: Priority Health Medicare |
$34.81
|
| Rate for Payer: Priority Health SBD |
$108.81
|
| Rate for Payer: Priority Health Tiered Network |
$27.85
|
| Rate for Payer: Railroad Medicare Medicare |
$34.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.22
|
| Rate for Payer: UHC Core |
$52.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$34.81
|
| Rate for Payer: UHC Exchange |
$52.22
|
| Rate for Payer: UHC Medicaid |
$18.21
|
| Rate for Payer: UHCCP Medicaid |
$18.21
|
| Rate for Payer: VA VA |
$34.81
|
|
|
HC DIGOXIN LVL
|
Facility
|
IP
|
$93.71
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
30100591
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.04 |
| Max. Negotiated Rate |
$84.34 |
| Rate for Payer: Aetna Commercial |
$79.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.91
|
| Rate for Payer: Cash Price |
$74.97
|
| Rate for Payer: Cofinity Advantage |
$65.60
|
| Rate for Payer: Cofinity Commercial |
$80.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.97
|
| Rate for Payer: Healthscope Commercial |
$84.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.28
|
| Rate for Payer: PHP Commercial |
$79.65
|
| Rate for Payer: Priority Health SBD |
$59.04
|
|
|
HC DIGOXIN LVL
|
Facility
|
OP
|
$93.71
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
30100591
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$84.34 |
| Rate for Payer: Aetna Commercial |
$79.65
|
| Rate for Payer: Aetna Medicare |
$13.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.60
|
| Rate for Payer: BCBS Complete |
$7.29
|
| Rate for Payer: BCBS MAPPO |
$13.28
|
| Rate for Payer: BCBS Trust/PPO |
$14.16
|
| Rate for Payer: BCN Commercial |
$14.16
|
| Rate for Payer: BCN Medicare Advantage |
$13.28
|
| Rate for Payer: Cash Price |
$74.97
|
| Rate for Payer: Cash Price |
$74.97
|
| Rate for Payer: Cofinity Advantage |
$65.60
|
| Rate for Payer: Cofinity Commercial |
$80.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.28
|
| Rate for Payer: Healthscope Commercial |
$84.34
|
| Rate for Payer: Mclaren Medicaid |
$6.95
|
| Rate for Payer: Mclaren Medicare |
$13.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.94
|
| Rate for Payer: Meridian Medicaid |
$13.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.65
|
| Rate for Payer: Nomi Health Commercial |
$19.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.28
|
| Rate for Payer: PACE Medicare |
$12.62
|
| Rate for Payer: PACE SWMI |
$13.28
|
| Rate for Payer: PHP Commercial |
$79.65
|
| Rate for Payer: PHP Medicare Advantage |
$13.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.28
|
| Rate for Payer: Priority Health Medicare |
$13.28
|
| Rate for Payer: Priority Health SBD |
$59.04
|
| Rate for Payer: Priority Health Tiered Network |
$10.62
|
| Rate for Payer: Railroad Medicare Medicare |
$13.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.92
|
| Rate for Payer: UHC Core |
$19.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.28
|
| Rate for Payer: UHC Exchange |
$19.92
|
| Rate for Payer: UHC Medicaid |
$6.95
|
| Rate for Payer: UHCCP Medicaid |
$6.95
|
| Rate for Payer: VA VA |
$13.28
|
|
|
HC DILANTIN LEVEL
|
Facility
|
OP
|
$37.14
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
30100039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.93 |
| Max. Negotiated Rate |
$33.43 |
| Rate for Payer: Aetna Commercial |
$31.57
|
| Rate for Payer: Aetna Medicare |
$13.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.56
|
| Rate for Payer: BCBS Complete |
$7.28
|
| Rate for Payer: BCBS MAPPO |
$13.25
|
| Rate for Payer: BCBS Trust/PPO |
$14.13
|
| Rate for Payer: BCN Commercial |
$14.13
|
| Rate for Payer: BCN Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cofinity Advantage |
$26.00
|
| Rate for Payer: Cofinity Commercial |
$31.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$33.43
|
| Rate for Payer: Mclaren Medicaid |
$6.93
|
| Rate for Payer: Mclaren Medicare |
$13.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.91
|
| Rate for Payer: Meridian Medicaid |
$13.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.57
|
| Rate for Payer: Nomi Health Commercial |
$19.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.86
|
| Rate for Payer: PACE Medicare |
