|
HC EVOKED OTOACOUSTIC EMISNS LIMITD
|
Facility
|
OP
|
$785.40
|
|
|
Service Code
|
CPT 92587
|
| Hospital Charge Code |
76100489
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$958.92 |
| Rate for Payer: Aetna Commercial |
$667.59
|
| Rate for Payer: Aetna Medicare |
$317.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$510.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.38
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$16.25
|
| Rate for Payer: BCN Commercial |
$16.25
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| Rate for Payer: Cash Price |
$628.32
|
| Rate for Payer: Cash Price |
$628.32
|
| Rate for Payer: Cofinity Commercial |
$675.44
|
| Rate for Payer: Cofinity Commercial |
$549.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$549.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$628.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$706.86
|
| Rate for Payer: Mclaren Medicaid |
$163.53
|
| Rate for Payer: Mclaren Medicare |
$305.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.36
|
| Rate for Payer: Meridian Medicaid |
$171.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$667.59
|
| Rate for Payer: Nomi Health Commercial |
$915.30
|
| Rate for Payer: PACE Medicare |
$289.84
|
| Rate for Payer: PACE SWMI |
$305.10
|
| Rate for Payer: PHP Commercial |
$667.59
|
| Rate for Payer: PHP Medicare Advantage |
$305.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$958.92
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$767.14
|
| Rate for Payer: Priority Health SBD |
$494.80
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.10
|
| Rate for Payer: UHC Medicare Advantage |
$305.10
|
| Rate for Payer: UHCCP Medicaid |
$171.77
|
| Rate for Payer: VA VA |
$305.10
|
|
|
HC EVOKED OTOACOUSTIC EMISNS LIMITD
|
Facility
|
IP
|
$785.40
|
|
|
Service Code
|
CPT 92587
|
| Hospital Charge Code |
76100489
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$494.80 |
| Max. Negotiated Rate |
$706.86 |
| Rate for Payer: Aetna Commercial |
$667.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$510.51
|
| Rate for Payer: Cash Price |
$628.32
|
| Rate for Payer: Cofinity Commercial |
$549.78
|
| Rate for Payer: Cofinity Commercial |
$675.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$549.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$628.32
|
| Rate for Payer: Healthscope Commercial |
$706.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$667.59
|
| Rate for Payer: PHP Commercial |
$667.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.51
|
| Rate for Payer: Priority Health SBD |
$494.80
|
|
|
HC EXAM AND SELECT ARCHIVE RETRIEVED
|
Facility
|
OP
|
$60.11
|
|
|
Service Code
|
CPT 88363
|
| Hospital Charge Code |
31000059
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$75.43 |
| Rate for Payer: Aetna Commercial |
$51.09
|
| Rate for Payer: Aetna Medicare |
$24.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.99
|
| Rate for Payer: BCBS Complete |
$13.50
|
| Rate for Payer: BCBS MAPPO |
$23.99
|
| Rate for Payer: BCBS Trust/PPO |
$32.53
|
| Rate for Payer: BCN Commercial |
$32.53
|
| Rate for Payer: BCN Medicare Advantage |
$23.99
|
| Rate for Payer: Cash Price |
$48.09
|
| Rate for Payer: Cash Price |
$48.09
|
| Rate for Payer: Cofinity Commercial |
$51.69
|
| Rate for Payer: Cofinity Commercial |
$42.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.99
|
| Rate for Payer: Healthscope Commercial |
$54.10
|
| Rate for Payer: Mclaren Medicaid |
$12.86
|
| Rate for Payer: Mclaren Medicare |
$23.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.19
|
| Rate for Payer: Meridian Medicaid |
$13.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.09
|
| Rate for Payer: Nomi Health Commercial |
$71.97
|
| Rate for Payer: PACE Medicare |
$22.79
|
| Rate for Payer: PACE SWMI |
$23.99
|
| Rate for Payer: PHP Commercial |
$51.09
|
| Rate for Payer: PHP Medicare Advantage |
$23.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.43
|
| Rate for Payer: Priority Health Medicare |
$23.99
|
| Rate for Payer: Priority Health Narrow Network |
$60.34
|
| Rate for Payer: Priority Health SBD |
$37.87
|
| Rate for Payer: Railroad Medicare Medicare |
$23.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.99
|
| Rate for Payer: UHC Medicare Advantage |
$23.99
|
| Rate for Payer: UHCCP Medicaid |
$13.51
|
| Rate for Payer: VA VA |
$23.99
|
|
|
HC EXAM AND SELECT ARCHIVE RETRIEVED
|
Facility
|
IP
|
$60.11
|
|
|
Service Code
|
CPT 88363
|
| Hospital Charge Code |
31000059
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$37.87 |
| Max. Negotiated Rate |
$54.10 |
