|
HC DSDNA AB WITH REFLEX, IGG, S
|
Facility
|
IP
|
$40.30
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
30200505
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.39 |
| Max. Negotiated Rate |
$36.27 |
| Rate for Payer: Aetna Commercial |
$34.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.20
|
| Rate for Payer: Cash Price |
$32.24
|
| Rate for Payer: Cofinity Advantage |
$28.21
|
| Rate for Payer: Cofinity Commercial |
$34.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.24
|
| Rate for Payer: Healthscope Commercial |
$36.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.23
|
| Rate for Payer: PHP Commercial |
$34.26
|
| Rate for Payer: Priority Health SBD |
$25.39
|
|
|
HC DSMA TC 99M PER STUDY
|
Facility
|
OP
|
$396.48
|
|
|
Service Code
|
HCPCS A9551
|
| Hospital Charge Code |
34300004
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$222.47 |
| Max. Negotiated Rate |
$2,081.41 |
| Rate for Payer: Aetna Commercial |
$337.01
|
| Rate for Payer: Aetna Medicare |
$686.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$824.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$824.91
|
| Rate for Payer: BCBS Complete |
$362.43
|
| Rate for Payer: BCBS MAPPO |
$659.93
|
| Rate for Payer: BCBS Trust/PPO |
$222.47
|
| Rate for Payer: BCN Commercial |
$222.47
|
| Rate for Payer: BCN Medicare Advantage |
$659.93
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Cofinity Advantage |
$277.54
|
| Rate for Payer: Cofinity Commercial |
$340.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$659.93
|
| Rate for Payer: Healthscope Commercial |
$356.83
|
| Rate for Payer: Mclaren Medicaid |
$345.14
|
| Rate for Payer: Mclaren Medicare |
$659.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$692.93
|
| Rate for Payer: Meridian Medicaid |
$692.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$758.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$725.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.01
|
| Rate for Payer: Nomi Health Commercial |
$1,979.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.36
|
| Rate for Payer: PACE Medicare |
$626.93
|
| Rate for Payer: PACE SWMI |
$659.93
|
| Rate for Payer: PHP Commercial |
$337.01
|
| Rate for Payer: PHP Medicare Advantage |
$659.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$345.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,081.41
|
| Rate for Payer: Priority Health Medicare |
$659.93
|
| Rate for Payer: Priority Health SBD |
$249.78
|
| Rate for Payer: Priority Health Tiered Network |
$1,665.13
|
| Rate for Payer: Railroad Medicare Medicare |
$659.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,088.88
|
| Rate for Payer: UHC Core |
$1,088.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$659.93
|
| Rate for Payer: UHC Exchange |
$1,088.88
|
| Rate for Payer: UHC Medicaid |
$345.14
|
| Rate for Payer: UHCCP Medicaid |
$345.14
|
| Rate for Payer: VA VA |
$659.93
|
|
|
HC DSMA TC 99M PER STUDY
|
Facility
|
IP
|
$396.48
|
|
|
Service Code
|
HCPCS A9551
|
| Hospital Charge Code |
34300004
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$249.78 |
| Max. Negotiated Rate |
$356.83 |
| Rate for Payer: Aetna Commercial |
$337.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.71
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Cofinity Advantage |
$277.54
|
| Rate for Payer: Cofinity Commercial |
$340.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.18
|
| Rate for Payer: Healthscope Commercial |
$356.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.36
|
| Rate for Payer: PHP Commercial |
$337.01
|
| Rate for Payer: Priority Health SBD |
$249.78
|
|
|
HC DTAP HEPB IPV VACCINE INTRAMUSCULAR
|
Facility
|
OP
|
$179.71
|
|
|
Service Code
|
CPT 90723
|
| Hospital Charge Code |
63600137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.88 |
| Max. Negotiated Rate |
$255.15 |
| Rate for Payer: Aetna Commercial |
$152.75
|
| Rate for Payer: Aetna Medicare |
$89.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.81
|
| Rate for Payer: BCBS Complete |
$71.88
|
| Rate for Payer: BCBS Trust/PPO |
$255.15
|
| Rate for Payer: BCN Commercial |
$255.15
|
| Rate for Payer: Cash Price |
$143.77
|
| Rate for Payer: Cash Price |
$143.77
|
| Rate for Payer: Cofinity Advantage |
$125.80
|
| Rate for Payer: Cofinity Commercial |
$154.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.77
|
| Rate for Payer: Healthscope Commercial |
$161.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$143.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.78
|