$12.59
|
| Rate for Payer: PACE SWMI |
$13.25
|
| Rate for Payer: PHP Commercial |
$31.57
|
| Rate for Payer: PHP Medicare Advantage |
$13.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.25
|
| Rate for Payer: Priority Health Medicare |
$13.25
|
| Rate for Payer: Priority Health SBD |
$23.40
|
| Rate for Payer: Priority Health Tiered Network |
$10.60
|
| Rate for Payer: Railroad Medicare Medicare |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.88
|
| Rate for Payer: UHC Core |
$19.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.25
|
| Rate for Payer: UHC Exchange |
$19.88
|
| Rate for Payer: UHC Medicaid |
$6.93
|
| Rate for Payer: UHCCP Medicaid |
$6.93
|
| Rate for Payer: VA VA |
$13.25
|
|
|
HC DILANTIN LEVEL
|
Facility
|
IP
|
$37.14
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
30100039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$33.43 |
| Rate for Payer: Aetna Commercial |
$31.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.14
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cofinity Advantage |
$26.00
|
| Rate for Payer: Cofinity Commercial |
$31.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.71
|
| Rate for Payer: Healthscope Commercial |
$33.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.86
|
| Rate for Payer: PHP Commercial |
$31.57
|
| Rate for Payer: Priority Health SBD |
$23.40
|
|
|
HC DILANTIN/PHENYTOIN FREE LEVEL
|
Facility
|
OP
|
$107.78
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
30100040
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Aetna Commercial |
$91.61
|
| Rate for Payer: Aetna Medicare |
$14.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.20
|
| Rate for Payer: BCBS Complete |
$7.56
|
| Rate for Payer: BCBS MAPPO |
$13.76
|
| Rate for Payer: BCBS Trust/PPO |
$14.67
|
| Rate for Payer: BCN Commercial |
$14.67
|
| Rate for Payer: BCN Medicare Advantage |
$13.76
|
| Rate for Payer: Cash Price |
$86.22
|
| Rate for Payer: Cash Price |
$86.22
|
| Rate for Payer: Cofinity Advantage |
$75.45
|
| Rate for Payer: Cofinity Commercial |
$92.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.76
|
| Rate for Payer: Healthscope Commercial |
$97.00
|
| Rate for Payer: Mclaren Medicaid |
$7.20
|
| Rate for Payer: Mclaren Medicare |
$13.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.45
|
| Rate for Payer: Meridian Medicaid |
$14.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.61
|
| Rate for Payer: Nomi Health Commercial |
$20.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.83
|
| Rate for Payer: PACE Medicare |
$13.07
|
| Rate for Payer: PACE SWMI |
$13.76
|
| Rate for Payer: PHP Commercial |
$91.61
|
| Rate for Payer: PHP Medicare Advantage |
$13.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.76
|
| Rate for Payer: Priority Health Medicare |
$13.76
|
| Rate for Payer: Priority Health SBD |
$67.90
|
| Rate for Payer: Priority Health Tiered Network |
$11.01
|
| Rate for Payer: Railroad Medicare Medicare |
$13.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.64
|
| Rate for Payer: UHC Core |
$20.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.76
|
| Rate for Payer: UHC Exchange |
$20.64
|
| Rate for Payer: UHC Medicaid |
$7.20
|
| Rate for Payer: UHCCP Medicaid |
$7.20
|
| Rate for Payer: VA VA |
$13.76
|
|
|
HC DILANTIN/PHENYTOIN FREE LEVEL
|
Facility
|
IP
|
$107.78
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
30100040
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.90 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Aetna Commercial |
$91.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.06
|
| Rate for Payer: Cash Price |
$86.22
|
| Rate for Payer: Cofinity Advantage |
$75.45
|
| Rate for Payer: Cofinity Commercial |
$92.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.22
|
| Rate for Payer: Healthscope Commercial |
$97.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.83
|
| Rate for Payer: PHP Commercial |
$91.61
|
| Rate for Payer: Priority Health SBD |
$67.90
|
|
|
HC DILAT FEMALE URETHRA,SUBSEQ
|
Facility
|
IP
|
$173.51
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
76100224
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.31 |
| Max. Negotiated Rate |
$156.16 |