| Rate for Payer: Aetna Commercial |
$51.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.07
|
| Rate for Payer: Cash Price |
$48.09
|
| Rate for Payer: Cofinity Commercial |
$42.08
|
| Rate for Payer: Cofinity Commercial |
$51.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.09
|
| Rate for Payer: Healthscope Commercial |
$54.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.09
|
| Rate for Payer: PHP Commercial |
$51.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.07
|
| Rate for Payer: Priority Health SBD |
$37.87
|
|
|
HC EXC BENIGN LESION FACE, EAR, EYELID, NOSE, LIP, MUC MEMB 0.5 OF LESS
|
Facility
|
IP
|
$600.08
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
76100101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.05 |
| Max. Negotiated Rate |
$540.07 |
| Rate for Payer: Aetna Commercial |
$510.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$390.05
|
| Rate for Payer: Cash Price |
$480.06
|
| Rate for Payer: Cofinity Commercial |
$420.06
|
| Rate for Payer: Cofinity Commercial |
$516.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$420.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$480.06
|
| Rate for Payer: Healthscope Commercial |
$540.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$510.07
|
| Rate for Payer: PHP Commercial |
$510.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$390.05
|
| Rate for Payer: Priority Health SBD |
$378.05
|
|
|
HC EXC BENIGN LESION FACE, EAR, EYELID, NOSE, LIP, MUC MEMB 0.5 OF LESS
|
Facility
|
OP
|
$600.08
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
76100101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.72 |
| Max. Negotiated Rate |
$2,166.65 |
| Rate for Payer: Aetna Commercial |
$510.07
|
| Rate for Payer: Aetna Medicare |
$716.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$390.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$861.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$861.70
|
| Rate for Payer: BCBS Complete |
$387.97
|
| Rate for Payer: BCBS MAPPO |
$689.36
|
| Rate for Payer: BCBS Trust/PPO |
$417.74
|
| Rate for Payer: BCN Commercial |
$417.74
|
| Rate for Payer: BCN Medicare Advantage |
$689.36
|
| Rate for Payer: Cash Price |
$480.06
|
| Rate for Payer: Cash Price |
$480.06
|
| Rate for Payer: Cash Price |
$480.06
|
| Rate for Payer: Cofinity Commercial |
$516.07
|
| Rate for Payer: Cofinity Commercial |
$420.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$420.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$480.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.36
|
| Rate for Payer: Healthscope Commercial |
$540.07
|
| Rate for Payer: Mclaren Medicaid |
$369.50
|
| Rate for Payer: Mclaren Medicare |
$689.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$723.83
|
| Rate for Payer: Meridian Medicaid |
$387.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$792.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$510.07
|
| Rate for Payer: Nomi Health Commercial |
$1,447.66
|
| Rate for Payer: PACE Medicare |
$654.89
|
| Rate for Payer: PACE SWMI |
$689.36
|
| Rate for Payer: PHP Commercial |
$510.07
|
| Rate for Payer: PHP Medicare Advantage |
$689.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$390.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,166.65
|
| Rate for Payer: Priority Health Medicare |
$689.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,733.32
|
| Rate for Payer: Priority Health SBD |
$378.05
|
| Rate for Payer: Railroad Medicare Medicare |
$689.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.72
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$689.36
|
| Rate for Payer: UHC Medicare Advantage |
$689.36
|
| Rate for Payer: UHCCP Medicaid |
$388.11
|
| Rate for Payer: VA VA |
$689.36
|
|
|
HC EXC BENIGN LESION FACE, EAR, EYELID, NOSE, LIP, MUC MEMB 0.6 TO 1.0 CM
|
Facility
|
OP
|
$600.08
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
76100102
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$139.03 |
| Max. Negotiated Rate |
$2,166.65 |
| Rate for Payer: Aetna Commercial |
$510.07
|
| Rate for Payer: Aetna Medicare |
$716.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$390.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$861.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$861.70
|
| Rate for Payer: BCBS Complete |
$387.97
|
| Rate for Payer: BCBS MAPPO |
$689.36
|
| Rate for Payer: BCBS Trust/PPO |
$417.74
|
| Rate for Payer: BCN Commercial |
$417.74
|
| Rate for Payer: BCN Medicare Advantage |
$689.36
|
| Rate for Payer: Cash Price |
$480.06
|
| Rate for Payer: Cash Price |
$480.06
|
| Rate for Payer: Cash Price |
