|
HC DECALCIFICATION
|
Facility
|
OP
|
$37.56
|
|
|
Service Code
|
CPT 88311
|
| Hospital Charge Code |
31000051
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.26 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Aetna Commercial |
$31.93
|
| Rate for Payer: Aetna Medicare |
$18.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.41
|
| Rate for Payer: BCBS Complete |
$15.02
|
| Rate for Payer: BCBS Trust/PPO |
$12.26
|
| Rate for Payer: BCN Commercial |
$12.26
|
| Rate for Payer: Cash Price |
$30.05
|
| Rate for Payer: Cash Price |
$30.05
|
| Rate for Payer: Cofinity Commercial |
$26.29
|
| Rate for Payer: Cofinity Commercial |
$32.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.05
|
| Rate for Payer: Healthscope Commercial |
$33.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.93
|
| Rate for Payer: PHP Commercial |
$31.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.41
|
| Rate for Payer: Priority Health SBD |
$23.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.98
|
|
|
HC DECALCIFICATION
|
Facility
|
IP
|
$37.56
|
|
|
Service Code
|
CPT 88311
|
| Hospital Charge Code |
31000051
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$23.66 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Aetna Commercial |
$31.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.41
|
| Rate for Payer: Cash Price |
$30.05
|
| Rate for Payer: Cofinity Commercial |
$26.29
|
| Rate for Payer: Cofinity Commercial |
$32.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.05
|
| Rate for Payer: Healthscope Commercial |
$33.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.93
|
| Rate for Payer: PHP Commercial |
$31.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.41
|
| Rate for Payer: Priority Health SBD |
$23.66
|
|
|
HC DECLOT BY THROMBOLYTIC
|
Facility
|
OP
|
$483.16
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
76100005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.31 |
| Max. Negotiated Rate |
$1,021.42 |
| Rate for Payer: Aetna Commercial |
$410.69
|
| Rate for Payer: Aetna Medicare |
$337.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$314.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$406.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$406.22
|
| Rate for Payer: BCBS Complete |
$182.90
|
| Rate for Payer: BCBS MAPPO |
$324.98
|
| Rate for Payer: BCBS Trust/PPO |
$214.11
|
| Rate for Payer: BCN Commercial |
$214.11
|
| Rate for Payer: BCN Medicare Advantage |
$324.98
|
| Rate for Payer: Cash Price |
$386.53
|
| Rate for Payer: Cash Price |
$386.53
|
| Rate for Payer: Cash Price |
$386.53
|
| Rate for Payer: Cofinity Commercial |
$415.52
|
| Rate for Payer: Cofinity Commercial |
$338.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$338.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.98
|
| Rate for Payer: Healthscope Commercial |
$434.84
|
| Rate for Payer: Mclaren Medicaid |
$174.19
|
| Rate for Payer: Mclaren Medicare |
$324.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$341.23
|
| Rate for Payer: Meridian Medicaid |
$182.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$373.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.69
|
| Rate for Payer: Nomi Health Commercial |
$682.46
|
| Rate for Payer: PACE Medicare |
$308.73
|
| Rate for Payer: PACE SWMI |
$324.98
|
| Rate for Payer: PHP Commercial |
$410.69
|
| Rate for Payer: PHP Medicare Advantage |
$324.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,021.42
|
| Rate for Payer: Priority Health Medicare |
$324.98
|
| Rate for Payer: Priority Health Narrow Network |
$817.14
|
| Rate for Payer: Priority Health SBD |
$304.39
|
| Rate for Payer: Railroad Medicare Medicare |
$324.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.31
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.98
|
| Rate for Payer: UHC Medicare Advantage |
$324.98
|
| Rate for Payer: UHCCP Medicaid |
$182.96
|
| Rate for Payer: VA VA |
$324.98
|
|
|
HC DECLOT BY THROMBOLYTIC
|
Facility
|
IP
|
$483.16
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
76100005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$304.39 |
| Max. Negotiated Rate |
$434.84 |
| Rate for Payer: Aetna Commercial |
$410.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$314.05
|
| Rate for Payer: Cash Price |
$386.53
|
| Rate for Payer: Cofinity Commercial |
$338.21
|
| Rate for Payer: Cofinity Commercial |
$415.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$338.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.53
|
| Rate for Payer: Healthscope Commercial |
$434.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.69