| Rate for Payer: Aetna Commercial |
$147.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.78
|
| Rate for Payer: Cash Price |
$138.81
|
| Rate for Payer: Cofinity Advantage |
$121.46
|
| Rate for Payer: Cofinity Commercial |
$149.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.81
|
| Rate for Payer: Healthscope Commercial |
$156.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.13
|
| Rate for Payer: PHP Commercial |
$147.48
|
| Rate for Payer: Priority Health SBD |
$109.31
|
|
|
HC DILAT FEMALE URETHRA,SUBSEQ
|
Facility
|
OP
|
$173.51
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
76100224
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$68.19 |
| Max. Negotiated Rate |
$428.73 |
| Rate for Payer: Aetna Commercial |
$147.48
|
| Rate for Payer: Aetna Medicare |
$137.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$68.67
|
| Rate for Payer: BCN Commercial |
$68.67
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$138.81
|
| Rate for Payer: Cash Price |
$138.81
|
| Rate for Payer: Cash Price |
$138.81
|
| Rate for Payer: Cofinity Advantage |
$121.46
|
| Rate for Payer: Cofinity Commercial |
$149.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$156.16
|
| Rate for Payer: Mclaren Medicaid |
$69.33
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$139.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.48
|
| Rate for Payer: Nomi Health Commercial |
$397.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.13
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$147.48
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.73
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health SBD |
$109.31
|
| Rate for Payer: Priority Health Tiered Network |
$342.98
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.78
|
| Rate for Payer: UHC Core |
$90.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$68.19
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
HC DILATION BILE DUCT OR AMPULLA EACH DUCT
|
Facility
|
IP
|
$675.66
|
|
|
Service Code
|
CPT 47542
|
| Hospital Charge Code |
36100499
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$425.67 |
| Max. Negotiated Rate |
$608.09 |
| Rate for Payer: Aetna Commercial |
$574.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$439.18
|
| Rate for Payer: Cash Price |
$540.53
|
| Rate for Payer: Cofinity Advantage |
$472.96
|
| Rate for Payer: Cofinity Commercial |
$581.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$540.53
|
| Rate for Payer: Healthscope Commercial |
$608.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$574.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$506.75
|
| Rate for Payer: PHP Commercial |
$574.31
|
| Rate for Payer: Priority Health SBD |
$425.67
|
|
|
HC DILATION BILE DUCT OR AMPULLA EACH DUCT
|
Facility
|
OP
|
$675.66
|
|
|
Service Code
|
CPT 47542
|
| Hospital Charge Code |
36100499
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$270.26 |
| Max. Negotiated Rate |
$1,216.71 |
| Rate for Payer: Aetna Commercial |
$574.31
|
| Rate for Payer: Aetna Medicare |
$337.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$439.18
|
| Rate for Payer: BCBS Complete |
$270.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,216.71
|
| Rate for Payer: BCN Commercial |
$1,216.71
|
| Rate for Payer: Cash Price |
$540.53
|
| Rate for Payer: Cash Price |
$540.53
|
| Rate for Payer: Cofinity Advantage |
$472.96
|
| Rate for Payer: Cofinity Commercial |
$581.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$540.53
|
| Rate for Payer: Healthscope Commercial |
$608.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$540.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$574.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$506.75
|
| Rate for Payer: PHP Commercial |
$574.31
|
| Rate for Payer: Priority Health SBD |
$425.67
|
|
|
HC DILATION BILIARY DUCT WITH STENT
|
Facility
|
OP
|
$3,736.26
|
|
|
Service Code
|
CPT 47556
|
| Hospital Charge Code |
36100209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,353.84 |
| Max. Negotiated Rate |
$34,252.33 |
| Rate for Payer: Aetna Commercial |
$3,175.82
|
| Rate for Payer: Aetna Medicare |
$11,015.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,428.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,239.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,239.51