| Rate for Payer: PHP Commercial |
$152.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$117.41
|
| Rate for Payer: Priority Health SBD |
$113.22
|
| Rate for Payer: Priority Health Tiered Network |
$93.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.96
|
| Rate for Payer: UHC Core |
$218.96
|
| Rate for Payer: UHC Exchange |
$218.96
|
|
|
HC DTAP HEPB IPV VACCINE INTRAMUSCULAR
|
Facility
|
IP
|
$179.71
|
|
|
Service Code
|
CPT 90723
|
| Hospital Charge Code |
63600137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$113.22 |
| Max. Negotiated Rate |
$161.74 |
| Rate for Payer: Aetna Commercial |
$152.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.81
|
| Rate for Payer: Cash Price |
$143.77
|
| Rate for Payer: Cofinity Advantage |
$125.80
|
| Rate for Payer: Cofinity Commercial |
$154.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.77
|
| Rate for Payer: Healthscope Commercial |
$161.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.78
|
| Rate for Payer: PHP Commercial |
$152.75
|
| Rate for Payer: Priority Health SBD |
$113.22
|
|
|
HC DTAP-IPV VACCINE 4-6 YEARS IM
|
Facility
|
OP
|
$78.20
|
|
|
Service Code
|
CPT 90696
|
| Hospital Charge Code |
63600120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.28 |
| Max. Negotiated Rate |
$154.69 |
| Rate for Payer: Aetna Commercial |
$66.47
|
| Rate for Payer: Aetna Medicare |
$39.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.83
|
| Rate for Payer: BCBS Complete |
$31.28
|
| Rate for Payer: BCBS Trust/PPO |
$154.69
|
| Rate for Payer: BCN Commercial |
$154.69
|
| Rate for Payer: Cash Price |
$62.56
|
| Rate for Payer: Cash Price |
$62.56
|
| Rate for Payer: Cofinity Advantage |
$54.74
|
| Rate for Payer: Cofinity Commercial |
$67.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.56
|
| Rate for Payer: Healthscope Commercial |
$70.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.65
|
| Rate for Payer: PHP Commercial |
$66.47
|
| Rate for Payer: Priority Health SBD |
$49.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.84
|
| Rate for Payer: UHC Core |
$129.84
|
| Rate for Payer: UHC Exchange |
$129.84
|
|
|
HC DTAP-IPV VACCINE 4-6 YEARS IM
|
Facility
|
IP
|
$78.20
|
|
|
Service Code
|
CPT 90696
|
| Hospital Charge Code |
63600120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.27 |
| Max. Negotiated Rate |
$70.38 |
| Rate for Payer: Aetna Commercial |
$66.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.83
|
| Rate for Payer: Cash Price |
$62.56
|
| Rate for Payer: Cofinity Advantage |
$54.74
|
| Rate for Payer: Cofinity Commercial |
$67.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.56
|
| Rate for Payer: Healthscope Commercial |
$70.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.65
|
| Rate for Payer: PHP Commercial |
$66.47
|
| Rate for Payer: Priority Health SBD |
$49.27
|
|
|
HC DTAP-IVP-HIB-HEPB INTRAMUSCULAR
|
Facility
|
OP
|
$169.79
|
|
|
Service Code
|
CPT 90697
|
| Hospital Charge Code |
63600207
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.92 |
| Max. Negotiated Rate |
$412.11 |
| Rate for Payer: Aetna Commercial |
$144.32
|
| Rate for Payer: Aetna Medicare |
$84.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.36
|
| Rate for Payer: BCBS Complete |
$67.92
|
| Rate for Payer: BCBS Trust/PPO |
$412.11
|
| Rate for Payer: BCN Commercial |
$412.11
|
| Rate for Payer: Cash Price |
$135.83
|
| Rate for Payer: Cash Price |
$135.83
|
| Rate for Payer: Cofinity Advantage |
$118.85
|
| Rate for Payer: Cofinity Commercial |
$146.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.83
|
| Rate for Payer: Healthscope Commercial |
$152.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.34
|
| Rate for Payer: PHP Commercial |
$144.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$177.69
|
| Rate for Payer: Priority Health SBD |
$106.97
|
| Rate for Payer: Priority Health Tiered Network |
$142.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$329.88
|
| Rate for Payer: UHC Core |
$329.88
|
| Rate for Payer: UHC Exchange |
$329.88
|
|
|
HC DTAP-IVP-HIB-HEPB INTRAMUSCULAR
|
Facility
|
IP
|
$169.79
|
|
|
Service Code
|
CPT 90697
|
| Hospital Charge Code |
63600207
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$106.97 |
| Max. Negotiated Rate |
$152.81 |
| Rate for Payer: Aetna Commercial |
$144.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.36
|
| Rate for Payer: Cash Price |
$135.83
|
| Rate for Payer: Cofinity Advantage |
$118.85
|
| Rate for Payer: Cofinity Commercial |
$146.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.83