|
| Rate for Payer: PHP Commercial |
$410.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.05
|
| Rate for Payer: Priority Health SBD |
$304.39
|
|
|
HC DECONTAMINATION AMB/SELF-DIRECTED
|
Facility
|
OP
|
$143.38
|
|
| Hospital Charge Code |
27000613
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.35 |
| Max. Negotiated Rate |
$129.04 |
| Rate for Payer: Aetna Commercial |
$121.87
|
| Rate for Payer: Aetna Medicare |
$71.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.20
|
| Rate for Payer: BCBS Complete |
$57.35
|
| Rate for Payer: Cash Price |
$114.70
|
| Rate for Payer: Cofinity Commercial |
$100.37
|
| Rate for Payer: Cofinity Commercial |
$123.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.70
|
| Rate for Payer: Healthscope Commercial |
$129.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.87
|
| Rate for Payer: PHP Commercial |
$121.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.20
|
| Rate for Payer: Priority Health SBD |
$90.33
|
|
|
HC DECONTAMINATION AMB/SELF-DIRECTED
|
Facility
|
IP
|
$143.38
|
|
| Hospital Charge Code |
27000613
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$90.33 |
| Max. Negotiated Rate |
$129.04 |
| Rate for Payer: Aetna Commercial |
$121.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.20
|
| Rate for Payer: Cash Price |
$114.70
|
| Rate for Payer: Cofinity Commercial |
$100.37
|
| Rate for Payer: Cofinity Commercial |
$123.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.70
|
| Rate for Payer: Healthscope Commercial |
$129.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.87
|
| Rate for Payer: PHP Commercial |
$121.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.20
|
| Rate for Payer: Priority Health SBD |
$90.33
|
|
|
HC DECONTAMINATION AMB W/ASSIST
|
Facility
|
IP
|
$823.25
|
|
| Hospital Charge Code |
27000026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$518.65 |
| Max. Negotiated Rate |
$740.92 |
| Rate for Payer: Aetna Commercial |
$699.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$535.11
|
| Rate for Payer: Cash Price |
$658.60
|
| Rate for Payer: Cofinity Commercial |
$576.28
|
| Rate for Payer: Cofinity Commercial |
$708.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$576.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$658.60
|
| Rate for Payer: Healthscope Commercial |
$740.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$699.76
|
| Rate for Payer: PHP Commercial |
$699.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$535.11
|
| Rate for Payer: Priority Health SBD |
$518.65
|
|
|
HC DECONTAMINATION AMB W/ASSIST
|
Facility
|
OP
|
$823.25
|
|
| Hospital Charge Code |
27000026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$329.30 |
| Max. Negotiated Rate |
$740.92 |
| Rate for Payer: Aetna Commercial |
$699.76
|
| Rate for Payer: Aetna Medicare |
$411.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$535.11
|
| Rate for Payer: BCBS Complete |
$329.30
|
| Rate for Payer: Cash Price |
$658.60
|
| Rate for Payer: Cofinity Commercial |
$576.28
|
| Rate for Payer: Cofinity Commercial |
$708.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$576.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$658.60
|
| Rate for Payer: Healthscope Commercial |
$740.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$699.76
|
| Rate for Payer: PHP Commercial |
$699.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$535.11
|
| Rate for Payer: Priority Health SBD |
$518.65
|
|
|
HC DECONTAMINATION NON AMBULATORY
|
Facility
|
OP
|
$1,646.48
|
|
| Hospital Charge Code |
27000126
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$658.59 |
| Max. Negotiated Rate |
$1,481.83 |
| Rate for Payer: Aetna Commercial |
$1,399.51
|
| Rate for Payer: Aetna Medicare |
$823.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,070.21
|
| Rate for Payer: BCBS Complete |
$658.59
|
| Rate for Payer: Cash Price |
$1,317.18
|
| Rate for Payer: Cofinity Commercial |
$1,152.54
|
| Rate for Payer: Cofinity Commercial |
$1,415.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,152.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,317.18
|
| Rate for Payer: Healthscope Commercial |
$1,481.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,399.51
|
| Rate for Payer: PHP Commercial |
$1,399.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,070.21
|
| Rate for Payer: Priority Health SBD |
$1,037.28
|
|
|
HC DECONTAMINATION NON AMBULATORY
|
Facility
|
IP
|
$1,646.48
|
|
| Hospital Charge Code |
27000126
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,037.28 |
