|
HC DTAP-IVP-HIB-HEPB INTRAMUSCULAR
|
Facility
|
IP
|
$166.46
|
|
|
Service Code
|
CPT 90697
|
| Hospital Charge Code |
63600207
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.87 |
| Max. Negotiated Rate |
$149.81 |
| Rate for Payer: Aetna Commercial |
$141.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.20
|
| Rate for Payer: Cash Price |
$133.17
|
| Rate for Payer: Cofinity Commercial |
$116.52
|
| Rate for Payer: Cofinity Commercial |
$143.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.17
|
| Rate for Payer: Healthscope Commercial |
$149.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.49
|
| Rate for Payer: PHP Commercial |
$141.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.20
|
| Rate for Payer: Priority Health SBD |
$104.87
|
|
|
HC DTPA PER STUDY
|
Facility
|
OP
|
$170.17
|
|
|
Service Code
|
HCPCS A9539
|
| Hospital Charge Code |
34300005
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$68.07 |
| Max. Negotiated Rate |
$153.15 |
| Rate for Payer: Aetna Commercial |
$144.64
|
| Rate for Payer: Aetna Medicare |
$85.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.61
|
| Rate for Payer: BCBS Complete |
$68.07
|
| Rate for Payer: Cash Price |
$136.14
|
| Rate for Payer: Cofinity Commercial |
$119.12
|
| Rate for Payer: Cofinity Commercial |
$146.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$119.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.14
|
| Rate for Payer: Healthscope Commercial |
$153.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.64
|
| Rate for Payer: PHP Commercial |
$144.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.61
|
| Rate for Payer: Priority Health SBD |
$107.21
|
|
|
HC DTPA PER STUDY
|
Facility
|
IP
|
$170.17
|
|
|
Service Code
|
HCPCS A9539
|
| Hospital Charge Code |
34300005
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$107.21 |
| Max. Negotiated Rate |
$153.15 |
| Rate for Payer: Aetna Commercial |
$144.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.61
|
| Rate for Payer: Cash Price |
$136.14
|
| Rate for Payer: Cofinity Commercial |
$119.12
|
| Rate for Payer: Cofinity Commercial |
$146.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$119.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.14
|
| Rate for Payer: Healthscope Commercial |
$153.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.64
|
| Rate for Payer: PHP Commercial |
$144.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.61
|
| Rate for Payer: Priority Health SBD |
$107.21
|
|
|
HC DUAL LEAD INSERTION
|
Facility
|
IP
|
$12,710.35
|
|
|
Service Code
|
CPT 33217
|
| Hospital Charge Code |
36100066
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,007.52 |
| Max. Negotiated Rate |
$11,439.32 |
| Rate for Payer: Aetna Commercial |
$10,803.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,261.73
|
| Rate for Payer: Cash Price |
$10,168.28
|
| Rate for Payer: Cofinity Commercial |
$10,930.90
|
| Rate for Payer: Cofinity Commercial |
$8,897.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,897.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,168.28
|
| Rate for Payer: Healthscope Commercial |
$11,439.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,803.80
|
| Rate for Payer: PHP Commercial |
$10,803.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,261.73
|
| Rate for Payer: Priority Health SBD |
$8,007.52
|
|
|
HC DUAL LEAD INSERTION
|
Facility
|
OP
|
$12,710.35
|
|
|
Service Code
|
CPT 33217
|
| Hospital Charge Code |
36100066
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,326.27 |
| Max. Negotiated Rate |
$22,720.18 |
| Rate for Payer: Aetna Commercial |
$10,803.80
|
| Rate for Payer: Aetna Medicare |
$8,394.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,261.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,089.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,089.25
|
| Rate for Payer: BCBS Complete |
$4,542.58
|
| Rate for Payer: BCBS MAPPO |
$8,071.40
|
| Rate for Payer: BCN Medicare Advantage |
$8,071.40
|
| Rate for Payer: Cash Price |
$10,168.28
|
| Rate for Payer: Cash Price |
$10,168.28
|
| Rate for Payer: Cofinity Commercial |
$8,897.25
|
| Rate for Payer: Cofinity Commercial |
$10,930.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,897.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,168.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,071.40
|
| Rate for Payer: Healthscope Commercial |
$11,439.32
|
| Rate for Payer: Mclaren Medicaid |
$4,326.27
|
| Rate for Payer: Mclaren Medicare |
$8,071.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,474.97
|
| Rate for Payer: Meridian Medicaid |
$4,542.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,282.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,803.80
|
| Rate for Payer: PACE Medicare |
$7,667.83
|
| Rate for Payer: PACE SWMI |
$8,071.40
|
| Rate for Payer: PHP Commercial |
$10,803.80
|
| Rate for Payer: PHP Medicare Advantage |
$8,071.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,326.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,261.73