|
| Rate for Payer: BCBS Complete |
$5,816.91
|
| Rate for Payer: BCBS MAPPO |
$10,591.61
|
| Rate for Payer: BCBS Trust/PPO |
$3,433.04
|
| Rate for Payer: BCN Commercial |
$3,433.04
|
| Rate for Payer: BCN Medicare Advantage |
$10,591.61
|
| Rate for Payer: Cash Price |
$2,989.01
|
| Rate for Payer: Cash Price |
$2,989.01
|
| Rate for Payer: Cash Price |
$2,989.01
|
| Rate for Payer: Cofinity Advantage |
$2,615.38
|
| Rate for Payer: Cofinity Commercial |
$3,213.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,989.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,591.61
|
| Rate for Payer: Healthscope Commercial |
$3,362.63
|
| Rate for Payer: Mclaren Medicaid |
$5,539.41
|
| Rate for Payer: Mclaren Medicare |
$10,591.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,121.19
|
| Rate for Payer: Meridian Medicaid |
$11,121.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,180.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,650.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,175.82
|
| Rate for Payer: Nomi Health Commercial |
$31,774.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,802.20
|
| Rate for Payer: PACE Medicare |
$10,062.03
|
| Rate for Payer: PACE SWMI |
$10,591.61
|
| Rate for Payer: PHP Commercial |
$3,175.82
|
| Rate for Payer: PHP Medicare Advantage |
$10,591.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,539.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$34,252.33
|
| Rate for Payer: Priority Health Medicare |
$10,591.61
|
| Rate for Payer: Priority Health SBD |
$2,353.84
|
| Rate for Payer: Priority Health Tiered Network |
$27,401.86
|
| Rate for Payer: Railroad Medicare Medicare |
$10,591.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,591.61
|
| Rate for Payer: UHC Medicaid |
$5,539.41
|
| Rate for Payer: UHCCP Medicaid |
$5,539.41
|
| Rate for Payer: VA VA |
$10,591.61
|
|
|
HC DILATION BILIARY DUCT WITH STENT
|
Facility
|
IP
|
$3,736.26
|
|
|
Service Code
|
CPT 47556
|
| Hospital Charge Code |
36100209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,353.84 |
| Max. Negotiated Rate |
$3,362.63 |
| Rate for Payer: Aetna Commercial |
$3,175.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,428.57
|
| Rate for Payer: Cash Price |
$2,989.01
|
| Rate for Payer: Cofinity Advantage |
$2,615.38
|
| Rate for Payer: Cofinity Commercial |
$3,213.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,989.01
|
| Rate for Payer: Healthscope Commercial |
$3,362.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,175.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,802.20
|
| Rate for Payer: PHP Commercial |
$3,175.82
|
| Rate for Payer: Priority Health SBD |
$2,353.84
|
|
|
HC DILATION BILIARY DUCT WO STENT
|
Facility
|
IP
|
$1,983.00
|
|
|
Service Code
|
CPT 47555
|
| Hospital Charge Code |
36100208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,249.29 |
| Max. Negotiated Rate |
$1,784.70 |
| Rate for Payer: Aetna Commercial |
$1,685.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,288.95
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cofinity Advantage |
$1,388.10
|
| Rate for Payer: Cofinity Commercial |
$1,705.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,586.40
|
| Rate for Payer: Healthscope Commercial |
$1,784.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,685.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,487.25
|
| Rate for Payer: PHP Commercial |
$1,685.55
|
| Rate for Payer: Priority Health SBD |
$1,249.29
|
|
|
HC DILATION BILIARY DUCT WO STENT
|
Facility
|
OP
|
$1,983.00
|
|
|
Service Code
|
CPT 47555
|
| Hospital Charge Code |
36100208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,249.29 |
| Max. Negotiated Rate |
$20,860.47 |
| Rate for Payer: Aetna Commercial |
$1,685.55
|
| Rate for Payer: Aetna Medicare |
$6,708.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,288.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,063.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,063.18
|
| Rate for Payer: BCBS Complete |
$3,542.64
|
| Rate for Payer: BCBS MAPPO |
$6,450.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,276.99
|