$480.06
|
| Rate for Payer: Cofinity Commercial |
$516.07
|
| Rate for Payer: Cofinity Commercial |
$420.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$420.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$480.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.36
|
| Rate for Payer: Healthscope Commercial |
$540.07
|
| Rate for Payer: Mclaren Medicaid |
$369.50
|
| Rate for Payer: Mclaren Medicare |
$689.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$723.83
|
| Rate for Payer: Meridian Medicaid |
$387.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$792.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$510.07
|
| Rate for Payer: Nomi Health Commercial |
$1,447.66
|
| Rate for Payer: PACE Medicare |
$654.89
|
| Rate for Payer: PACE SWMI |
$689.36
|
| Rate for Payer: PHP Commercial |
$510.07
|
| Rate for Payer: PHP Medicare Advantage |
$689.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$390.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,166.65
|
| Rate for Payer: Priority Health Medicare |
$689.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,733.32
|
| Rate for Payer: Priority Health SBD |
$378.05
|
| Rate for Payer: Railroad Medicare Medicare |
$689.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.03
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$689.36
|
| Rate for Payer: UHC Medicare Advantage |
$689.36
|
| Rate for Payer: UHCCP Medicaid |
$388.11
|
| Rate for Payer: VA VA |
$689.36
|
|
|
HC EXC BENIGN LESION FACE, EAR, EYELID, NOSE, LIP, MUC MEMB 0.6 TO 1.0 CM
|
Facility
|
IP
|
$600.08
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
76100102
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.05 |
| Max. Negotiated Rate |
$540.07 |
| Rate for Payer: Aetna Commercial |
$510.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$390.05
|
| Rate for Payer: Cash Price |
$480.06
|
| Rate for Payer: Cofinity Commercial |
$420.06
|
| Rate for Payer: Cofinity Commercial |
$516.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$420.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$480.06
|
| Rate for Payer: Healthscope Commercial |
$540.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$510.07
|
| Rate for Payer: PHP Commercial |
$510.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$390.05
|
| Rate for Payer: Priority Health SBD |
$378.05
|
|
|
HC EXC BENIGN LESION FACE, EAR, EYELID, NOSE, LIP, MUC MEMB 1.1 TO 2.0 CM
|
Facility
|
IP
|
$1,176.05
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
76100103
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$740.91 |
| Max. Negotiated Rate |
$1,058.44 |
| Rate for Payer: Aetna Commercial |
$999.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$764.43
|
| Rate for Payer: Cash Price |
$940.84
|
| Rate for Payer: Cofinity Commercial |
$1,011.40
|
| Rate for Payer: Cofinity Commercial |
$823.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$823.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$940.84
|
| Rate for Payer: Healthscope Commercial |
$1,058.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$999.64
|
| Rate for Payer: PHP Commercial |
$999.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$764.43
|
| Rate for Payer: Priority Health SBD |
$740.91
|
|
|
HC EXC BENIGN LESION FACE, EAR, EYELID, NOSE, LIP, MUC MEMB 1.1 TO 2.0 CM
|
Facility
|
OP
|
$1,176.05
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
76100103
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$153.63 |
| Max. Negotiated Rate |
$2,166.65 |
| Rate for Payer: Aetna Commercial |
$999.64
|
| Rate for Payer: Aetna Medicare |
$716.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$764.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$861.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$861.70
|
| Rate for Payer: BCBS Complete |
$387.97
|
| Rate for Payer: BCBS MAPPO |
$689.36
|
| Rate for Payer: BCBS Trust/PPO |
$417.74
|
| Rate for Payer: BCN Commercial |
$417.74
|
| Rate for Payer: BCN Medicare Advantage |
$689.36
|
| Rate for Payer: Cash Price |
$940.84
|
| Rate for Payer: Cash Price |
$940.84
|
| Rate for Payer: Cash Price |
$940.84
|
| Rate for Payer: Cofinity Commercial |
$823.24
|
| Rate for Payer: Cofinity Commercial |
$1,011.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$823.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$940.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.36
|
| Rate for Payer: Healthscope Commercial |
$1,058.44
|
| Rate for Payer: Mclaren Medicaid |
$369.50
|
| Rate for Payer: Mclaren Medicare |
$689.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$723.83
