|
HC EXTRA VASCULAR ICD
|
Facility
|
IP
|
$26,875.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800160
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16,931.25 |
| Max. Negotiated Rate |
$24,187.50 |
| Rate for Payer: Aetna Commercial |
$22,843.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,468.75
|
| Rate for Payer: Cash Price |
$21,500.00
|
| Rate for Payer: Cofinity Advantage |
$18,812.50
|
| Rate for Payer: Cofinity Commercial |
$23,112.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,500.00
|
| Rate for Payer: Healthscope Commercial |
$24,187.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,843.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20,156.25
|
| Rate for Payer: PHP Commercial |
$22,843.75
|
| Rate for Payer: Priority Health SBD |
$16,931.25
|
|
|
HC EXTRA VASCULAR ICD
|
Facility
|
OP
|
$26,875.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800160
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,561.88 |
| Max. Negotiated Rate |
$24,187.50 |
| Rate for Payer: Aetna Commercial |
$22,843.75
|
| Rate for Payer: Aetna Medicare |
$13,437.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,468.75
|
| Rate for Payer: BCBS Complete |
$10,750.00
|
| Rate for Payer: Cash Price |
$21,500.00
|
| Rate for Payer: Cofinity Advantage |
$18,812.50
|
| Rate for Payer: Cofinity Commercial |
$23,112.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,500.00
|
| Rate for Payer: Healthscope Commercial |
$24,187.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,500.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,843.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20,156.25
|
| Rate for Payer: PHP Commercial |
$22,843.75
|
| Rate for Payer: Priority Health SBD |
$16,931.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,468.75
|
| Rate for Payer: UHC Core |
$14,001.88
|
| Rate for Payer: UHC Exchange |
$10,561.88
|
|
|
HC EXTRA VASCULAR LEAD
|
Facility
|
OP
|
$8,085.00
|
|
|
Service Code
|
HCPCS C1896
|
| Hospital Charge Code |
27800161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,177.41 |
| Max. Negotiated Rate |
$7,276.50 |
| Rate for Payer: Aetna Commercial |
$6,872.25
|
| Rate for Payer: Aetna Medicare |
$4,042.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,255.25
|
| Rate for Payer: BCBS Complete |
$3,234.00
|
| Rate for Payer: Cash Price |
$6,468.00
|
| Rate for Payer: Cofinity Advantage |
$5,659.50
|
| Rate for Payer: Cofinity Commercial |
$6,953.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,468.00
|
| Rate for Payer: Healthscope Commercial |
$7,276.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,468.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,872.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,063.75
|
| Rate for Payer: PHP Commercial |
$6,872.25
|
| Rate for Payer: Priority Health SBD |
$5,093.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,255.25
|
| Rate for Payer: UHC Core |
$4,212.28
|
| Rate for Payer: UHC Exchange |
$3,177.41
|
|
|
HC EXTRA VASCULAR LEAD
|
Facility
|
IP
|
$8,085.00
|
|
|
Service Code
|
HCPCS C1896
|
| Hospital Charge Code |
27800161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,093.55 |
| Max. Negotiated Rate |
$7,276.50 |
| Rate for Payer: Aetna Commercial |
$6,872.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,255.25
|
| Rate for Payer: Cash Price |
$6,468.00
|
| Rate for Payer: Cofinity Advantage |
$5,659.50
|
| Rate for Payer: Cofinity Commercial |
$6,953.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,468.00
|
| Rate for Payer: Healthscope Commercial |
$7,276.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,872.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,063.75
|
| Rate for Payer: PHP Commercial |
$6,872.25
|
| Rate for Payer: Priority Health SBD |
$5,093.55
|
|
|
HC EXTRA VASCULAR STERNAL TUNNELING TOOL
|
Facility
|
IP
|
$1,500.00
|
|
| Hospital Charge Code |
27200398
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$945.00 |
| Max. Negotiated Rate |
$1,350.00 |
| Rate for Payer: Aetna Commercial |
$1,275.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$975.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cofinity Advantage |
$1,050.00
|
| Rate for Payer: Cofinity Commercial |
$1,290.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,200.00
|
| Rate for Payer: Healthscope Commercial |
$1,350.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,275.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,125.00
|
| Rate for Payer: PHP Commercial |
$1,275.00
|
| Rate for Payer: Priority Health SBD |
$945.00
|
|
|
HC EXTRA VASCULAR STERNAL TUNNELING TOOL
|
Facility
|
OP
|
$1,500.00
|
|
| Hospital Charge Code |
27200398
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$589.50 |
| Max. Negotiated Rate |
$1,350.00 |
| Rate for Payer: Aetna Commercial |
$1,275.00
|
| Rate for Payer: Aetna Medicare |
$750.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$975.00
|
| Rate for Payer: BCBS Complete |