| Max. Negotiated Rate |
$1,481.83 |
| Rate for Payer: Aetna Commercial |
$1,399.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,070.21
|
| Rate for Payer: Cash Price |
$1,317.18
|
| Rate for Payer: Cofinity Commercial |
$1,152.54
|
| Rate for Payer: Cofinity Commercial |
$1,415.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,152.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,317.18
|
| Rate for Payer: Healthscope Commercial |
$1,481.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,399.51
|
| Rate for Payer: PHP Commercial |
$1,399.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,070.21
|
| Rate for Payer: Priority Health SBD |
$1,037.28
|
|
|
HC DEFINITY CONTRAST 1ST ML
|
Facility
|
IP
|
$296.10
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$186.54 |
| Max. Negotiated Rate |
$266.49 |
| Rate for Payer: Aetna Commercial |
$251.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.46
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$207.27
|
| Rate for Payer: Cofinity Commercial |
$254.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$207.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.88
|
| Rate for Payer: Healthscope Commercial |
$266.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.68
|
| Rate for Payer: PHP Commercial |
$251.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.46
|
| Rate for Payer: Priority Health SBD |
$186.54
|
|
|
HC DEFINITY CONTRAST 1ST ML
|
Facility
|
OP
|
$296.10
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.26 |
| Max. Negotiated Rate |
$266.49 |
| Rate for Payer: Aetna Commercial |
$251.68
|
| Rate for Payer: Aetna Medicare |
$148.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.46
|
| Rate for Payer: BCBS Complete |
$118.44
|
| Rate for Payer: BCBS Trust/PPO |
$50.26
|
| Rate for Payer: BCN Commercial |
$50.26
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$207.27
|
| Rate for Payer: Cofinity Commercial |
$254.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$207.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.88
|
| Rate for Payer: Healthscope Commercial |
$266.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.68
|
| Rate for Payer: PHP Commercial |
$251.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.46
|
| Rate for Payer: Priority Health SBD |
$186.54
|
|
|
HC DEFINITY CONTRAST 2ND ML
|
Facility
|
IP
|
$296.10
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$186.54 |
| Max. Negotiated Rate |
$266.49 |
| Rate for Payer: Aetna Commercial |
$251.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.46
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$207.27
|
| Rate for Payer: Cofinity Commercial |
$254.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$207.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.88
|
| Rate for Payer: Healthscope Commercial |
$266.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.68
|
| Rate for Payer: PHP Commercial |
$251.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.46
|
| Rate for Payer: Priority Health SBD |
$186.54
|
|
|
HC DEFINITY CONTRAST 2ND ML
|
Facility
|
OP
|
$296.10
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.26 |
| Max. Negotiated Rate |
$266.49 |
| Rate for Payer: Aetna Commercial |
$251.68
|
| Rate for Payer: Aetna Medicare |
$148.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.46
|
| Rate for Payer: BCBS Complete |
$118.44
|
| Rate for Payer: BCBS Trust/PPO |
$50.26
|
| Rate for Payer: BCN Commercial |
$50.26
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$207.27
|
| Rate for Payer: Cofinity Commercial |
$254.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$207.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.88
|
| Rate for Payer: Healthscope Commercial |
$266.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.68
|
| Rate for Payer: PHP Commercial |
$251.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.46
|
| Rate for Payer: Priority Health SBD |
$186.54
|
|
|
HC DEGARELIX INJECTION PER 1MG
|
Facility
|
OP
|
$6.24
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
63600146
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$12.84 |
| Rate for Payer: Aetna Commercial |
$5.30
|
| Rate for Payer: Aetna Medicare |
$4.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.35
|
| Rate for Payer: BCBS Complete |
$2.41
|
| Rate for Payer: BCBS MAPPO |
$4.28
|
| Rate for Payer: BCBS Trust/PPO |
$11.84
|
| Rate for Payer: BCN Commercial |
$11.84
|
| Rate for Payer: BCN Medicare Advantage |
$4.28
|
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Cofinity Commercial |