|
| Rate for Payer: Healthscope Commercial |
$152.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.34
|
| Rate for Payer: PHP Commercial |
$144.32
|
| Rate for Payer: Priority Health SBD |
$106.97
|
|
|
HC DTPA PER STUDY
|
Facility
|
OP
|
$446.00
|
|
|
Service Code
|
HCPCS A9539
|
| Hospital Charge Code |
34300005
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$47.39 |
| Max. Negotiated Rate |
$401.40 |
| Rate for Payer: Aetna Commercial |
$379.10
|
| Rate for Payer: Aetna Medicare |
$223.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.90
|
| Rate for Payer: BCBS Complete |
$178.40
|
| Rate for Payer: BCBS Trust/PPO |
$81.42
|
| Rate for Payer: BCN Commercial |
$81.42
|
| Rate for Payer: Cash Price |
$356.80
|
| Rate for Payer: Cash Price |
$356.80
|
| Rate for Payer: Cofinity Advantage |
$312.20
|
| Rate for Payer: Cofinity Commercial |
$383.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.80
|
| Rate for Payer: Healthscope Commercial |
$401.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$356.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.50
|
| Rate for Payer: PHP Commercial |
$379.10
|
| Rate for Payer: Priority Health SBD |
$280.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.39
|
| Rate for Payer: UHC Core |
$47.39
|
| Rate for Payer: UHC Exchange |
$47.39
|
|
|
HC DTPA PER STUDY
|
Facility
|
IP
|
$446.00
|
|
|
Service Code
|
HCPCS A9539
|
| Hospital Charge Code |
34300005
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$280.98 |
| Max. Negotiated Rate |
$401.40 |
| Rate for Payer: Aetna Commercial |
$379.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.90
|
| Rate for Payer: Cash Price |
$356.80
|
| Rate for Payer: Cofinity Advantage |
$312.20
|
| Rate for Payer: Cofinity Commercial |
$383.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.80
|
| Rate for Payer: Healthscope Commercial |
$401.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.50
|
| Rate for Payer: PHP Commercial |
$379.10
|
| Rate for Payer: Priority Health SBD |
$280.98
|
|
|
HC DUAL LEAD INSERTION
|
Facility
|
OP
|
$12,964.56
|
|
|
Service Code
|
CPT 33217
|
| Hospital Charge Code |
36100066
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,312.46 |
| Max. Negotiated Rate |
$26,665.62 |
| Rate for Payer: Aetna Commercial |
$11,019.88
|
| Rate for Payer: Aetna Medicare |
$8,575.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,426.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,307.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,307.04
|
| Rate for Payer: BCBS Complete |
$4,528.50
|
| Rate for Payer: BCBS MAPPO |
$8,245.63
|
| Rate for Payer: BCBS Trust/PPO |
$6,254.25
|
| Rate for Payer: BCN Commercial |
$6,254.25
|
| Rate for Payer: BCN Medicare Advantage |
$8,245.63
|
| Rate for Payer: Cash Price |
$10,371.65
|
| Rate for Payer: Cash Price |
$10,371.65
|
| Rate for Payer: Cash Price |
$10,371.65
|
| Rate for Payer: Cofinity Advantage |
$9,075.19
|
| Rate for Payer: Cofinity Commercial |
$11,149.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,371.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,245.63
|
| Rate for Payer: Healthscope Commercial |
$11,668.10
|
| Rate for Payer: Mclaren Medicaid |
$4,312.46
|
| Rate for Payer: Mclaren Medicare |
$8,245.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,657.91
|
| Rate for Payer: Meridian Medicaid |
$8,657.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,482.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,070.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,019.88
|
| Rate for Payer: Nomi Health Commercial |
$24,736.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,723.42
|
| Rate for Payer: PACE Medicare |
$7,833.35
|
| Rate for Payer: PACE SWMI |
$8,245.63
|
| Rate for Payer: PHP Commercial |
$11,019.88
|
| Rate for Payer: PHP Medicare Advantage |
$8,245.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,312.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26,665.62
|
| Rate for Payer: Priority Health Medicare |
$8,245.63
|
| Rate for Payer: Priority Health SBD |
$8,167.67
|
| Rate for Payer: Priority Health Tiered Network |
$21,332.50
|
| Rate for Payer: Railroad Medicare Medicare |
$8,245.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,245.63
|
| Rate for Payer: UHC Medicaid |
$4,312.46
|
| Rate for Payer: UHCCP Medicaid |
$4,312.46
|
| Rate for Payer: VA VA |
$8,245.63
|
|
|
HC DUAL LEAD INSERTION
|
Facility
|
IP
|
$12,964.56
|
|
|
Service Code
|
CPT 33217
|
| Hospital Charge Code |
36100066