$600.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cofinity Advantage |
$1,050.00
|
| Rate for Payer: Cofinity Commercial |
$1,290.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,200.00
|
| Rate for Payer: Healthscope Commercial |
$1,350.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,200.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,275.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,125.00
|
| Rate for Payer: PHP Commercial |
$1,275.00
|
| Rate for Payer: Priority Health SBD |
$945.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$975.00
|
| Rate for Payer: UHC Core |
$781.50
|
| Rate for Payer: UHC Exchange |
$589.50
|
|
|
HC EXTRA VASCULAR TRANSVERSE TUNNELING TOOL
|
Facility
|
IP
|
$1,500.00
|
|
| Hospital Charge Code |
27200399
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$945.00 |
| Max. Negotiated Rate |
$1,350.00 |
| Rate for Payer: Aetna Commercial |
$1,275.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$975.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cofinity Advantage |
$1,050.00
|
| Rate for Payer: Cofinity Commercial |
$1,290.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,200.00
|
| Rate for Payer: Healthscope Commercial |
$1,350.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,275.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,125.00
|
| Rate for Payer: PHP Commercial |
$1,275.00
|
| Rate for Payer: Priority Health SBD |
$945.00
|
|
|
HC EXTRA VASCULAR TRANSVERSE TUNNELING TOOL
|
Facility
|
OP
|
$1,500.00
|
|
| Hospital Charge Code |
27200399
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$589.50 |
| Max. Negotiated Rate |
$1,350.00 |
| Rate for Payer: Aetna Commercial |
$1,275.00
|
| Rate for Payer: Aetna Medicare |
$750.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$975.00
|
| Rate for Payer: BCBS Complete |
$600.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cofinity Advantage |
$1,050.00
|
| Rate for Payer: Cofinity Commercial |
$1,290.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,200.00
|
| Rate for Payer: Healthscope Commercial |
$1,350.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,200.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,275.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,125.00
|
| Rate for Payer: PHP Commercial |
$1,275.00
|
| Rate for Payer: Priority Health SBD |
$945.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$975.00
|
| Rate for Payer: UHC Core |
$781.50
|
| Rate for Payer: UHC Exchange |
$589.50
|
|
|
HC EZPAP SUPPLY
|
Facility
|
IP
|
$130.55
|
|
| Hospital Charge Code |
27000072
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$82.25 |
| Max. Negotiated Rate |
$117.50 |
| Rate for Payer: Aetna Commercial |
$110.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.86
|
| Rate for Payer: Cash Price |
$104.44
|
| Rate for Payer: Cofinity Advantage |
$91.39
|
| Rate for Payer: Cofinity Commercial |
$112.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.44
|
| Rate for Payer: Healthscope Commercial |
$117.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.91
|
| Rate for Payer: PHP Commercial |
$110.97
|
| Rate for Payer: Priority Health SBD |
$82.25
|
|
|
HC EZPAP SUPPLY
|
Facility
|
OP
|
$130.55
|
|
| Hospital Charge Code |
27000072
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$51.31 |
| Max. Negotiated Rate |
$117.50 |
| Rate for Payer: Aetna Commercial |
$110.97
|
| Rate for Payer: Aetna Medicare |
$65.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.86
|
| Rate for Payer: BCBS Complete |
$52.22
|
| Rate for Payer: Cash Price |
$104.44
|
| Rate for Payer: Cofinity Advantage |
$91.39
|
| Rate for Payer: Cofinity Commercial |
$112.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.44
|
| Rate for Payer: Healthscope Commercial |
$117.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.91
|
| Rate for Payer: PHP Commercial |
$110.97
|
| Rate for Payer: Priority Health SBD |
$82.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.86
|
| Rate for Payer: UHC Core |
$68.02
|
| Rate for Payer: UHC Exchange |
$51.31
|
|
|
HC F-18 SODIUM FLUORIDE <=30MCI
|
Facility
|
OP
|
$494.43
|
|
|
Service Code
|
HCPCS A9580
|
| Hospital Charge Code |
34300028
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$197.77 |
| Max. Negotiated Rate |
$797.52 |
| Rate for Payer: Aetna Commercial |
$420.27
|
| Rate for Payer: Aetna Medicare |
$247.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.38
|
| Rate for Payer: BCBS Complete |
$197.77
|
| Rate for Payer: BCBS Trust/PPO |
$797.52
|
| Rate for Payer: BCN Commercial |
$797.52
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cofinity Advantage |
$346.10
|
| Rate for Payer: Cofinity Commercial |
$425.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.54
|
| Rate for Payer: Healthscope Commercial |
$444.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$395.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$370.82
|