| Rate for Payer: BCN Commercial |
$1,276.99
|
| Rate for Payer: BCN Medicare Advantage |
$6,450.54
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cofinity Advantage |
$1,388.10
|
| Rate for Payer: Cofinity Commercial |
$1,705.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,586.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,450.54
|
| Rate for Payer: Healthscope Commercial |
$1,784.70
|
| Rate for Payer: Mclaren Medicaid |
$3,373.63
|
| Rate for Payer: Mclaren Medicare |
$6,450.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,773.07
|
| Rate for Payer: Meridian Medicaid |
$6,773.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,418.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,095.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,685.55
|
| Rate for Payer: Nomi Health Commercial |
$19,351.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,487.25
|
| Rate for Payer: PACE Medicare |
$6,128.01
|
| Rate for Payer: PACE SWMI |
$6,450.54
|
| Rate for Payer: PHP Commercial |
$1,685.55
|
| Rate for Payer: PHP Medicare Advantage |
$6,450.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,373.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20,860.47
|
| Rate for Payer: Priority Health Medicare |
$6,450.54
|
| Rate for Payer: Priority Health SBD |
$1,249.29
|
| Rate for Payer: Priority Health Tiered Network |
$16,688.38
|
| Rate for Payer: Railroad Medicare Medicare |
$6,450.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,450.54
|
| Rate for Payer: UHC Medicaid |
$3,373.63
|
| Rate for Payer: UHCCP Medicaid |
$3,373.63
|
| Rate for Payer: VA VA |
$6,450.54
|
|
|
HC DILATION CERVICAL CANAL
|
Facility
|
OP
|
$8,102.32
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
36000112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.67 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Commercial |
$6,886.97
|
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,266.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$29.67
|
| Rate for Payer: BCN Commercial |
$29.67
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Cash Price |
$6,481.86
|
| Rate for Payer: Cash Price |
$6,481.86
|
| Rate for Payer: Cash Price |
$6,481.86
|
| Rate for Payer: Cofinity Advantage |
$5,671.62
|
| Rate for Payer: Cofinity Commercial |
$6,968.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,481.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Healthscope Commercial |
$7,292.09
|
| Rate for Payer: Mclaren Medicaid |
$1,686.93
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,886.97
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,076.74
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Commercial |
$6,886.97
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health SBD |
$5,104.46
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,266.51
|
| Rate for Payer: UHC Core |
$4,221.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Exchange |
$3,184.21
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
HC DILATION CERVICAL CANAL
|
Facility
|
IP
|
$8,102.32
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
36000112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,104.46 |
| Max. Negotiated Rate |
$7,292.09 |
| Rate for Payer: Aetna Commercial |
$6,886.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,266.51
|
| Rate for Payer: Cash Price |
$6,481.86
|
| Rate for Payer: Cofinity Advantage |
$5,671.62
|
| Rate for Payer: Cofinity Commercial |
$6,968.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,481.86
|
| Rate for Payer: Healthscope Commercial |
$7,292.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,886.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,076.74
|
| Rate for Payer: PHP Commercial |
$6,886.97
|
| Rate for Payer: Priority Health SBD |
$5,104.46
|
|
|
HC DILATION & CURETTAGE DX/THER NONOBSTETRIC
|
Facility
|
IP
|
$9,990.90
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
36000136
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,294.27 |
| Max. Negotiated Rate |
$8,991.81 |
| Rate for Payer: Aetna Commercial |
$8,492.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,494.09
|
| Rate for Payer: Cash Price |
$7,992.72
|
| Rate for Payer: Cofinity Advantage |
$6,993.63
