|
HC DIFFUSION
|
Facility
|
OP
|
$396.56
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000009
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$158.62 |
| Max. Negotiated Rate |
$356.90 |
| Rate for Payer: Aetna Commercial |
$337.08
|
| Rate for Payer: Aetna Medicare |
$198.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.76
|
| Rate for Payer: BCBS Complete |
$158.62
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Cofinity Commercial |
$277.59
|
| Rate for Payer: Cofinity Commercial |
$341.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$277.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.25
|
| Rate for Payer: Healthscope Commercial |
$356.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.08
|
| Rate for Payer: PHP Commercial |
$337.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.76
|
| Rate for Payer: Priority Health SBD |
$249.83
|
| Rate for Payer: UHC Core |
$293.45
|
| Rate for Payer: UHC Exchange |
$293.45
|
|
|
HC DIFFUSION
|
Facility
|
IP
|
$396.56
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000009
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$249.83 |
| Max. Negotiated Rate |
$356.90 |
| Rate for Payer: Aetna Commercial |
$337.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.76
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Cofinity Commercial |
$277.59
|
| Rate for Payer: Cofinity Commercial |
$341.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$277.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.25
|
| Rate for Payer: Healthscope Commercial |
$356.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.08
|
| Rate for Payer: PHP Commercial |
$337.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.76
|
| Rate for Payer: Priority Health SBD |
$249.83
|
|
|
HC DI GEORGE SYNDROME
|
Facility
|
IP
|
$169.32
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
31000033
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$106.67 |
| Max. Negotiated Rate |
$152.39 |
| Rate for Payer: Aetna Commercial |
$143.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.06
|
| Rate for Payer: Cash Price |
$135.46
|
| Rate for Payer: Cofinity Commercial |
$118.52
|
| Rate for Payer: Cofinity Commercial |
$145.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.46
|
| Rate for Payer: Healthscope Commercial |
$152.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.92
|
| Rate for Payer: PHP Commercial |
$143.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.06
|
| Rate for Payer: Priority Health SBD |
$106.67
|
|
|
HC DI GEORGE SYNDROME
|
Facility
|
OP
|
$169.32
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
31000033
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$18.66 |
| Max. Negotiated Rate |
$152.39 |
| Rate for Payer: Aetna Commercial |
$143.92
|
| Rate for Payer: Aetna Medicare |
$36.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.06
|
| 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 |
$19.59
|
| Rate for Payer: BCBS MAPPO |
$34.81
|
| Rate for Payer: BCN Medicare Advantage |
$34.81
|
| Rate for Payer: Cash Price |
$135.46
|
| Rate for Payer: Cash Price |
$135.46
|
| Rate for Payer: Cofinity Commercial |
$145.62
|
| Rate for Payer: Cofinity Commercial |
$118.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.81
|
| Rate for Payer: Healthscope Commercial |
$152.39
|
| Rate for Payer: Mclaren Medicaid |
$18.66
|
| 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 |
$19.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.92
|
| Rate for Payer: PACE Medicare |
$33.07
|
| Rate for Payer: PACE SWMI |
$34.81
|
| Rate for Payer: PHP Commercial |
$143.92
|
| Rate for Payer: PHP Medicare Advantage |
$34.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.06
|
| Rate for Payer: Priority Health Medicare |
$34.81
|
| Rate for Payer: Priority Health SBD |
$106.67
|
| Rate for Payer: Railroad Medicare Medicare |
$34.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.81
|
| Rate for Payer: UHC Medicare Advantage |
$34.81
|
| Rate for Payer: UHCCP Medicaid |
$19.60
|
| Rate for Payer: VA VA |
$34.81
|
|
|
HC DIGOXIN LVL
|
Facility
|
OP
|
$91.87
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
30100591
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$82.68 |
| Rate for Payer: Aetna Commercial |
$78.09
|
| Rate for Payer: Aetna Medicare |
$13.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.72
|
| 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 |
$7.47
|
| Rate for Payer: BCBS MAPPO |
$13.28
|
| Rate for Payer: BCN Medicare Advantage |
$13.28
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cofinity Commercial |
$79.01
|
| Rate for Payer: Cofinity Commercial |
$64.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.28
|
| Rate for Payer: Healthscope Commercial |
$82.68
|
| Rate for Payer: Mclaren Medicaid |