|
| Rate for Payer: Meridian Medicaid |
$387.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$792.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$999.64
|
| Rate for Payer: Nomi Health Commercial |
$1,447.66
|
| Rate for Payer: PACE Medicare |
$654.89
|
| Rate for Payer: PACE SWMI |
$689.36
|
| Rate for Payer: PHP Commercial |
$999.64
|
| Rate for Payer: PHP Medicare Advantage |
$689.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$764.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,166.65
|
| Rate for Payer: Priority Health Medicare |
$689.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,733.32
|
| Rate for Payer: Priority Health SBD |
$740.91
|
| Rate for Payer: Railroad Medicare Medicare |
$689.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.63
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$689.36
|
| Rate for Payer: UHC Medicare Advantage |
$689.36
|
| Rate for Payer: UHCCP Medicaid |
$388.11
|
| Rate for Payer: VA VA |
$689.36
|
|
|
HC EXC FACE MM BENIGN +MARG 2.1 - 3 CM
|
Facility
|
IP
|
$4,244.83
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
36000109
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,674.24 |
| Max. Negotiated Rate |
$3,820.35 |
| Rate for Payer: Aetna Commercial |
$3,608.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,759.14
|
| Rate for Payer: Cash Price |
$3,395.86
|
| Rate for Payer: Cofinity Commercial |
$2,971.38
|
| Rate for Payer: Cofinity Commercial |
$3,650.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,971.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,395.86
|
| Rate for Payer: Healthscope Commercial |
$3,820.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,608.11
|
| Rate for Payer: PHP Commercial |
$3,608.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,759.14
|
| Rate for Payer: Priority Health SBD |
$2,674.24
|
|
|
HC EXC FACE MM BENIGN +MARG 2.1 - 3 CM
|
Facility
|
OP
|
$4,244.83
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
36000109
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$187.72 |
| Max. Negotiated Rate |
$4,989.41 |
| Rate for Payer: Aetna Commercial |
$3,608.11
|
| Rate for Payer: Aetna Medicare |
$1,650.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,759.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$965.26
|
| Rate for Payer: BCN Commercial |
$965.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$3,395.86
|
| Rate for Payer: Cash Price |
$3,395.86
|
| Rate for Payer: Cash Price |
$3,395.86
|
| Rate for Payer: Cofinity Commercial |
$3,650.55
|
| Rate for Payer: Cofinity Commercial |
$2,971.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,971.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,395.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$3,820.35
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,608.11
|
| Rate for Payer: Nomi Health Commercial |
$3,333.71
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$3,608.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,759.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,989.41
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,991.53
|
| Rate for Payer: Priority Health SBD |
$2,674.24
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.72
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$893.75
|
| Rate for Payer: VA VA |
$1,587.48
|
|
|
HC EXC FACE MM BENIGN +MARG 3.1 - 4 CM
|
Facility
|
OP
|
$4,244.83
|
|
|
Service Code
|
CPT 11444
|
| Hospital Charge Code |
36000108
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$237.18 |
| Max. Negotiated Rate |
$4,989.41 |
| Rate for Payer: Aetna Commercial |
$3,608.11
|
| Rate for Payer: Aetna Medicare |
$1,650.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,759.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$543.70
|
| Rate for Payer: BCN Commercial |
$543.70
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$3,395.86
|
| Rate for Payer: Cash Price |
$3,395.86
|
| Rate for Payer: Cash Price |
$3,395.86
|
| Rate for Payer: Cofinity Commercial |
$3,650.55
|
| Rate for Payer: Cofinity Commercial |
$2,971.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,971.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,395.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$3,820.35
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,608.11
|
| Rate for Payer: Nomi Health Commercial |
$3,333.71
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$3,608.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,759.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,989.41
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,991.53