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,167.67 |
| Max. Negotiated Rate |
$11,668.10 |
| Rate for Payer: Aetna Commercial |
$11,019.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,426.96
|
| Rate for Payer: Cash Price |
$10,371.65
|
| Rate for Payer: Cofinity Advantage |
$9,075.19
|
| Rate for Payer: Cofinity Commercial |
$11,149.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,371.65
|
| Rate for Payer: Healthscope Commercial |
$11,668.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,019.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,723.42
|
| Rate for Payer: PHP Commercial |
$11,019.88
|
| Rate for Payer: Priority Health SBD |
$8,167.67
|
|
|
HC DUCK FEATHERS IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200083
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
|
|
HC DUCK FEATHERS IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200083
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC DUODENOSCOPY/COLONOSCOPY
|
Facility
|
IP
|
$4,487.77
|
|
| Hospital Charge Code |
36000033
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,827.30 |
| Max. Negotiated Rate |
$4,038.99 |
| Rate for Payer: Aetna Commercial |
$3,814.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,917.05
|
| Rate for Payer: Cash Price |
$3,590.22
|
| Rate for Payer: Cofinity Advantage |
$3,141.44
|
| Rate for Payer: Cofinity Commercial |
$3,859.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,590.22
|
| Rate for Payer: Healthscope Commercial |
$4,038.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,814.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,365.83
|
| Rate for Payer: PHP Commercial |
$3,814.60
|
| Rate for Payer: Priority Health SBD |
$2,827.30
|
|
|
HC DUODENOSCOPY/COLONOSCOPY
|
Facility
|
OP
|
$4,487.77
|
|
| Hospital Charge Code |
36000033
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,795.11 |
| Max. Negotiated Rate |
$4,038.99 |
| Rate for Payer: Aetna Commercial |
$3,814.60
|
| Rate for Payer: Aetna Medicare |
$2,243.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,917.05
|
| Rate for Payer: BCBS Complete |
$1,795.11
|
| Rate for Payer: Cash Price |
$3,590.22
|
| Rate for Payer: Cofinity Advantage |
$3,141.44
|
| Rate for Payer: Cofinity Commercial |
$3,859.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,590.22
|
| Rate for Payer: Healthscope Commercial |
$4,038.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,590.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,814.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,365.83
|
| Rate for Payer: PHP Commercial |
$3,814.60
|
| Rate for Payer: Priority Health SBD |
$2,827.30
|
|
|
HC DUODENOSCOPY (EGD)
|
Facility
|
OP
|
$2,237.45
|
|
| Hospital Charge Code |
36000029
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$894.98 |
| Max. Negotiated Rate |
$2,013.70 |
| Rate for Payer: Aetna Commercial |
$1,901.83
|
| Rate for Payer: Aetna Medicare |
$1,118.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,454.34
|
| Rate for Payer: BCBS Complete |
$894.98
|
| Rate for Payer: Cash Price |
$1,789.96
|
| Rate for Payer: Cofinity Advantage |
$1,566.21
|
| Rate for Payer: Cofinity Commercial |
$1,924.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,789.96
|
| Rate for Payer: Healthscope Commercial |
$2,013.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,789.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,901.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,678.09
|
| Rate for Payer: PHP Commercial |
$1,901.83
|
| Rate for Payer: Priority Health SBD |
$1,409.59
|
|
|
HC DUODENOSCOPY (EGD)
|
Facility
|
IP
|
$2,237.45
|
|
| Hospital Charge Code |
36000029
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,409.59 |
| Max. Negotiated Rate |
$2,013.70 |
| Rate for Payer: Aetna Commercial |
$1,901.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,454.34
|
| Rate for Payer: Cash Price |
$1,789.96
|
| Rate for Payer: Cofinity Advantage |
$1,566.21
|
| Rate for Payer: Cofinity Commercial |
$1,924.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,789.96
|
| Rate for Payer: Healthscope Commercial |
$2,013.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,901.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,678.09
|
| Rate for Payer: PHP Commercial |
$1,901.83
|
| Rate for Payer: Priority Health SBD |
$1,409.59
|
|
|
HC DUODENUM/FLEX SIGMOID
|
Facility
|
OP
|
$3,971.88
|
|
| Hospital Charge Code |
36000034
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,588.75 |
| Max. Negotiated Rate |
$3,574.69 |