$5.37
|
| Rate for Payer: Cofinity Commercial |
$4.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.28
|
| Rate for Payer: Healthscope Commercial |
$5.62
|
| Rate for Payer: Mclaren Medicaid |
$2.29
|
| Rate for Payer: Mclaren Medicare |
$4.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.49
|
| Rate for Payer: Meridian Medicaid |
$2.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.30
|
| Rate for Payer: Nomi Health Commercial |
$12.84
|
| Rate for Payer: PACE Medicare |
$4.07
|
| Rate for Payer: PACE SWMI |
$4.28
|
| Rate for Payer: PHP Commercial |
$5.30
|
| Rate for Payer: PHP Medicare Advantage |
$4.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.01
|
| Rate for Payer: Priority Health Medicare |
$4.28
|
| Rate for Payer: Priority Health Narrow Network |
$9.61
|
| Rate for Payer: Priority Health SBD |
$3.93
|
| Rate for Payer: Railroad Medicare Medicare |
$4.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.28
|
| Rate for Payer: UHC Medicare Advantage |
$4.28
|
| Rate for Payer: UHCCP Medicaid |
$2.41
|
| Rate for Payer: VA VA |
$4.28
|
|
|
HC DEGARELIX INJECTION PER 1MG
|
Facility
|
IP
|
$6.24
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
63600146
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Aetna Commercial |
$5.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.06
|
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Cofinity Commercial |
$4.37
|
| Rate for Payer: Cofinity Commercial |
$5.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.99
|
| Rate for Payer: Healthscope Commercial |
$5.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.30
|
| Rate for Payer: PHP Commercial |
$5.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.06
|
| Rate for Payer: Priority Health SBD |
$3.93
|
|
|
HC DEGLYCEROLIZED RED BLOOD CELLS
|
Facility
|
IP
|
$944.06
|
|
|
Service Code
|
HCPCS P9039
|
| Hospital Charge Code |
39000049
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$594.76 |
| Max. Negotiated Rate |
$849.65 |
| Rate for Payer: Aetna Commercial |
$802.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$613.64
|
| Rate for Payer: Cash Price |
$755.25
|
| Rate for Payer: Cofinity Commercial |
$660.84
|
| Rate for Payer: Cofinity Commercial |
$811.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$660.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$755.25
|
| Rate for Payer: Healthscope Commercial |
$849.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$802.45
|
| Rate for Payer: PHP Commercial |
$802.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$613.64
|
| Rate for Payer: Priority Health SBD |
$594.76
|
|
|
HC DEGLYCEROLIZED RED BLOOD CELLS
|
Facility
|
OP
|
$944.06
|
|
|
Service Code
|
HCPCS P9039
|
| Hospital Charge Code |
39000049
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$343.32 |
| Max. Negotiated Rate |
$2,013.16 |
| Rate for Payer: Aetna Commercial |
$802.45
|
| Rate for Payer: Aetna Medicare |
$666.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$613.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$800.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$800.65
|
| Rate for Payer: BCBS Complete |
$360.48
|
| Rate for Payer: BCBS MAPPO |
$640.52
|
| Rate for Payer: BCBS Trust/PPO |
$862.55
|
| Rate for Payer: BCN Commercial |
$862.55
|
| Rate for Payer: BCN Medicare Advantage |
$640.52
|
| Rate for Payer: Cash Price |
$755.25
|
| Rate for Payer: Cash Price |
$755.25
|
| Rate for Payer: Cofinity Commercial |
$811.89
|
| Rate for Payer: Cofinity Commercial |
$660.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$660.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$755.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$640.52
|
| Rate for Payer: Healthscope Commercial |
$849.65
|
| Rate for Payer: Mclaren Medicaid |
$343.32
|
| Rate for Payer: Mclaren Medicare |
$640.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$672.55
|
| Rate for Payer: Meridian Medicaid |
$360.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$736.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$802.45
|
| Rate for Payer: Nomi Health Commercial |
$1,921.56
|
| Rate for Payer: PACE Medicare |
$608.49
|
| Rate for Payer: PACE SWMI |
$640.52
|
| Rate for Payer: PHP Commercial |
$802.45
|
| Rate for Payer: PHP Medicare Advantage |
$640.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$343.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$613.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,013.16
|
| Rate for Payer: Priority Health Medicare |
$640.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,610.53