|
| Rate for Payer: Priority Health SBD |
$2,674.24
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.18
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$893.75
|
| Rate for Payer: VA VA |
$1,587.48
|
|
|
HC EXC FACE MM BENIGN +MARG 3.1 - 4 CM
|
Facility
|
IP
|
$4,244.83
|
|
|
Service Code
|
CPT 11444
|
| Hospital Charge Code |
36000108
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,674.24 |
| Max. Negotiated Rate |
$3,820.35 |
| Rate for Payer: Aetna Commercial |
$3,608.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,759.14
|
| Rate for Payer: Cash Price |
$3,395.86
|
| Rate for Payer: Cofinity Commercial |
$2,971.38
|
| Rate for Payer: Cofinity Commercial |
$3,650.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,971.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,395.86
|
| Rate for Payer: Healthscope Commercial |
$3,820.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,608.11
|
| Rate for Payer: PHP Commercial |
$3,608.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,759.14
|
| Rate for Payer: Priority Health SBD |
$2,674.24
|
|
|
HC EXC FACE MM BENIGN +MARG >4 CM
|
Facility
|
IP
|
$7,150.67
|
|
|
Service Code
|
CPT 11446
|
| Hospital Charge Code |
36000107
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,504.92 |
| Max. Negotiated Rate |
$6,435.60 |
| Rate for Payer: Aetna Commercial |
$6,078.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,647.94
|
| Rate for Payer: Cash Price |
$5,720.54
|
| Rate for Payer: Cofinity Commercial |
$5,005.47
|
| Rate for Payer: Cofinity Commercial |
$6,149.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,005.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,720.54
|
| Rate for Payer: Healthscope Commercial |
$6,435.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,078.07
|
| Rate for Payer: PHP Commercial |
$6,078.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,647.94
|
| Rate for Payer: Priority Health SBD |
$4,504.92
|
|
|
HC EXC FACE MM BENIGN +MARG >4 CM
|
Facility
|
OP
|
$7,150.67
|
|
|
Service Code
|
CPT 11446
|
| Hospital Charge Code |
36000107
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.51 |
| Max. Negotiated Rate |
$8,813.49 |
| Rate for Payer: Aetna Commercial |
$6,078.07
|
| Rate for Payer: Aetna Medicare |
$2,916.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,647.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,505.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,505.22
|
| Rate for Payer: BCBS Complete |
$1,578.19
|
| Rate for Payer: BCBS MAPPO |
$2,804.18
|
| Rate for Payer: BCBS Trust/PPO |
$922.00
|
| Rate for Payer: BCN Commercial |
$922.00
|
| Rate for Payer: BCN Medicare Advantage |
$2,804.18
|
| Rate for Payer: Cash Price |
$5,720.54
|
| Rate for Payer: Cash Price |
$5,720.54
|
| Rate for Payer: Cash Price |
$5,720.54
|
| Rate for Payer: Cofinity Commercial |
$6,149.58
|
| Rate for Payer: Cofinity Commercial |
$5,005.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,005.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,720.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,804.18
|
| Rate for Payer: Healthscope Commercial |
$6,435.60
|
| Rate for Payer: Mclaren Medicaid |
$1,503.04
|
| Rate for Payer: Mclaren Medicare |
$2,804.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,944.39
|
| Rate for Payer: Meridian Medicaid |
$1,578.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,224.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,078.07
|
| Rate for Payer: Nomi Health Commercial |
$5,888.78
|
| Rate for Payer: PACE Medicare |
$2,663.97
|
| Rate for Payer: PACE SWMI |
$2,804.18
|
| Rate for Payer: PHP Commercial |
$6,078.07
|
| Rate for Payer: PHP Medicare Advantage |
$2,804.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,503.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,647.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,813.49
|
| Rate for Payer: Priority Health Medicare |
$2,804.18
|
| Rate for Payer: Priority Health Narrow Network |
$7,050.79
|
| Rate for Payer: Priority Health SBD |
$4,504.92
|
| Rate for Payer: Railroad Medicare Medicare |
$2,804.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$334.51
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,804.18
|
| Rate for Payer: UHC Medicare Advantage |
$2,804.18
|
| Rate for Payer: UHCCP Medicaid |
$1,578.75
|
| Rate for Payer: VA VA |
$2,804.18
|
|
|
HC EXCHANGE ABSCESS CYST DRAIN CATHETER
|
Facility
|
IP
|
$2,562.94
|
|
|
Service Code
|
CPT 49423
|
| Hospital Charge Code |
36100222
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,614.65 |
| Max. Negotiated Rate |