$7.12
|
| 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 |
$7.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.09
|
| Rate for Payer: PACE Medicare |
$12.62
|
| Rate for Payer: PACE SWMI |
$13.28
|
| Rate for Payer: PHP Commercial |
$78.09
|
| Rate for Payer: PHP Medicare Advantage |
$13.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.72
|
| Rate for Payer: Priority Health Medicare |
$13.28
|
| Rate for Payer: Priority Health SBD |
$57.88
|
| Rate for Payer: Railroad Medicare Medicare |
$13.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.28
|
| Rate for Payer: UHC Medicare Advantage |
$13.28
|
| Rate for Payer: UHCCP Medicaid |
$7.48
|
| Rate for Payer: VA VA |
$13.28
|
|
|
HC DIGOXIN LVL
|
Facility
|
IP
|
$91.87
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
30100591
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.88 |
| Max. Negotiated Rate |
$82.68 |
| Rate for Payer: Aetna Commercial |
$78.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.72
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cofinity Commercial |
$64.31
|
| Rate for Payer: Cofinity Commercial |
$79.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.50
|
| Rate for Payer: Healthscope Commercial |
$82.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.09
|
| Rate for Payer: PHP Commercial |
$78.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.72
|
| Rate for Payer: Priority Health SBD |
$57.88
|
|
|
HC DILANTIN LEVEL
|
Facility
|
OP
|
$36.41
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
30100039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$37.30 |
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: Aetna Medicare |
$13.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.67
|
| 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 |
$7.46
|
| Rate for Payer: BCBS MAPPO |
$13.25
|
| Rate for Payer: BCN Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Cofinity Commercial |
$25.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Mclaren Medicaid |
$7.10
|
| 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 |
$7.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: PACE Medicare |
$12.59
|
| Rate for Payer: PACE SWMI |
$13.25
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: PHP Medicare Advantage |
$13.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health Medicare |
$13.25
|
| Rate for Payer: Priority Health SBD |
$22.94
|
| Rate for Payer: Railroad Medicare Medicare |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.25
|
| Rate for Payer: UHC Medicare Advantage |
$13.25
|
| Rate for Payer: UHCCP Medicaid |
$7.46
|
| Rate for Payer: VA VA |
$13.25
|
|
|
HC DILANTIN LEVEL
|
Facility
|
IP
|
$36.41
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
30100039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.67
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$25.49
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health SBD |
$22.94
|
|
|
HC DILANTIN/PHENYTOIN FREE LEVEL
|
Facility
|
OP
|
$105.67
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
30100040
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.38 |
| Max. Negotiated Rate |
$95.10 |
| Rate for Payer: Aetna Commercial |
$89.82
|
| Rate for Payer: Aetna Medicare |
$14.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.69
|
| 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 |
$7.74
|
| Rate for Payer: BCBS MAPPO |
$13.76
|
| Rate for Payer: BCN Medicare Advantage |
$13.76
|
| Rate for Payer: Cash Price |
$84.54
|
| Rate for Payer: Cash Price |
$84.54
|
| Rate for Payer: Cofinity Commercial |
$90.88
|
| Rate for Payer: Cofinity Commercial |
$73.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.76
|
| Rate for Payer: Healthscope Commercial |
$95.10
|
| Rate for Payer: Mclaren Medicaid |
$7.38
|
| 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 |
$7.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.82
|
| Rate for Payer: PACE Medicare |
$13.07
|
| Rate for Payer: PACE SWMI |
$13.76
|
| Rate for Payer: PHP Commercial |
$89.82
|
| Rate for Payer: PHP Medicare Advantage |
$13.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.69
|
| Rate for Payer: Priority Health Medicare |
$13.76
|
| Rate for Payer: Priority Health SBD |
$66.57
|
| Rate for Payer: Railroad Medicare Medicare |
$13.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.76
|
| Rate for Payer: UHC Medicare Advantage |
$13.76
|
| Rate for Payer: UHCCP Medicaid |
$7.75
|
| Rate for Payer: VA VA |
$13.76
|
|
|
HC DILANTIN/PHENYTOIN FREE LEVEL
|
Facility
|
IP
|
$105.67
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
30100040
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.57 |
| Max. Negotiated Rate |
$95.10 |
| Rate for Payer: Aetna Commercial |
$89.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.69
|