| Rate for Payer: PHP Commercial |
$420.27
|
| Rate for Payer: Priority Health SBD |
$311.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$446.41
|
| Rate for Payer: UHC Core |
$446.41
|
| Rate for Payer: UHC Exchange |
$446.41
|
|
|
HC F-18 SODIUM FLUORIDE <=30MCI
|
Facility
|
IP
|
$494.43
|
|
|
Service Code
|
HCPCS A9580
|
| Hospital Charge Code |
34300028
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$311.49 |
| Max. Negotiated Rate |
$444.99 |
| Rate for Payer: Aetna Commercial |
$420.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.38
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cofinity Advantage |
$346.10
|
| Rate for Payer: Cofinity Commercial |
$425.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.54
|
| Rate for Payer: Healthscope Commercial |
$444.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$370.82
|
| Rate for Payer: PHP Commercial |
$420.27
|
| Rate for Payer: Priority Health SBD |
$311.49
|
|
|
HC F232 OVALBUMIN
|
Facility
|
OP
|
$32.10
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200439
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$28.89 |
| Rate for Payer: Aetna Commercial |
$27.29
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$9.85
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$19.12
|
| Rate for Payer: BCN Commercial |
$19.12
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$25.68
|
| Rate for Payer: Cash Price |
$25.68
|
| Rate for Payer: Cofinity Advantage |
$22.47
|
| Rate for Payer: Cofinity Commercial |
$27.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$28.89
|
| Rate for Payer: Mclaren Medicaid |
$9.38
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.29
|
| Rate for Payer: Nomi Health Commercial |
$26.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.07
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$27.29
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.93
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$20.22
|
| Rate for Payer: Priority Health Tiered Network |
$14.34
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.90
|
| Rate for Payer: UHC Core |
$26.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.93
|
| Rate for Payer: UHC Exchange |
$26.90
|
| Rate for Payer: UHC Medicaid |
$9.38
|
| Rate for Payer: UHCCP Medicaid |
$9.38
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC F232 OVALBUMIN
|
Facility
|
IP
|
$32.10
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200439
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.22 |
| Max. Negotiated Rate |
$28.89 |
| Rate for Payer: Aetna Commercial |
$27.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.86
|
| Rate for Payer: Cash Price |
$25.68
|
| Rate for Payer: Cofinity Advantage |
$22.47
|
| Rate for Payer: Cofinity Commercial |
$27.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.68
|
| Rate for Payer: Healthscope Commercial |
$28.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.07
|
| Rate for Payer: PHP Commercial |
$27.29
|
| Rate for Payer: Priority Health SBD |
$20.22
|
|
|
HC F233 OVOMUCOID
|
Facility
|
OP
|
$32.10
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200440
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$28.89 |
| Rate for Payer: Aetna Commercial |
$27.29
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$9.85
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$19.12
|
| Rate for Payer: BCN Commercial |
$19.12
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$25.68
|
| Rate for Payer: Cash Price |
$25.68
|
| Rate for Payer: Cofinity Advantage |
$22.47
|
| Rate for Payer: Cofinity Commercial |
$27.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$28.89
|
| Rate for Payer: Mclaren Medicaid |
$9.38
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.29
|
| Rate for Payer: Nomi Health Commercial |
$26.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.07
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$27.29
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.93
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$20.22
|
| Rate for Payer: Priority Health Tiered Network |
$14.34
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.90
|
| Rate for Payer: UHC Core |
$26.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.93
|
| Rate for Payer: UHC Exchange |
$26.90
|
| Rate for Payer: UHC Medicaid |
$9.38
|
| Rate for Payer: UHCCP Medicaid |
$9.38
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC F233 OVOMUCOID
|
Facility
|
IP
|
$32.10
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200440
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.22 |
| Max. Negotiated Rate |
$28.89 |
| Rate for Payer: Aetna Commercial |
$27.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.86
|
| Rate for Payer: Cash Price |
$25.68
|
| Rate for Payer: Cofinity Advantage |
$22.47
|
| Rate for Payer: Cofinity Commercial |
$27.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.68
|
| Rate for Payer: Healthscope Commercial |