$2,306.65 |
| Rate for Payer: Aetna Commercial |
$2,178.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,665.91
|
| Rate for Payer: Cash Price |
$2,050.35
|
| Rate for Payer: Cofinity Commercial |
$1,794.06
|
| Rate for Payer: Cofinity Commercial |
$2,204.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,794.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,050.35
|
| Rate for Payer: Healthscope Commercial |
$2,306.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,178.50
|
| Rate for Payer: PHP Commercial |
$2,178.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,665.91
|
| Rate for Payer: Priority Health SBD |
$1,614.65
|
|
|
HC EXCHANGE ABSCESS CYST DRAIN CATHETER
|
Facility
|
OP
|
$2,562.94
|
|
|
Service Code
|
CPT 49423
|
| Hospital Charge Code |
36100222
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$73.79 |
| Max. Negotiated Rate |
$5,841.66 |
| Rate for Payer: Aetna Commercial |
$2,178.50
|
| Rate for Payer: Aetna Medicare |
$1,932.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,665.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,323.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,323.29
|
| Rate for Payer: BCBS Complete |
$1,046.04
|
| Rate for Payer: BCBS MAPPO |
$1,858.63
|
| Rate for Payer: BCBS Trust/PPO |
$637.58
|
| Rate for Payer: BCN Commercial |
$637.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,858.63
|
| Rate for Payer: Cash Price |
$2,050.35
|
| Rate for Payer: Cash Price |
$2,050.35
|
| Rate for Payer: Cash Price |
$2,050.35
|
| Rate for Payer: Cofinity Commercial |
$1,794.06
|
| Rate for Payer: Cofinity Commercial |
$2,204.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,794.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,050.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,858.63
|
| Rate for Payer: Healthscope Commercial |
$2,306.65
|
| Rate for Payer: Mclaren Medicaid |
$996.23
|
| Rate for Payer: Mclaren Medicare |
$1,858.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,951.56
|
| Rate for Payer: Meridian Medicaid |
$1,046.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,137.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,178.50
|
| Rate for Payer: Nomi Health Commercial |
$3,903.12
|
| Rate for Payer: PACE Medicare |
$1,765.70
|
| Rate for Payer: PACE SWMI |
$1,858.63
|
| Rate for Payer: PHP Commercial |
$2,178.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,858.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$996.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,665.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,841.66
|
| Rate for Payer: Priority Health Medicare |
$1,858.63
|
| Rate for Payer: Priority Health Narrow Network |
$4,673.33
|
| Rate for Payer: Priority Health SBD |
$1,614.65
|
| Rate for Payer: Railroad Medicare Medicare |
$1,858.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.79
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,858.63
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,858.63
|
| Rate for Payer: UHCCP Medicaid |
$1,046.41
|
| Rate for Payer: VA VA |
$1,858.63
|
|
|
HC EXCHANGE BILIARY DRAIN CATH
|
Facility
|
OP
|
$4,333.80
|
|
|
Service Code
|
CPT 47536
|
| Hospital Charge Code |
36100493
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$136.59 |
| Max. Negotiated Rate |
$10,867.50 |
| Rate for Payer: Aetna Commercial |
$3,683.73
|
| Rate for Payer: Aetna Medicare |
$3,596.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,816.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,322.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,322.12
|
| Rate for Payer: BCBS Complete |
$1,945.99
|
| Rate for Payer: BCBS MAPPO |
$3,457.70
|
| Rate for Payer: BCBS Trust/PPO |
$2,345.34
|
| Rate for Payer: BCN Commercial |
$2,345.34
|
| Rate for Payer: BCN Medicare Advantage |
$3,457.70
|
| Rate for Payer: Cash Price |
$3,467.04
|
| Rate for Payer: Cash Price |
$3,467.04
|
| Rate for Payer: Cash Price |
$3,467.04
|
| Rate for Payer: Cofinity Commercial |
$3,033.66
|
| Rate for Payer: Cofinity Commercial |
$3,727.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,033.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,467.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,457.70
|
| Rate for Payer: Healthscope Commercial |
$3,900.42
|
| Rate for Payer: Mclaren Medicaid |
$1,853.33
|
| Rate for Payer: Mclaren Medicare |
$3,457.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,630.58
|
| Rate for Payer: Meridian Medicaid |
$1,945.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,976.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,683.73
|