|
| Rate for Payer: Cofinity Commercial |
$8,592.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,992.72
|
| Rate for Payer: Healthscope Commercial |
$8,991.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,492.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,493.18
|
| Rate for Payer: PHP Commercial |
$8,492.26
|
| Rate for Payer: Priority Health SBD |
$6,294.27
|
|
|
HC DILATION & CURETTAGE DX/THER NONOBSTETRIC
|
Facility
|
OP
|
$9,990.90
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
36000136
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,686.93 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Commercial |
$8,492.26
|
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,494.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,798.71
|
| Rate for Payer: BCN Commercial |
$1,798.71
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Cash Price |
$7,992.72
|
| Rate for Payer: Cash Price |
$7,992.72
|
| Rate for Payer: Cash Price |
$7,992.72
|
| Rate for Payer: Cofinity Advantage |
$6,993.63
|
| Rate for Payer: Cofinity Commercial |
$8,592.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,992.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Healthscope Commercial |
$8,991.81
|
| Rate for Payer: Mclaren Medicaid |
$1,686.93
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,492.26
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,493.18
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Commercial |
$8,492.26
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health SBD |
$6,294.27
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,494.09
|
| Rate for Payer: UHC Core |
$5,205.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Exchange |
$3,926.42
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
HC DILATION URETHRA, INITIAL
|
Facility
|
IP
|
$220.23
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
76100266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.74 |
| Max. Negotiated Rate |
$198.21 |
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.15
|
| Rate for Payer: Cash Price |
$176.18
|
| Rate for Payer: Cofinity Advantage |
$154.16
|
| Rate for Payer: Cofinity Commercial |
$189.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.18
|
| Rate for Payer: Healthscope Commercial |
$198.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.17
|
| Rate for Payer: PHP Commercial |
$187.20
|
| Rate for Payer: Priority Health SBD |
$138.74
|
|
|
HC DILATION URETHRA, INITIAL
|
Facility
|
OP
|
$220.23
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
76100266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.59 |
| Max. Negotiated Rate |
$414.63 |
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: Aetna Medicare |
$133.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$160.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$160.26
|
| Rate for Payer: BCBS Complete |
$70.41
|
| Rate for Payer: BCBS MAPPO |
$128.21
|
| Rate for Payer: BCBS Trust/PPO |
$42.59
|
| Rate for Payer: BCN Commercial |
$42.59
|
| Rate for Payer: BCN Medicare Advantage |
$128.21
|
| Rate for Payer: Cash Price |
$176.18
|
| Rate for Payer: Cash Price |
$176.18
|
| Rate for Payer: Cash Price |
$176.18
|
| Rate for Payer: Cofinity Advantage |
$154.16
|
| Rate for Payer: Cofinity Commercial |
$189.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.21
|
| Rate for Payer: Healthscope Commercial |
$198.21
|
| Rate for Payer: Mclaren Medicaid |
$67.05
|
| Rate for Payer: Mclaren Medicare |
$128.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.62
|
| Rate for Payer: Meridian Medicaid |
$134.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$147.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$141.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.20
|
| Rate for Payer: Nomi Health Commercial |
$384.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.17
|
| Rate for Payer: PACE Medicare |
$121.80
|
| Rate for Payer: PACE SWMI |
$128.21
|
| Rate for Payer: PHP Commercial |
$187.20
|
| Rate for Payer: PHP Medicare Advantage |
$128.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$414.63
|
| Rate for Payer: Priority Health Medicare |
$128.21
|
| Rate for Payer: Priority Health SBD |
$138.74
|