|
| Rate for Payer: Priority Health Medicare |
$8,071.40
|
| Rate for Payer: Priority Health SBD |
$8,007.52
|
| Rate for Payer: Railroad Medicare Medicare |
$8,071.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,720.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,071.40
|
| Rate for Payer: UHC Medicare Advantage |
$8,071.40
|
| Rate for Payer: UHCCP Medicaid |
$4,544.20
|
| Rate for Payer: VA VA |
$8,071.40
|
|
|
HC DUCK FEATHERS IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200083
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
|
|
HC DUCK FEATHERS IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200083
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| 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 |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| 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 |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC DUODENOSCOPY/COLONOSCOPY
|
Facility
|
IP
|
$4,399.77
|
|
| Hospital Charge Code |
36000033
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,771.86 |
| Max. Negotiated Rate |
$3,959.79 |
| Rate for Payer: Aetna Commercial |
$3,739.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,859.85
|
| Rate for Payer: Cash Price |
$3,519.82
|
| Rate for Payer: Cofinity Commercial |
$3,079.84
|
| Rate for Payer: Cofinity Commercial |
$3,783.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,079.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,519.82
|
| Rate for Payer: Healthscope Commercial |
$3,959.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,739.80
|
| Rate for Payer: PHP Commercial |
$3,739.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,859.85
|
| Rate for Payer: Priority Health SBD |
$2,771.86
|
|
|
HC DUODENOSCOPY/COLONOSCOPY
|
Facility
|
OP
|
$4,399.77
|
|
| Hospital Charge Code |
36000033
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,759.91 |
| Max. Negotiated Rate |
$3,959.79 |
| Rate for Payer: Aetna Commercial |
$3,739.80
|
| Rate for Payer: Aetna Medicare |
$2,199.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,859.85
|
| Rate for Payer: BCBS Complete |
$1,759.91
|
| Rate for Payer: Cash Price |
$3,519.82
|
| Rate for Payer: Cofinity Commercial |
$3,079.84
|
| Rate for Payer: Cofinity Commercial |
$3,783.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,079.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,519.82
|
| Rate for Payer: Healthscope Commercial |
$3,959.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,739.80
|
| Rate for Payer: PHP Commercial |
$3,739.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,859.85
|
| Rate for Payer: Priority Health SBD |
$2,771.86
|
|
|
HC DUODENOSCOPY (EGD)
|
Facility
|
IP
|
$2,193.58
|
|
| Hospital Charge Code |
36000029
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,381.96 |
| Max. Negotiated Rate |
$1,974.22 |
| Rate for Payer: Aetna Commercial |
$1,864.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,425.83
|
| Rate for Payer: Cash Price |
$1,754.86
|
| Rate for Payer: Cofinity Commercial |
$1,535.51
|
| Rate for Payer: Cofinity Commercial |
$1,886.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,535.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,754.86
|
| Rate for Payer: Healthscope Commercial |
$1,974.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,864.54
|
| Rate for Payer: PHP Commercial |
$1,864.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,425.83
|
| Rate for Payer: Priority Health SBD |
$1,381.96
|
|
|
HC DUODENOSCOPY (EGD)
|
Facility
|
OP
|
$2,193.58
|
|
| Hospital Charge Code |
36000029
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$877.43 |
| Max. Negotiated Rate |
$1,974.22 |
| Rate for Payer: Aetna Commercial |
$1,864.54
|
| Rate for Payer: Aetna Medicare |
$1,096.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,425.83
|
| Rate for Payer: BCBS Complete |
$877.43
|
| Rate for Payer: Cash Price |
$1,754.86
|
| Rate for Payer: Cofinity Commercial |
$1,535.51
|
| Rate for Payer: Cofinity Commercial |
$1,886.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,535.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,754.86
|
| Rate for Payer: Healthscope Commercial |
$1,974.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,864.54
|
| Rate for Payer: PHP Commercial |
$1,864.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,425.83
|
| Rate for Payer: Priority Health SBD |
$1,381.96
|
|
|
HC DUODENUM/FLEX SIGMOID
|
Facility
|
IP
|
$3,894.00
|
|
| Hospital Charge Code |
36000034
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,453.22 |
| Max. Negotiated Rate |
$3,504.60 |
| Rate for Payer: Aetna Commercial |
$3,309.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,531.10
|
| Rate for Payer: Cash Price |
$3,115.20
|
| Rate for Payer: Cofinity Commercial |
$2,725.80
|
| Rate for Payer: Cofinity Commercial |
$3,348.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,725.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,115.20
|