| Rate for Payer: Nomi Health Commercial |
$7,261.17
|
| Rate for Payer: PACE Medicare |
$3,284.82
|
| Rate for Payer: PACE SWMI |
$3,457.70
|
| Rate for Payer: PHP Commercial |
$3,683.73
|
| Rate for Payer: PHP Medicare Advantage |
$3,457.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,853.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,816.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,867.50
|
| Rate for Payer: Priority Health Medicare |
$3,457.70
|
| Rate for Payer: Priority Health Narrow Network |
$8,694.00
|
| Rate for Payer: Priority Health SBD |
$2,730.29
|
| Rate for Payer: Railroad Medicare Medicare |
$3,457.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.59
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,457.70
|
| Rate for Payer: UHC Exchange |
$5,811.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,457.70
|
| Rate for Payer: UHCCP Medicaid |
$1,946.69
|
| Rate for Payer: VA VA |
$3,457.70
|
|
|
HC EXCHANGE BILIARY DRAIN CATH
|
Facility
|
IP
|
$4,333.80
|
|
|
Service Code
|
CPT 47536
|
| Hospital Charge Code |
36100493
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,730.29 |
| Max. Negotiated Rate |
$3,900.42 |
| Rate for Payer: Aetna Commercial |
$3,683.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,816.97
|
| Rate for Payer: Cash Price |
$3,467.04
|
| Rate for Payer: Cofinity Commercial |
$3,033.66
|
| Rate for Payer: Cofinity Commercial |
$3,727.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,033.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,467.04
|
| Rate for Payer: Healthscope Commercial |
$3,900.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,683.73
|
| Rate for Payer: PHP Commercial |
$3,683.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,816.97
|
| Rate for Payer: Priority Health SBD |
$2,730.29
|
|
|
HC EXCHANGE NEPHROSTOMY CATHETER
|
Facility
|
IP
|
$3,542.33
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
36100507
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,231.67 |
| Max. Negotiated Rate |
$3,188.10 |
| Rate for Payer: Aetna Commercial |
$3,010.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,302.51
|
| Rate for Payer: Cash Price |
$2,833.86
|
| Rate for Payer: Cofinity Commercial |
$2,479.63
|
| Rate for Payer: Cofinity Commercial |
$3,046.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,479.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,833.86
|
| Rate for Payer: Healthscope Commercial |
$3,188.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,010.98
|
| Rate for Payer: PHP Commercial |
$3,010.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,302.51
|
| Rate for Payer: Priority Health SBD |
$2,231.67
|
|
|
HC EXCHANGE NEPHROSTOMY CATHETER
|
Facility
|
OP
|
$3,542.33
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
36100507
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$103.44 |
| Max. Negotiated Rate |
$6,308.24 |
| Rate for Payer: Aetna Commercial |
$3,010.98
|
| Rate for Payer: Aetna Medicare |
$2,087.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,302.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,508.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,508.86
|
| Rate for Payer: BCBS Complete |
$1,129.59
|
| Rate for Payer: BCBS MAPPO |
$2,007.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,189.31
|
| Rate for Payer: BCN Commercial |
$2,189.31
|
| Rate for Payer: BCN Medicare Advantage |
$2,007.09
|
| Rate for Payer: Cash Price |
$2,833.86
|
| Rate for Payer: Cash Price |
$2,833.86
|
| Rate for Payer: Cash Price |
$2,833.86
|
| Rate for Payer: Cofinity Commercial |
$2,479.63
|
| Rate for Payer: Cofinity Commercial |
$3,046.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,479.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,833.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,007.09
|
| Rate for Payer: Healthscope Commercial |
$3,188.10
|
| Rate for Payer: Mclaren Medicaid |
$1,075.80
|
| Rate for Payer: Mclaren Medicare |
$2,007.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,107.44
|
| Rate for Payer: Meridian Medicaid |
$1,129.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,308.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,010.98
|
| Rate for Payer: Nomi Health Commercial |
$4,214.89
|
| Rate for Payer: PACE Medicare |
$1,906.74
|
| Rate for Payer: PACE SWMI |
$2,007.09
|
| Rate for Payer: PHP Commercial |
$3,010.98
|
| Rate for Payer: PHP Medicare Advantage |
$2,007.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,302.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,308.24
|
| Rate for Payer: Priority Health Medicare |