| Rate for Payer: Cash Price |
$84.54
|
| Rate for Payer: Cofinity Commercial |
$73.97
|
| Rate for Payer: Cofinity Commercial |
$90.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.54
|
| Rate for Payer: Healthscope Commercial |
$95.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.82
|
| Rate for Payer: PHP Commercial |
$89.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.69
|
| Rate for Payer: Priority Health SBD |
$66.57
|
|
|
HC DILAT FEMALE URETHRA,SUBSEQ
|
Facility
|
OP
|
$170.11
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
76100224
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.38 |
| Max. Negotiated Rate |
$353.86 |
| Rate for Payer: Aetna Commercial |
$144.59
|
| Rate for Payer: Aetna Medicare |
$130.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.14
|
| Rate for Payer: BCBS Complete |
$70.75
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| Rate for Payer: Cash Price |
$136.09
|
| Rate for Payer: Cash Price |
$136.09
|
| Rate for Payer: Cofinity Commercial |
$146.29
|
| Rate for Payer: Cofinity Commercial |
$119.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$119.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.71
|
| Rate for Payer: Healthscope Commercial |
$153.10
|
| Rate for Payer: Mclaren Medicaid |
$67.38
|
| Rate for Payer: Mclaren Medicare |
$125.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.00
|
| Rate for Payer: Meridian Medicaid |
$70.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.59
|
| Rate for Payer: PACE Medicare |
$119.42
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Commercial |
$144.59
|
| Rate for Payer: PHP Medicare Advantage |
$125.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.57
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: Priority Health SBD |
$107.17
|
| Rate for Payer: Railroad Medicare Medicare |
$125.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.71
|
| Rate for Payer: UHC Medicare Advantage |
$125.71
|
| Rate for Payer: UHCCP Medicaid |
$70.77
|
| Rate for Payer: VA VA |
$125.71
|
|
|
HC DILAT FEMALE URETHRA,SUBSEQ
|
Facility
|
IP
|
$170.11
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
76100224
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.17 |
| Max. Negotiated Rate |
$153.10 |
| Rate for Payer: Aetna Commercial |
$144.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.57
|
| Rate for Payer: Cash Price |
$136.09
|
| Rate for Payer: Cofinity Commercial |
$119.08
|
| Rate for Payer: Cofinity Commercial |
$146.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$119.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.09
|
| Rate for Payer: Healthscope Commercial |
$153.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.59
|
| Rate for Payer: PHP Commercial |
$144.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.57
|
| Rate for Payer: Priority Health SBD |
$107.17
|
|
|
HC DILATION BILE DUCT OR AMPULLA EACH DUCT
|
Facility
|
IP
|
$662.41
|
|
|
Service Code
|
CPT 47542
|
| Hospital Charge Code |
36100499
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$417.32 |
| Max. Negotiated Rate |
$596.17 |
| Rate for Payer: Aetna Commercial |
$563.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.57
|
| Rate for Payer: Cash Price |
$529.93
|
| Rate for Payer: Cofinity Commercial |
$463.69
|
| Rate for Payer: Cofinity Commercial |
$569.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$463.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$529.93
|
| Rate for Payer: Healthscope Commercial |
$596.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.05
|
| Rate for Payer: PHP Commercial |
$563.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.57
|
| Rate for Payer: Priority Health SBD |
$417.32
|
|
|
HC DILATION BILE DUCT OR AMPULLA EACH DUCT
|
Facility
|
OP
|
$662.41
|
|
|
Service Code
|
CPT 47542
|
| Hospital Charge Code |
36100499
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$264.96 |
| Max. Negotiated Rate |
$596.17 |
| Rate for Payer: Aetna Commercial |
$563.05
|
| Rate for Payer: Aetna Medicare |
$331.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.57
|
| Rate for Payer: BCBS Complete |
$264.96
|
| Rate for Payer: Cash Price |
$529.93
|
| Rate for Payer: Cofinity Commercial |
$463.69
|
| Rate for Payer: Cofinity Commercial |
$569.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$463.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$529.93
|
| Rate for Payer: Healthscope Commercial |
$596.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.05
|
| Rate for Payer: PHP Commercial |
$563.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.57
|
| Rate for Payer: Priority Health SBD |
$417.32
|
|
|
HC DILATION BILIARY DUCT WITH STENT
|
Facility
|
OP
|
$3,663.00
|
|
|
Service Code
|
CPT 47556
|
| Hospital Charge Code |
36100209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,307.69 |