$28.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.07
|
| Rate for Payer: PHP Commercial |
$27.29
|
| Rate for Payer: Priority Health SBD |
$20.22
|
|
|
HC F352 RARA H8 PR-10 PEANUT
|
Facility
|
OP
|
$32.10
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200450
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$28.89 |
| Rate for Payer: Aetna Commercial |
$27.29
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$9.85
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$19.12
|
| Rate for Payer: BCN Commercial |
$19.12
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$25.68
|
| Rate for Payer: Cash Price |
$25.68
|
| Rate for Payer: Cofinity Advantage |
$22.47
|
| Rate for Payer: Cofinity Commercial |
$27.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$28.89
|
| Rate for Payer: Mclaren Medicaid |
$9.38
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.29
|
| Rate for Payer: Nomi Health Commercial |
$26.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.07
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$27.29
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.93
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$20.22
|
| Rate for Payer: Priority Health Tiered Network |
$14.34
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.90
|
| Rate for Payer: UHC Core |
$26.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.93
|
| Rate for Payer: UHC Exchange |
$26.90
|
| Rate for Payer: UHC Medicaid |
$9.38
|
| Rate for Payer: UHCCP Medicaid |
$9.38
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC F352 RARA H8 PR-10 PEANUT
|
Facility
|
IP
|
$32.10
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200450
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.22 |
| Max. Negotiated Rate |
$28.89 |
| Rate for Payer: Aetna Commercial |
$27.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.86
|
| Rate for Payer: Cash Price |
$25.68
|
| Rate for Payer: Cofinity Advantage |
$22.47
|
| Rate for Payer: Cofinity Commercial |
$27.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.68
|
| Rate for Payer: Healthscope Commercial |
$28.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.07
|
| Rate for Payer: PHP Commercial |
$27.29
|
| Rate for Payer: Priority Health SBD |
$20.22
|
|
|
HC F422 RARA H1 PEANUT
|
Facility
|
IP
|
$32.10
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200446
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.22 |
| Max. Negotiated Rate |
$28.89 |
| Rate for Payer: Aetna Commercial |
$27.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.86
|
| Rate for Payer: Cash Price |
$25.68
|
| Rate for Payer: Cofinity Advantage |
$22.47
|
| Rate for Payer: Cofinity Commercial |
$27.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.68
|
| Rate for Payer: Healthscope Commercial |
$28.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.07
|
| Rate for Payer: PHP Commercial |
$27.29
|
| Rate for Payer: Priority Health SBD |
$20.22
|
|
|
HC F422 RARA H1 PEANUT
|
Facility
|
OP
|
$32.10
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200446
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$28.89 |
| Rate for Payer: Aetna Commercial |
$27.29
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$9.85
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$19.12
|
| Rate for Payer: BCN Commercial |
$19.12
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$25.68
|
| Rate for Payer: Cash Price |
$25.68
|
| Rate for Payer: Cofinity Advantage |
$22.47
|
| Rate for Payer: Cofinity Commercial |
$27.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$28.89
|
| Rate for Payer: Mclaren Medicaid |
$9.38
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.29
|
| Rate for Payer: Nomi Health Commercial |
$26.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.07
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$27.29
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.93
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$20.22
|
| Rate for Payer: Priority Health Tiered Network |
$14.34
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.90
|
| Rate for Payer: UHC Core |
$26.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.93
|
| Rate for Payer: UHC Exchange |
$26.90
|
| Rate for Payer: UHC Medicaid |
$9.38
|
| Rate for Payer: UHCCP Medicaid |
$9.38
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC F423 RARA H2 PEANUT
|
Facility
|
OP
|
$32.10
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200447
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$28.89 |
| Rate for Payer: Aetna Commercial |
$27.29
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$9.85
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$19.12
|
| Rate for Payer: BCN Commercial |
$19.12
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$25.68
|
| Rate for Payer: Cash Price |
$25.68
|
| Rate for Payer: Cofinity Advantage |
$22.47
|
| Rate for Payer: Cofinity Commercial |
$27.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$28.89