| Rate for Payer: Healthscope Commercial |
$3,504.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,309.90
|
| Rate for Payer: PHP Commercial |
$3,309.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,531.10
|
| Rate for Payer: Priority Health SBD |
$2,453.22
|
|
|
HC DUODENUM/FLEX SIGMOID
|
Facility
|
OP
|
$3,894.00
|
|
| Hospital Charge Code |
36000034
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,557.60 |
| Max. Negotiated Rate |
$3,504.60 |
| Rate for Payer: Aetna Commercial |
$3,309.90
|
| Rate for Payer: Aetna Medicare |
$1,947.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,531.10
|
| Rate for Payer: BCBS Complete |
$1,557.60
|
| Rate for Payer: Cash Price |
$3,115.20
|
| Rate for Payer: Cofinity Commercial |
$2,725.80
|
| Rate for Payer: Cofinity Commercial |
$3,348.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,725.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,115.20
|
| Rate for Payer: Healthscope Commercial |
$3,504.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,309.90
|
| Rate for Payer: PHP Commercial |
$3,309.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,531.10
|
| Rate for Payer: Priority Health SBD |
$2,453.22
|
|
|
HC DUODERM CGF 4X4
|
Facility
|
OP
|
$47.73
|
|
| Hospital Charge Code |
27100010
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$19.09 |
| Max. Negotiated Rate |
$42.96 |
| Rate for Payer: Aetna Commercial |
$40.57
|
| Rate for Payer: Aetna Medicare |
$23.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.02
|
| Rate for Payer: BCBS Complete |
$19.09
|
| Rate for Payer: Cash Price |
$38.18
|
| Rate for Payer: Cofinity Commercial |
$33.41
|
| Rate for Payer: Cofinity Commercial |
$41.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.18
|
| Rate for Payer: Healthscope Commercial |
$42.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.57
|
| Rate for Payer: PHP Commercial |
$40.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.02
|
| Rate for Payer: Priority Health SBD |
$30.07
|
|
|
HC DUODERM CGF 4X4
|
Facility
|
IP
|
$47.73
|
|
| Hospital Charge Code |
27100010
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.07 |
| Max. Negotiated Rate |
$42.96 |
| Rate for Payer: Aetna Commercial |
$40.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.02
|
| Rate for Payer: Cash Price |
$38.18
|
| Rate for Payer: Cofinity Commercial |
$33.41
|
| Rate for Payer: Cofinity Commercial |
$41.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.18
|
| Rate for Payer: Healthscope Commercial |
$42.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.57
|
| Rate for Payer: PHP Commercial |
$40.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.02
|
| Rate for Payer: Priority Health SBD |
$30.07
|
|
|
HC DUODERM CGF 6X6
|
Facility
|
OP
|
$75.60
|
|
| Hospital Charge Code |
27100011
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.24 |
| Max. Negotiated Rate |
$68.04 |
| Rate for Payer: Aetna Commercial |
$64.26
|
| Rate for Payer: Aetna Medicare |
$37.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.14
|
| Rate for Payer: BCBS Complete |
$30.24
|
| Rate for Payer: Cash Price |
$60.48
|
| Rate for Payer: Cofinity Commercial |
$52.92
|
| Rate for Payer: Cofinity Commercial |
$65.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.48
|
| Rate for Payer: Healthscope Commercial |
$68.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.26
|
| Rate for Payer: PHP Commercial |
$64.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.14
|
| Rate for Payer: Priority Health SBD |
$47.63
|
|
|
HC DUODERM CGF 6X6
|
Facility
|
IP
|
$75.60
|
|
| Hospital Charge Code |
27100011
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$47.63 |
| Max. Negotiated Rate |
$68.04 |
| Rate for Payer: Aetna Commercial |
$64.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.14
|
| Rate for Payer: Cash Price |
$60.48
|
| Rate for Payer: Cofinity Commercial |
$52.92
|
| Rate for Payer: Cofinity Commercial |
$65.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.48
|
| Rate for Payer: Healthscope Commercial |
$68.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.26
|
| Rate for Payer: PHP Commercial |
$64.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.14
|
| Rate for Payer: Priority Health SBD |
$47.63
|
|
|
HC DUODERM CGF 8X8
|
Facility
|
OP
|
$105.53
|
|
| Hospital Charge Code |
27100012
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$42.21 |
| Max. Negotiated Rate |
$94.98 |
| Rate for Payer: Aetna Commercial |
$89.70
|
| Rate for Payer: Aetna Medicare |
$52.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.59
|
| Rate for Payer: BCBS Complete |
$42.21
|
| Rate for Payer: Cash Price |
$84.42
|
| Rate for Payer: Cofinity Commercial |
$73.87
|
| Rate for Payer: Cofinity Commercial |
$90.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.42
|
| Rate for Payer: Healthscope Commercial |
$94.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.70
|
| Rate for Payer: PHP Commercial |
$89.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.59
|