|
| Rate for Payer: Priority Health SBD |
$594.76
|
| Rate for Payer: Railroad Medicare Medicare |
$640.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,803.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$640.52
|
| Rate for Payer: UHC Exchange |
$698.60
|
| Rate for Payer: UHC Medicare Advantage |
$640.52
|
| Rate for Payer: UHCCP Medicaid |
$360.61
|
| Rate for Payer: VA VA |
$640.52
|
|
|
HC DELAY FLAP/SCTJ FLAP EYELIDS NOSE EARS/LIPS
|
Facility
|
OP
|
$5,205.06
|
|
|
Service Code
|
CPT 15630
|
| Hospital Charge Code |
76100415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$358.96 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna Commercial |
$4,424.30
|
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,383.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$804.62
|
| Rate for Payer: BCN Commercial |
$804.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Cash Price |
$4,164.05
|
| Rate for Payer: Cash Price |
$4,164.05
|
| Rate for Payer: Cash Price |
$4,164.05
|
| Rate for Payer: Cofinity Commercial |
$4,476.35
|
| Rate for Payer: Cofinity Commercial |
$3,643.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,643.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,164.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Healthscope Commercial |
$4,684.55
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,424.30
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Commercial |
$4,424.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,383.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Priority Health SBD |
$3,279.19
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$358.96
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$1,009.03
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
HC DELAY FLAP/SCTJ FLAP EYELIDS NOSE EARS/LIPS
|
Facility
|
IP
|
$5,205.06
|
|
|
Service Code
|
CPT 15630
|
| Hospital Charge Code |
76100415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,279.19 |
| Max. Negotiated Rate |
$4,684.55 |
| Rate for Payer: Aetna Commercial |
$4,424.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,383.29
|
| Rate for Payer: Cash Price |
$4,164.05
|
| Rate for Payer: Cofinity Commercial |
$3,643.54
|
| Rate for Payer: Cofinity Commercial |
$4,476.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,643.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,164.05
|
| Rate for Payer: Healthscope Commercial |
$4,684.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,424.30
|
| Rate for Payer: PHP Commercial |
$4,424.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,383.29
|
| Rate for Payer: Priority Health SBD |
$3,279.19
|
|
|
HC DELIVERY/BIRTH RM RESUSCITATION
|
Facility
|
OP
|
$837.20
|
|
|
Service Code
|
CPT 99465
|
| Hospital Charge Code |
72000011
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$149.42 |
| Max. Negotiated Rate |
$2,015.13 |
| Rate for Payer: Aetna Commercial |
$711.62
|
| Rate for Payer: Aetna Medicare |
$666.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$544.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$801.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$801.44
|
| Rate for Payer: BCBS Complete |
$360.84
|
| Rate for Payer: BCBS MAPPO |
$641.15
|
| Rate for Payer: BCN Medicare Advantage |
$641.15
|
| Rate for Payer: Cash Price |
$669.76
|
| Rate for Payer: Cash Price |
$669.76
|
| Rate for Payer: Cofinity Commercial |
$719.99
|
| Rate for Payer: Cofinity Commercial |
$586.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$586.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$669.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$641.15
|
| Rate for Payer: Healthscope Commercial |
$753.48
|
| Rate for Payer: Mclaren Medicaid |
$343.66
|
| Rate for Payer: Mclaren Medicare |
$641.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$673.21
|
| Rate for Payer: Meridian Medicaid |
$360.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$737.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$711.62
|
| Rate for Payer: Nomi Health Commercial |
$1,923.45
|
| Rate for Payer: PACE Medicare |
$609.09
|
| Rate for Payer: PACE SWMI |
$641.15
|
| Rate for Payer: PHP Commercial |
$711.62
|
| Rate for Payer: PHP Medicare Advantage |
$641.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$343.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,015.13
|
| Rate for Payer: Priority Health Medicare |
$641.15
|
| Rate for Payer: Priority Health Narrow Network |
$1,612.10
|
| Rate for Payer: Priority Health SBD |
$527.44
|
| Rate for Payer: Railroad Medicare Medicare |