| Max. Negotiated Rate |
$28,582.07 |
| Rate for Payer: Aetna Commercial |
$3,113.55
|
| Rate for Payer: Aetna Medicare |
$10,560.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,380.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,692.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,692.31
|
| Rate for Payer: BCBS Complete |
$5,714.59
|
| Rate for Payer: BCBS MAPPO |
$10,153.85
|
| Rate for Payer: BCN Medicare Advantage |
$10,153.85
|
| Rate for Payer: Cash Price |
$2,930.40
|
| Rate for Payer: Cash Price |
$2,930.40
|
| Rate for Payer: Cofinity Commercial |
$3,150.18
|
| Rate for Payer: Cofinity Commercial |
$2,564.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,564.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,930.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,153.85
|
| Rate for Payer: Healthscope Commercial |
$3,296.70
|
| Rate for Payer: Mclaren Medicaid |
$5,442.46
|
| Rate for Payer: Mclaren Medicare |
$10,153.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,661.54
|
| Rate for Payer: Meridian Medicaid |
$5,714.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,676.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,113.55
|
| Rate for Payer: PACE Medicare |
$9,646.16
|
| Rate for Payer: PACE SWMI |
$10,153.85
|
| Rate for Payer: PHP Commercial |
$3,113.55
|
| Rate for Payer: PHP Medicare Advantage |
$10,153.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,442.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,380.95
|
| Rate for Payer: Priority Health Medicare |
$10,153.85
|
| Rate for Payer: Priority Health SBD |
$2,307.69
|
| Rate for Payer: Railroad Medicare Medicare |
$10,153.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,582.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,153.85
|
| Rate for Payer: UHC Medicare Advantage |
$10,153.85
|
| Rate for Payer: UHCCP Medicaid |
$5,716.62
|
| Rate for Payer: VA VA |
$10,153.85
|
|
|
HC DILATION BILIARY DUCT WITH STENT
|
Facility
|
IP
|
$3,663.00
|
|
|
Service Code
|
CPT 47556
|
| Hospital Charge Code |
36100209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,307.69 |
| Max. Negotiated Rate |
$3,296.70 |
| Rate for Payer: Aetna Commercial |
$3,113.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,380.95
|
| Rate for Payer: Cash Price |
$2,930.40
|
| Rate for Payer: Cofinity Commercial |
$2,564.10
|
| Rate for Payer: Cofinity Commercial |
$3,150.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,564.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,930.40
|
| Rate for Payer: Healthscope Commercial |
$3,296.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,113.55
|
| Rate for Payer: PHP Commercial |
$3,113.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,380.95
|
| Rate for Payer: Priority Health SBD |
$2,307.69
|
|
|
HC DILATION BILIARY DUCT WO STENT
|
Facility
|
IP
|
$1,944.12
|
|
|
Service Code
|
CPT 47555
|
| Hospital Charge Code |
36100208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,224.80 |
| Max. Negotiated Rate |
$1,749.71 |
| Rate for Payer: Aetna Commercial |
$1,652.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,263.68
|
| Rate for Payer: Cash Price |
$1,555.30
|
| Rate for Payer: Cofinity Commercial |
$1,360.88
|
| Rate for Payer: Cofinity Commercial |
$1,671.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,360.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,555.30
|
| Rate for Payer: Healthscope Commercial |
$1,749.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,652.50
|
| Rate for Payer: PHP Commercial |
$1,652.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,263.68
|
| Rate for Payer: Priority Health SBD |
$1,224.80
|
|
|
HC DILATION BILIARY DUCT WO STENT
|
Facility
|
OP
|
$1,944.12
|
|
|
Service Code
|
CPT 47555
|
| Hospital Charge Code |
36100208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,224.80 |
| Max. Negotiated Rate |
$9,688.38 |
| Rate for Payer: Aetna Commercial |
$1,652.50
|
| Rate for Payer: Aetna Medicare |
$3,579.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,263.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,302.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,302.27
|
| Rate for Payer: BCBS Complete |
$1,937.06
|
| Rate for Payer: BCBS MAPPO |
$3,441.82
|
| Rate for Payer: BCN Medicare Advantage |
$3,441.82
|
| Rate for Payer: Cash Price |
$1,555.30
|
| Rate for Payer: Cash Price |
$1,555.30
|
| Rate for Payer: Cofinity Commercial |
$1,671.94
|
| Rate for Payer: Cofinity Commercial |
$1,360.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,360.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,555.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,441.82
|
| Rate for Payer: Healthscope Commercial |
$1,749.71
|
| Rate for Payer: Mclaren Medicaid |
$1,844.82
|