| Rate for Payer: Priority Health SBD |
$66.48
|
|
|
HC DUODERM CGF 8X8
|
Facility
|
IP
|
$105.53
|
|
| Hospital Charge Code |
27100012
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$66.48 |
| Max. Negotiated Rate |
$94.98 |
| Rate for Payer: Aetna Commercial |
$89.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.59
|
| Rate for Payer: Cash Price |
$84.42
|
| Rate for Payer: Cofinity Commercial |
$73.87
|
| Rate for Payer: Cofinity Commercial |
$90.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.42
|
| Rate for Payer: Healthscope Commercial |
$94.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.70
|
| Rate for Payer: PHP Commercial |
$89.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.59
|
| Rate for Payer: Priority Health SBD |
$66.48
|
|
|
HC DUOGLIDE CATHETER
|
Facility
|
OP
|
$650.22
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200176
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$260.09 |
| Max. Negotiated Rate |
$585.20 |
| Rate for Payer: Aetna Commercial |
$552.69
|
| Rate for Payer: Aetna Medicare |
$325.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$422.64
|
| Rate for Payer: BCBS Complete |
$260.09
|
| Rate for Payer: Cash Price |
$520.18
|
| Rate for Payer: Cofinity Commercial |
$455.15
|
| Rate for Payer: Cofinity Commercial |
$559.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$455.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.18
|
| Rate for Payer: Healthscope Commercial |
$585.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$552.69
|
| Rate for Payer: PHP Commercial |
$552.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.64
|
| Rate for Payer: Priority Health SBD |
$409.64
|
|
|
HC DUOGLIDE CATHETER
|
Facility
|
IP
|
$650.22
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200176
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$409.64 |
| Max. Negotiated Rate |
$585.20 |
| Rate for Payer: Aetna Commercial |
$552.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$422.64
|
| Rate for Payer: Cash Price |
$520.18
|
| Rate for Payer: Cofinity Commercial |
$455.15
|
| Rate for Payer: Cofinity Commercial |
$559.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$455.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.18
|
| Rate for Payer: Healthscope Commercial |
$585.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$552.69
|
| Rate for Payer: PHP Commercial |
$552.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.64
|
| Rate for Payer: Priority Health SBD |
$409.64
|
|
|
HC DUPLX HEMODIALYSIS ACCESS
|
Facility
|
IP
|
$967.42
|
|
|
Service Code
|
CPT 93990
|
| Hospital Charge Code |
92100017
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$609.47 |
| Max. Negotiated Rate |
$870.68 |
| Rate for Payer: Aetna Commercial |
$822.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$628.82
|
| Rate for Payer: Cash Price |
$773.94
|
| Rate for Payer: Cofinity Commercial |
$677.19
|
| Rate for Payer: Cofinity Commercial |
$831.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$677.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$773.94
|
| Rate for Payer: Healthscope Commercial |
$870.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$822.31
|
| Rate for Payer: PHP Commercial |
$822.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$628.82
|
| Rate for Payer: Priority Health SBD |
$609.47
|
|
|
HC DUPLX HEMODIALYSIS ACCESS
|
Facility
|
OP
|
$967.42
|
|
|
Service Code
|
CPT 93990
|
| Hospital Charge Code |
92100017
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$870.68 |
| Rate for Payer: Aetna Commercial |
$822.31
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$628.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$773.94
|
| Rate for Payer: Cash Price |
$773.94
|
| Rate for Payer: Cofinity Commercial |
$831.98
|
| Rate for Payer: Cofinity Commercial |
$677.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$677.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$773.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$870.68
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$822.31
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$822.31
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$628.82
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health SBD |
$609.47
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.93
|
| Rate for Payer: UHC Core |
$715.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$715.89
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$58.39
|
| Rate for Payer: VA VA |
$103.71
|
|
|
HC DUST MITE DF IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200039
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
|
|
HC DUST MITE DF IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200039
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| 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 |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| 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 |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
