|
HC FIBEROPTIC IABP KIT
|
Facility
|
OP
|
$2,676.43
|
|
| Hospital Charge Code |
27200301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,070.57 |
| Max. Negotiated Rate |
$2,408.79 |
| Rate for Payer: Aetna Commercial |
$2,274.97
|
| Rate for Payer: Aetna Medicare |
$1,338.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,739.68
|
| Rate for Payer: BCBS Complete |
$1,070.57
|
| Rate for Payer: Cash Price |
$2,141.14
|
| Rate for Payer: Cofinity Commercial |
$1,873.50
|
| Rate for Payer: Cofinity Commercial |
$2,301.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,873.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,141.14
|
| Rate for Payer: Healthscope Commercial |
$2,408.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,274.97
|
| Rate for Payer: PHP Commercial |
$2,274.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,739.68
|
| Rate for Payer: Priority Health SBD |
$1,686.15
|
|
|
HC FIBRINOGEN
|
Facility
|
OP
|
$76.91
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
30500045
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$69.22 |
| Rate for Payer: Aetna Commercial |
$65.37
|
| Rate for Payer: Aetna Medicare |
$10.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.15
|
| Rate for Payer: BCBS Complete |
$5.47
|
| Rate for Payer: BCBS MAPPO |
$9.72
|
| Rate for Payer: BCBS Trust/PPO |
$8.60
|
| Rate for Payer: BCN Commercial |
$8.60
|
| Rate for Payer: BCN Medicare Advantage |
$9.72
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cofinity Commercial |
$66.14
|
| Rate for Payer: Cofinity Commercial |
$53.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.72
|
| Rate for Payer: Healthscope Commercial |
$69.22
|
| Rate for Payer: Mclaren Medicaid |
$5.21
|
| Rate for Payer: Mclaren Medicare |
$9.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.21
|
| Rate for Payer: Meridian Medicaid |
$5.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.37
|
| Rate for Payer: Nomi Health Commercial |
$14.58
|
| Rate for Payer: PACE Medicare |
$9.23
|
| Rate for Payer: PACE SWMI |
$9.72
|
| Rate for Payer: PHP Commercial |
$65.37
|
| Rate for Payer: PHP Medicare Advantage |
$9.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.72
|
| Rate for Payer: Priority Health Medicare |
$9.72
|
| Rate for Payer: Priority Health Narrow Network |
$7.78
|
| Rate for Payer: Priority Health SBD |
$48.45
|
| Rate for Payer: Railroad Medicare Medicare |
$9.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.72
|
| Rate for Payer: UHC Medicare Advantage |
$9.72
|
| Rate for Payer: UHCCP Medicaid |
$5.47
|
| Rate for Payer: VA VA |
$9.72
|
|
|
HC FIBRINOGEN
|
Facility
|
IP
|
$76.91
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
30500045
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$48.45 |
| Max. Negotiated Rate |
$69.22 |
| Rate for Payer: Aetna Commercial |
$65.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.99
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cofinity Commercial |
$53.84
|
| Rate for Payer: Cofinity Commercial |
$66.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.53
|
| Rate for Payer: Healthscope Commercial |
$69.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.37
|
| Rate for Payer: PHP Commercial |
$65.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.99
|
| Rate for Payer: Priority Health SBD |
$48.45
|
|
|
HC FIBROTEST-ACTITEST, S
|
Facility
|
OP
|
$290.70
|
|
|
Service Code
|
CPT 81596
|
| Hospital Charge Code |
30000155
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.69 |
| Max. Negotiated Rate |
$604.80 |
| Rate for Payer: Aetna Commercial |
$247.10
|
| Rate for Payer: Aetna Medicare |
$75.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$90.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$90.24
|
| Rate for Payer: BCBS Complete |
$40.63
|
| Rate for Payer: BCBS MAPPO |
$72.19
|
| Rate for Payer: BCBS Trust/PPO |
$63.90
|
| Rate for Payer: BCN Commercial |
$63.90
|
| Rate for Payer: BCN Medicare Advantage |
$72.19
|
| Rate for Payer: Cash Price |
$232.56
|
| Rate for Payer: Cash Price |
$232.56
|
| Rate for Payer: Cofinity Commercial |
$203.49
|
| Rate for Payer: Cofinity Commercial |
$250.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.19
|
| Rate for Payer: Healthscope Commercial |
$261.63
|
| Rate for Payer: Mclaren Medicaid |
$38.69
|
| Rate for Payer: Mclaren Medicare |
$72.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.80
|
| Rate for Payer: Meridian Medicaid |
$40.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.10
|
| Rate for Payer: Nomi Health Commercial |
$216.57
|
| Rate for Payer: PACE Medicare |
$68.58
|
| Rate for Payer: PACE SWMI |
$72.19
|
| Rate for Payer: PHP Commercial |
$247.10
|
| Rate for Payer: PHP Medicare Advantage |
$72.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.19
|
| Rate for Payer: Priority Health Medicare |
$72.19
|
| Rate for Payer: Priority Health Narrow Network |
$57.75
|
| Rate for Payer: Priority Health SBD |
$183.14
|
| Rate for Payer: Railroad Medicare Medicare |
$72.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.63
|
| Rate for Payer: UHC Core |
$604.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.19
|
| Rate for Payer: UHC Exchange |
$604.80
|
| Rate for Payer: UHC Medicare Advantage |
$72.19
|
| Rate for Payer: UHCCP Medicaid |
$40.64
|
| Rate for Payer: VA VA |
$72.19
|
|
|
HC FIBROTEST-ACTITEST, S
|
Facility
|
IP
|
$290.70
|
|
|
Service Code
|
CPT 81596
|
| Hospital Charge Code |
30000155
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$183.14 |
| Max. Negotiated Rate |
$261.63 |
| Rate for Payer: Aetna Commercial |
$247.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.96
|
| Rate for Payer: Cash Price |
$232.56
|
| Rate for Payer: Cofinity Commercial |
$203.49
|
| Rate for Payer: Cofinity Commercial |
$250.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.56
|
| Rate for Payer: Healthscope Commercial |