| Rate for Payer: Aetna Commercial |
$3,376.10
|
| Rate for Payer: Aetna Medicare |
$1,985.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,581.72
|
| Rate for Payer: BCBS Complete |
$1,588.75
|
| Rate for Payer: Cash Price |
$3,177.50
|
| Rate for Payer: Cofinity Advantage |
$2,780.32
|
| Rate for Payer: Cofinity Commercial |
$3,415.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,177.50
|
| Rate for Payer: Healthscope Commercial |
$3,574.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,177.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,376.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,978.91
|
| Rate for Payer: PHP Commercial |
$3,376.10
|
| Rate for Payer: Priority Health SBD |
$2,502.28
|
|
|
HC DUODENUM/FLEX SIGMOID
|
Facility
|
IP
|
$3,971.88
|
|
| Hospital Charge Code |
36000034
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,502.28 |
| Max. Negotiated Rate |
$3,574.69 |
| Rate for Payer: Aetna Commercial |
$3,376.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,581.72
|
| Rate for Payer: Cash Price |
$3,177.50
|
| Rate for Payer: Cofinity Advantage |
$2,780.32
|
| Rate for Payer: Cofinity Commercial |
$3,415.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,177.50
|
| Rate for Payer: Healthscope Commercial |
$3,574.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,376.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,978.91
|
| Rate for Payer: PHP Commercial |
$3,376.10
|
| Rate for Payer: Priority Health SBD |
$2,502.28
|
|
|
HC DUODERM CGF 4X4
|
Facility
|
OP
|
$48.68
|
|
| Hospital Charge Code |
27100010
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$43.81 |
| Rate for Payer: Aetna Commercial |
$41.38
|
| Rate for Payer: Aetna Medicare |
$24.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.64
|
| Rate for Payer: BCBS Complete |
$19.47
|
| Rate for Payer: Cash Price |
$38.94
|
| Rate for Payer: Cofinity Advantage |
$34.08
|
| Rate for Payer: Cofinity Commercial |
$41.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.94
|
| Rate for Payer: Healthscope Commercial |
$43.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.51
|
| Rate for Payer: PHP Commercial |
$41.38
|
| Rate for Payer: Priority Health SBD |
$30.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.64
|
| Rate for Payer: UHC Core |
$25.36
|
| Rate for Payer: UHC Exchange |
$19.13
|
|
|
HC DUODERM CGF 4X4
|
Facility
|
IP
|
$48.68
|
|
| Hospital Charge Code |
27100010
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.67 |
| Max. Negotiated Rate |
$43.81 |
| Rate for Payer: Aetna Commercial |
$41.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.64
|
| Rate for Payer: Cash Price |
$38.94
|
| Rate for Payer: Cofinity Advantage |
$34.08
|
| Rate for Payer: Cofinity Commercial |
$41.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.94
|
| Rate for Payer: Healthscope Commercial |
$43.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.51
|
| Rate for Payer: PHP Commercial |
$41.38
|
| Rate for Payer: Priority Health SBD |
$30.67
|
|
|
HC DUODERM CGF 6X6
|
Facility
|
OP
|
$77.11
|
|
| Hospital Charge Code |
27100011
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$69.40 |
| Rate for Payer: Aetna Commercial |
$65.54
|
| Rate for Payer: Aetna Medicare |
$38.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.12
|
| Rate for Payer: BCBS Complete |
$30.84
|
| Rate for Payer: Cash Price |
$61.69
|
| Rate for Payer: Cofinity Advantage |
$53.98
|
| Rate for Payer: Cofinity Commercial |
$66.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.69
|
| Rate for Payer: Healthscope Commercial |
$69.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.83
|
| Rate for Payer: PHP Commercial |
$65.54
|
| Rate for Payer: Priority Health SBD |
$48.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.12
|
| Rate for Payer: UHC Core |
$40.17
|
| Rate for Payer: UHC Exchange |
$30.30
|
|
|
HC DUODERM CGF 6X6
|
Facility
|
IP
|
$77.11
|
|
| Hospital Charge Code |
27100011
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$48.58 |
| Max. Negotiated Rate |
$69.40 |
| Rate for Payer: Aetna Commercial |
$65.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.12
|
| Rate for Payer: Cash Price |
$61.69
|
| Rate for Payer: Cofinity Advantage |
$53.98
|
| Rate for Payer: Cofinity Commercial |
$66.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.69
|
| Rate for Payer: Healthscope Commercial |
$69.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.83
|
| Rate for Payer: PHP Commercial |
$65.54
|
| Rate for Payer: Priority Health SBD |
$48.58
|
|