| Rate for Payer: Mclaren Medicare |
$3,441.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,613.91
|
| Rate for Payer: Meridian Medicaid |
$1,937.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,958.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,652.50
|
| Rate for Payer: PACE Medicare |
$3,269.73
|
| Rate for Payer: PACE SWMI |
$3,441.82
|
| Rate for Payer: PHP Commercial |
$1,652.50
|
| Rate for Payer: PHP Medicare Advantage |
$3,441.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,844.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,263.68
|
| Rate for Payer: Priority Health Medicare |
$3,441.82
|
| Rate for Payer: Priority Health SBD |
$1,224.80
|
| Rate for Payer: Railroad Medicare Medicare |
$3,441.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,688.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,441.82
|
| Rate for Payer: UHC Medicare Advantage |
$3,441.82
|
| Rate for Payer: UHCCP Medicaid |
$1,937.74
|
| Rate for Payer: VA VA |
$3,441.82
|
|
|
HC DILATION CERVICAL CANAL
|
Facility
|
OP
|
$7,943.45
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
36000112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,662.10 |
| Max. Negotiated Rate |
$8,728.81 |
| Rate for Payer: Aetna Commercial |
$6,751.93
|
| Rate for Payer: Aetna Medicare |
$3,224.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,163.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,876.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,876.16
|
| Rate for Payer: BCBS Complete |
$1,745.20
|
| Rate for Payer: BCBS MAPPO |
$3,100.93
|
| Rate for Payer: BCN Medicare Advantage |
$3,100.93
|
| Rate for Payer: Cash Price |
$6,354.76
|
| Rate for Payer: Cash Price |
$6,354.76
|
| Rate for Payer: Cofinity Commercial |
$6,831.37
|
| Rate for Payer: Cofinity Commercial |
$5,560.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,560.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,354.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,100.93
|
| Rate for Payer: Healthscope Commercial |
$7,149.10
|
| Rate for Payer: Mclaren Medicaid |
$1,662.10
|
| Rate for Payer: Mclaren Medicare |
$3,100.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,255.98
|
| Rate for Payer: Meridian Medicaid |
$1,745.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,566.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,751.93
|
| Rate for Payer: PACE Medicare |
$2,945.88
|
| Rate for Payer: PACE SWMI |
$3,100.93
|
| Rate for Payer: PHP Commercial |
$6,751.93
|
| Rate for Payer: PHP Medicare Advantage |
$3,100.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,662.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,163.24
|
| Rate for Payer: Priority Health Medicare |
$3,100.93
|
| Rate for Payer: Priority Health SBD |
$5,004.37
|
| Rate for Payer: Railroad Medicare Medicare |
$3,100.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,728.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,100.93
|
| Rate for Payer: UHC Medicare Advantage |
$3,100.93
|
| Rate for Payer: UHCCP Medicaid |
$1,745.82
|
| Rate for Payer: VA VA |
$3,100.93
|
|
|
HC DILATION CERVICAL CANAL
|
Facility
|
IP
|
$7,943.45
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
36000112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,004.37 |
| Max. Negotiated Rate |
$7,149.10 |
| Rate for Payer: Aetna Commercial |
$6,751.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,163.24
|
| Rate for Payer: Cash Price |
$6,354.76
|
| Rate for Payer: Cofinity Commercial |
$5,560.41
|
| Rate for Payer: Cofinity Commercial |
$6,831.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,560.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,354.76
|
| Rate for Payer: Healthscope Commercial |
$7,149.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,751.93
|
| Rate for Payer: PHP Commercial |
$6,751.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,163.24
|
| Rate for Payer: Priority Health SBD |
$5,004.37
|
|
|
HC DILATION URETHRA, INITIAL
|
Facility
|
OP
|
$215.91
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
76100266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$429.53 |
| Rate for Payer: Aetna Commercial |
$183.52
|
| Rate for Payer: Aetna Medicare |
$158.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.74
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$152.59
|
| Rate for Payer: BCN Medicare Advantage |
$152.59
|
| Rate for Payer: Cash Price |
$172.73
|
| Rate for Payer: Cash Price |
$172.73
|
| Rate for Payer: Cofinity Commercial |
$185.68
|
| Rate for Payer: Cofinity Commercial |
$151.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$151.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$194.32
|
| Rate for Payer: Mclaren Medicaid |
$81.79
|
| Rate for Payer: Mclaren Medicare |
$152.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.22