|
| Rate for Payer: Mclaren Medicaid |
$9.38
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.29
|
| Rate for Payer: Nomi Health Commercial |
$26.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.07
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$27.29
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.93
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$20.22
|
| Rate for Payer: Priority Health Tiered Network |
$14.34
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.90
|
| Rate for Payer: UHC Core |
$26.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.93
|
| Rate for Payer: UHC Exchange |
$26.90
|
| Rate for Payer: UHC Medicaid |
$9.38
|
| Rate for Payer: UHCCP Medicaid |
$9.38
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC F423 RARA H2 PEANUT
|
Facility
|
IP
|
$32.10
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200447
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.22 |
| Max. Negotiated Rate |
$28.89 |
| Rate for Payer: Aetna Commercial |
$27.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.86
|
| Rate for Payer: Cash Price |
$25.68
|
| Rate for Payer: Cofinity Advantage |
$22.47
|
| Rate for Payer: Cofinity Commercial |
$27.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.68
|
| Rate for Payer: Healthscope Commercial |
$28.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.07
|
| Rate for Payer: PHP Commercial |
$27.29
|
| Rate for Payer: Priority Health SBD |
$20.22
|
|
|
HC F424 RARA H3 PEANUT
|
Facility
|
IP
|
$32.10
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200448
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.22 |
| Max. Negotiated Rate |
$28.89 |
| Rate for Payer: Aetna Commercial |
$27.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.86
|
| Rate for Payer: Cash Price |
$25.68
|
| Rate for Payer: Cofinity Advantage |
$22.47
|
| Rate for Payer: Cofinity Commercial |
$27.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.68
|
| Rate for Payer: Healthscope Commercial |
$28.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.07
|
| Rate for Payer: PHP Commercial |
$27.29
|
| Rate for Payer: Priority Health SBD |
$20.22
|
|
|
HC F424 RARA H3 PEANUT
|
Facility
|
OP
|
$32.10
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200448
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$28.89 |
| Rate for Payer: Aetna Commercial |
$27.29
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$9.85
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$19.12
|
| Rate for Payer: BCN Commercial |
$19.12
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$25.68
|
| Rate for Payer: Cash Price |
$25.68
|
| Rate for Payer: Cofinity Advantage |
$22.47
|
| Rate for Payer: Cofinity Commercial |
$27.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$28.89
|
| Rate for Payer: Mclaren Medicaid |
$9.38
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.29
|
| Rate for Payer: Nomi Health Commercial |
$26.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.07
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$27.29
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.93
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$20.22
|
| Rate for Payer: Priority Health Tiered Network |
$14.34
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.90
|
| Rate for Payer: UHC Core |
$26.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.93
|
| Rate for Payer: UHC Exchange |
$26.90
|
| Rate for Payer: UHC Medicaid |
$9.38
|
| Rate for Payer: UHCCP Medicaid |
$9.38
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC F427 RARA H9 LTP PEANUT
|
Facility
|
OP
|
$32.10
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200451
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$28.89 |
| Rate for Payer: Aetna Commercial |
$27.29
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$9.85
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$19.12
|
| Rate for Payer: BCN Commercial |
$19.12
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$25.68
|
| Rate for Payer: Cash Price |
$25.68
|
| Rate for Payer: Cofinity Advantage |
$22.47
|
| Rate for Payer: Cofinity Commercial |
$27.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$28.89
|
| Rate for Payer: Mclaren Medicaid |
$9.38
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.29
|
| Rate for Payer: Nomi Health Commercial |
$26.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.07
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$27.29
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.93
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$20.22
|
| Rate for Payer: Priority Health Tiered Network |
$14.34
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.90
|
| Rate for Payer: UHC Core |
$26.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.93
|
| Rate for Payer: UHC Exchange |
$26.90
|
| Rate for Payer: UHC Medicaid |
$9.38
|
| Rate for Payer: UHCCP Medicaid |
$9.38
|
| Rate for Payer: VA VA |
$17.93
|
|