| Rate for Payer: Priority Health Tiered Network |
$331.70
|
| Rate for Payer: Railroad Medicare Medicare |
$128.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.15
|
| Rate for Payer: UHC Core |
$114.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$128.21
|
| Rate for Payer: UHC Exchange |
$86.55
|
| Rate for Payer: UHC Medicaid |
$67.05
|
| Rate for Payer: UHCCP Medicaid |
$67.05
|
| Rate for Payer: VA VA |
$128.21
|
|
|
HC DILATION URETHRAL STRICTURE MALE
|
Facility
|
IP
|
$373.92
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
76100231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$235.57 |
| Max. Negotiated Rate |
$336.53 |
| Rate for Payer: Aetna Commercial |
$317.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.05
|
| Rate for Payer: Cash Price |
$299.14
|
| Rate for Payer: Cofinity Advantage |
$261.74
|
| Rate for Payer: Cofinity Commercial |
$321.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.14
|
| Rate for Payer: Healthscope Commercial |
$336.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.44
|
| Rate for Payer: PHP Commercial |
$317.83
|
| Rate for Payer: Priority Health SBD |
$235.57
|
|
|
HC DILATION URETHRAL STRICTURE MALE
|
Facility
|
OP
|
$373.92
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
76100231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.30 |
| Max. Negotiated Rate |
$805.08 |
| Rate for Payer: Aetna Commercial |
$317.83
|
| Rate for Payer: Aetna Medicare |
$258.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$311.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$311.19
|
| Rate for Payer: BCBS Complete |
$136.72
|
| Rate for Payer: BCBS MAPPO |
$248.95
|
| Rate for Payer: BCBS Trust/PPO |
$36.30
|
| Rate for Payer: BCN Commercial |
$36.30
|
| Rate for Payer: BCN Medicare Advantage |
$248.95
|
| Rate for Payer: Cash Price |
$299.14
|
| Rate for Payer: Cash Price |
$299.14
|
| Rate for Payer: Cash Price |
$299.14
|
| Rate for Payer: Cofinity Advantage |
$261.74
|
| Rate for Payer: Cofinity Commercial |
$321.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.95
|
| Rate for Payer: Healthscope Commercial |
$336.53
|
| Rate for Payer: Mclaren Medicaid |
$130.20
|
| Rate for Payer: Mclaren Medicare |
$248.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.40
|
| Rate for Payer: Meridian Medicaid |
$261.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$286.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$273.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.83
|
| Rate for Payer: Nomi Health Commercial |
$746.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.44
|
| Rate for Payer: PACE Medicare |
$236.50
|
| Rate for Payer: PACE SWMI |
$248.95
|
| Rate for Payer: PHP Commercial |
$317.83
|
| Rate for Payer: PHP Medicare Advantage |
$248.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$805.08
|
| Rate for Payer: Priority Health Medicare |
$248.95
|
| Rate for Payer: Priority Health SBD |
$235.57
|
| Rate for Payer: Priority Health Tiered Network |
$644.06
|
| Rate for Payer: Railroad Medicare Medicare |
$248.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.05
|
| Rate for Payer: UHC Core |
$194.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$248.95
|
| Rate for Payer: UHC Exchange |
$146.95
|
| Rate for Payer: UHC Medicaid |
$130.20
|
| Rate for Payer: UHCCP Medicaid |
$130.20
|
| Rate for Payer: VA VA |
$248.95
|
|
|
HC DILATOR SIZE 12
|
Facility
|
OP
|
$35.26
|
|
| Hospital Charge Code |
27000055
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.86 |
| Max. Negotiated Rate |
$31.73 |
| Rate for Payer: Aetna Commercial |
$29.97
|
| Rate for Payer: Aetna Medicare |
$17.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.92
|
| Rate for Payer: BCBS Complete |
$14.10
|
| Rate for Payer: Cash Price |
$28.21
|
| Rate for Payer: Cofinity Advantage |
$24.68
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.21
|
| Rate for Payer: Healthscope Commercial |
$31.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.45
|
| Rate for Payer: PHP Commercial |
$29.97
|
| Rate for Payer: Priority Health SBD |
$22.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.92
|
| Rate for Payer: UHC Core |
$18.37
|
| Rate for Payer: UHC Exchange |
$13.86
|
|