$2,007.09
|
| Rate for Payer: Priority Health Narrow Network |
$5,046.59
|
| Rate for Payer: Priority Health SBD |
$2,231.67
|
| Rate for Payer: Railroad Medicare Medicare |
$2,007.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.44
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,007.09
|
| Rate for Payer: UHC Exchange |
$1,566.00
|
| Rate for Payer: UHC Medicare Advantage |
$2,007.09
|
| Rate for Payer: UHCCP Medicaid |
$1,129.99
|
| Rate for Payer: VA VA |
$2,007.09
|
|
|
HC EXCHANGE TRANSFUSION NONINFANT
|
Facility
|
IP
|
$1,524.05
|
|
|
Service Code
|
CPT 36455
|
| Hospital Charge Code |
39100001
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$960.15 |
| Max. Negotiated Rate |
$1,371.64 |
| Rate for Payer: Aetna Commercial |
$1,295.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$990.63
|
| Rate for Payer: Cash Price |
$1,219.24
|
| Rate for Payer: Cofinity Commercial |
$1,066.84
|
| Rate for Payer: Cofinity Commercial |
$1,310.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,066.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,219.24
|
| Rate for Payer: Healthscope Commercial |
$1,371.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,295.44
|
| Rate for Payer: PHP Commercial |
$1,295.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$990.63
|
| Rate for Payer: Priority Health SBD |
$960.15
|
|
|
HC EXCHANGE TRANSFUSION NONINFANT
|
Facility
|
OP
|
$1,524.05
|
|
|
Service Code
|
CPT 36455
|
| Hospital Charge Code |
39100001
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$98.92 |
| Max. Negotiated Rate |
$1,371.64 |
| Rate for Payer: Aetna Commercial |
$1,295.44
|
| Rate for Payer: Aetna Medicare |
$445.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$990.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$535.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$535.42
|
| Rate for Payer: BCBS Complete |
$241.07
|
| Rate for Payer: BCBS MAPPO |
$428.34
|
| Rate for Payer: BCBS Trust/PPO |
$98.92
|
| Rate for Payer: BCN Commercial |
$98.92
|
| Rate for Payer: BCN Medicare Advantage |
$428.34
|
| Rate for Payer: Cash Price |
$1,219.24
|
| Rate for Payer: Cash Price |
$1,219.24
|
| Rate for Payer: Cash Price |
$1,219.24
|
| Rate for Payer: Cofinity Commercial |
$1,310.68
|
| Rate for Payer: Cofinity Commercial |
$1,066.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,066.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,219.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$428.34
|
| Rate for Payer: Healthscope Commercial |
$1,371.64
|
| Rate for Payer: Mclaren Medicaid |
$229.59
|
| Rate for Payer: Mclaren Medicare |
$428.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$449.76
|
| Rate for Payer: Meridian Medicaid |
$241.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$492.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,295.44
|
| Rate for Payer: Nomi Health Commercial |
$1,285.02
|
| Rate for Payer: PACE Medicare |
$406.92
|
| Rate for Payer: PACE SWMI |
$428.34
|
| Rate for Payer: PHP Commercial |
$1,295.44
|
| Rate for Payer: PHP Medicare Advantage |
$428.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$229.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$990.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,346.26
|
| Rate for Payer: Priority Health Medicare |
$428.34
|
| Rate for Payer: Priority Health Narrow Network |
$1,077.01
|
| Rate for Payer: Priority Health SBD |
$960.15
|
| Rate for Payer: Railroad Medicare Medicare |
$428.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.44
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$428.34
|
| Rate for Payer: UHC Exchange |
$1,127.80
|
| Rate for Payer: UHC Medicare Advantage |
$428.34
|
| Rate for Payer: UHCCP Medicaid |
$241.16
|
| Rate for Payer: VA VA |
$428.34
|
|
|
HC EXCHANGE WIRE PTCA
|
Facility
|
IP
|
$550.26
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200029
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$346.66 |
| Max. Negotiated Rate |
$495.23 |
| Rate for Payer: Aetna Commercial |
$467.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$357.67
|
| Rate for Payer: Cash Price |
$440.21
|
| Rate for Payer: Cofinity Commercial |
$385.18
|
| Rate for Payer: Cofinity Commercial |
$473.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$385.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$440.21
|
| Rate for Payer: Healthscope Commercial |
$495.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$467.72
|
| Rate for Payer: PHP Commercial |
$467.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.67
|
| Rate for Payer: Priority Health SBD |
$346.66
|
|