$641.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$641.15
|
| Rate for Payer: UHC Exchange |
$619.53
|
| Rate for Payer: UHC Medicare Advantage |
$641.15
|
| Rate for Payer: UHCCP Medicaid |
$360.97
|
| Rate for Payer: VA VA |
$641.15
|
|
|
HC DELIVERY/BIRTH RM RESUSCITATION
|
Facility
|
IP
|
$837.20
|
|
|
Service Code
|
CPT 99465
|
| Hospital Charge Code |
72000011
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$527.44 |
| Max. Negotiated Rate |
$753.48 |
| Rate for Payer: Aetna Commercial |
$711.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$544.18
|
| Rate for Payer: Cash Price |
$669.76
|
| Rate for Payer: Cofinity Commercial |
$586.04
|
| Rate for Payer: Cofinity Commercial |
$719.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$586.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$669.76
|
| Rate for Payer: Healthscope Commercial |
$753.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$711.62
|
| Rate for Payer: PHP Commercial |
$711.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.18
|
| Rate for Payer: Priority Health SBD |
$527.44
|
|
|
HC DEMO EVAL NEB MDI IPPB
|
Facility
|
IP
|
$244.93
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
41000009
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$154.31 |
| Max. Negotiated Rate |
$220.44 |
| Rate for Payer: Aetna Commercial |
$208.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.20
|
| Rate for Payer: Cash Price |
$195.94
|
| Rate for Payer: Cofinity Commercial |
$171.45
|
| Rate for Payer: Cofinity Commercial |
$210.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.94
|
| Rate for Payer: Healthscope Commercial |
$220.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.19
|
| Rate for Payer: PHP Commercial |
$208.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.20
|
| Rate for Payer: Priority Health SBD |
$154.31
|
|
|
HC DEMO EVAL NEB MDI IPPB
|
Facility
|
OP
|
$244.93
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
41000009
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$17.91 |
| Max. Negotiated Rate |
$626.34 |
| Rate for Payer: Aetna Commercial |
$208.19
|
| Rate for Payer: Aetna Medicare |
$207.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.10
|
| Rate for Payer: BCBS Complete |
$112.15
|
| Rate for Payer: BCBS MAPPO |
$199.28
|
| Rate for Payer: BCBS Trust/PPO |
$76.80
|
| Rate for Payer: BCN Commercial |
$76.80
|
| Rate for Payer: BCN Medicare Advantage |
$199.28
|
| Rate for Payer: Cash Price |
$195.94
|
| Rate for Payer: Cash Price |
$195.94
|
| Rate for Payer: Cofinity Commercial |
$210.64
|
| Rate for Payer: Cofinity Commercial |
$171.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.28
|
| Rate for Payer: Healthscope Commercial |
$220.44
|
| Rate for Payer: Mclaren Medicaid |
$106.81
|
| Rate for Payer: Mclaren Medicare |
$199.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.24
|
| Rate for Payer: Meridian Medicaid |
$112.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.19
|
| Rate for Payer: Nomi Health Commercial |
$597.84
|
| Rate for Payer: PACE Medicare |
$189.32
|
| Rate for Payer: PACE SWMI |
$199.28
|
| Rate for Payer: PHP Commercial |
$208.19
|
| Rate for Payer: PHP Medicare Advantage |
$199.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$626.34
|
| Rate for Payer: Priority Health Medicare |
$199.28
|
| Rate for Payer: Priority Health Narrow Network |
$501.07
|
| Rate for Payer: Priority Health SBD |
$154.31
|
| Rate for Payer: Railroad Medicare Medicare |
$199.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$199.28
|
| Rate for Payer: UHC Exchange |
$181.25
|
| Rate for Payer: UHC Medicare Advantage |
$199.28
|
| Rate for Payer: UHCCP Medicaid |
$112.19
|
| Rate for Payer: VA VA |
$199.28
|
|
|
HC DEMO HOME USE INR MONITOR
|
Facility
|
IP
|
$586.39
|
|
|
Service Code
|
HCPCS G0248
|
| Hospital Charge Code |
51000042
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$369.43 |
| Max. Negotiated Rate |
$527.75 |
| Rate for Payer: Aetna Commercial |
$498.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$381.15
|
| Rate for Payer: Cash Price |
$469.11
|
| Rate for Payer: Cofinity Commercial |
$504.30
|
| Rate for Payer: Cofinity Commercial |
$410.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$410.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$469.11
|
| Rate for Payer: Healthscope Commercial |
$527.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$498.43
|
| Rate for Payer: PHP Commercial |
$498.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.15
|
| Rate for Payer: Priority Health SBD |
$369.43
|
|