|
| Rate for Payer: Meridian Medicaid |
$85.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.52
|
| Rate for Payer: PACE Medicare |
$144.96
|
| Rate for Payer: PACE SWMI |
$152.59
|
| Rate for Payer: PHP Commercial |
$183.52
|
| Rate for Payer: PHP Medicare Advantage |
$152.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.34
|
| Rate for Payer: Priority Health Medicare |
$152.59
|
| Rate for Payer: Priority Health SBD |
$136.02
|
| Rate for Payer: Railroad Medicare Medicare |
$152.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.59
|
| Rate for Payer: UHC Medicare Advantage |
$152.59
|
| Rate for Payer: UHCCP Medicaid |
$85.91
|
| Rate for Payer: VA VA |
$152.59
|
|
|
HC DILATION URETHRA, INITIAL
|
Facility
|
IP
|
$215.91
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
76100266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.02 |
| Max. Negotiated Rate |
$194.32 |
| Rate for Payer: Aetna Commercial |
$183.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.34
|
| Rate for Payer: Cash Price |
$172.73
|
| Rate for Payer: Cofinity Commercial |
$151.14
|
| Rate for Payer: Cofinity Commercial |
$185.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$151.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.73
|
| Rate for Payer: Healthscope Commercial |
$194.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.52
|
| Rate for Payer: PHP Commercial |
$183.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.34
|
| Rate for Payer: Priority Health SBD |
$136.02
|
|
|
HC DILATION URETHRAL STRICTURE MALE
|
Facility
|
OP
|
$366.59
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
76100231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.14 |
| Max. Negotiated Rate |
$667.69 |
| Rate for Payer: Aetna Commercial |
$311.60
|
| Rate for Payer: Aetna Medicare |
$246.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.50
|
| Rate for Payer: BCBS Complete |
$133.50
|
| Rate for Payer: BCBS MAPPO |
$237.20
|
| Rate for Payer: BCN Medicare Advantage |
$237.20
|
| Rate for Payer: Cash Price |
$293.27
|
| Rate for Payer: Cash Price |
$293.27
|
| Rate for Payer: Cofinity Commercial |
$315.27
|
| Rate for Payer: Cofinity Commercial |
$256.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$256.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.20
|
| Rate for Payer: Healthscope Commercial |
$329.93
|
| Rate for Payer: Mclaren Medicaid |
$127.14
|
| Rate for Payer: Mclaren Medicare |
$237.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.06
|
| Rate for Payer: Meridian Medicaid |
$133.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.60
|
| Rate for Payer: PACE Medicare |
$225.34
|
| Rate for Payer: PACE SWMI |
$237.20
|
| Rate for Payer: PHP Commercial |
$311.60
|
| Rate for Payer: PHP Medicare Advantage |
$237.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.28
|
| Rate for Payer: Priority Health Medicare |
$237.20
|
| Rate for Payer: Priority Health SBD |
$230.95
|
| Rate for Payer: Railroad Medicare Medicare |
$237.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$667.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$237.20
|
| Rate for Payer: UHC Medicare Advantage |
$237.20
|
| Rate for Payer: UHCCP Medicaid |
$133.54
|
| Rate for Payer: VA VA |
$237.20
|
|
|
HC DILATION URETHRAL STRICTURE MALE
|
Facility
|
IP
|
$366.59
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
76100231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$230.95 |
| Max. Negotiated Rate |
$329.93 |
| Rate for Payer: Aetna Commercial |
$311.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.28
|
| Rate for Payer: Cash Price |
$293.27
|
| Rate for Payer: Cofinity Commercial |
$256.61
|
| Rate for Payer: Cofinity Commercial |
$315.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$256.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.27
|
| Rate for Payer: Healthscope Commercial |
$329.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.60
|
| Rate for Payer: PHP Commercial |
$311.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.28
|
| Rate for Payer: Priority Health SBD |
$230.95
|
|
|
HC DILATOR SIZE 12
|
Facility
|
IP
|
$34.57
|
|
| Hospital Charge Code |
27000055
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.78 |
| Max. Negotiated Rate |
$31.11 |
| Rate for Payer: Aetna Commercial |
$29.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.47
|
| Rate for Payer: Cash Price |
$27.66
|
| Rate for Payer: Cofinity Commercial |
$24.20
|
| Rate for Payer: Cofinity Commercial |
$29.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.66
|
| Rate for Payer: Healthscope Commercial |
$31.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.38
|
| Rate for Payer: PHP Commercial |
$29.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.47
|
| Rate for Payer: Priority Health SBD |
$21.78
|
|