$261.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.10
|
| Rate for Payer: PHP Commercial |
$247.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.96
|
| Rate for Payer: Priority Health SBD |
$183.14
|
|
|
HC FILSHIE CLIP
|
Facility
|
OP
|
$335.82
|
|
| Hospital Charge Code |
27000076
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$134.33 |
| Max. Negotiated Rate |
$302.24 |
| Rate for Payer: Aetna Commercial |
$285.45
|
| Rate for Payer: Aetna Medicare |
$167.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.28
|
| Rate for Payer: BCBS Complete |
$134.33
|
| Rate for Payer: Cash Price |
$268.66
|
| Rate for Payer: Cofinity Commercial |
$235.07
|
| Rate for Payer: Cofinity Commercial |
$288.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$235.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.66
|
| Rate for Payer: Healthscope Commercial |
$302.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.45
|
| Rate for Payer: PHP Commercial |
$285.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.28
|
| Rate for Payer: Priority Health SBD |
$211.57
|
|
|
HC FILSHIE CLIP
|
Facility
|
IP
|
$335.82
|
|
| Hospital Charge Code |
27000076
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$211.57 |
| Max. Negotiated Rate |
$302.24 |
| Rate for Payer: Aetna Commercial |
$285.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.28
|
| Rate for Payer: Cash Price |
$268.66
|
| Rate for Payer: Cofinity Commercial |
$235.07
|
| Rate for Payer: Cofinity Commercial |
$288.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$235.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.66
|
| Rate for Payer: Healthscope Commercial |
$302.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.45
|
| Rate for Payer: PHP Commercial |
$285.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.28
|
| Rate for Payer: Priority Health SBD |
$211.57
|
|
|
HC FILTER ATS LIPIGUARD
|
Facility
|
OP
|
$58.14
|
|
| Hospital Charge Code |
27000121
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.26 |
| Max. Negotiated Rate |
$52.33 |
| Rate for Payer: Aetna Commercial |
$49.42
|
| Rate for Payer: Aetna Medicare |
$29.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.79
|
| Rate for Payer: BCBS Complete |
$23.26
|
| Rate for Payer: Cash Price |
$46.51
|
| Rate for Payer: Cofinity Commercial |
$40.70
|
| Rate for Payer: Cofinity Commercial |
$50.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.51
|
| Rate for Payer: Healthscope Commercial |
$52.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.42
|
| Rate for Payer: PHP Commercial |
$49.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.79
|
| Rate for Payer: Priority Health SBD |
$36.63
|
|
|
HC FILTER ATS LIPIGUARD
|
Facility
|
IP
|
$58.14
|
|
| Hospital Charge Code |
27000121
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.63 |
| Max. Negotiated Rate |
$52.33 |
| Rate for Payer: Aetna Commercial |
$49.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.79
|
| Rate for Payer: Cash Price |
$46.51
|
| Rate for Payer: Cofinity Commercial |
$40.70
|
| Rate for Payer: Cofinity Commercial |
$50.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.51
|
| Rate for Payer: Healthscope Commercial |
$52.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.42
|
| Rate for Payer: PHP Commercial |
$49.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.79
|
| Rate for Payer: Priority Health SBD |
$36.63
|
|
|
HC FILTERWIRE
|
Facility
|
OP
|
$3,814.45
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27800011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.78 |
| Max. Negotiated Rate |
$3,433.00 |
| Rate for Payer: Aetna Commercial |
$3,242.28
|
| Rate for Payer: Aetna Medicare |
$1,907.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,479.39
|
| Rate for Payer: BCBS Complete |
$1,525.78
|
| Rate for Payer: Cash Price |
$3,051.56
|
| Rate for Payer: Cofinity Commercial |
$2,670.12
|
| Rate for Payer: Cofinity Commercial |
$3,280.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,670.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,051.56
|
| Rate for Payer: Healthscope Commercial |
$3,433.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,242.28
|
| Rate for Payer: PHP Commercial |
$3,242.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,479.39
|
| Rate for Payer: Priority Health SBD |
$2,403.10
|
|
|
HC FILTERWIRE
|
Facility
|
IP
|
$3,814.45
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27800011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,403.10 |
| Max. Negotiated Rate |
$3,433.00 |
| Rate for Payer: Aetna Commercial |
$3,242.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,479.39
|
| Rate for Payer: Cash Price |
$3,051.56
|
| Rate for Payer: Cofinity Commercial |
$2,670.12
|
| Rate for Payer: Cofinity Commercial |
$3,280.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,670.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,051.56
|
| Rate for Payer: Healthscope Commercial |
$3,433.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,242.28
|
| Rate for Payer: PHP Commercial |
$3,242.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,479.39
|
| Rate for Payer: Priority Health SBD |
$2,403.10
|
|
|
HC FINGER SPLINT, STATIC, SUPPLY
|
Facility
|
IP
|
$20.81
|
|
| Hospital Charge Code |
27000646
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.11 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health SBD |
$13.11
|
|
|
HC FINGER SPLINT, STATIC, SUPPLY
|
Facility
|
OP
|
$20.81
|
|
| Hospital Charge Code |
27000646
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$10.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: BCBS Complete |
$8.32
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health SBD |
$13.11
|
|
|
HC FISH PRENATAL ANEUPLOIDY
|
Facility
|
IP
|
$168.54
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000034
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$106.18 |
| Max. Negotiated Rate |
$151.69 |
| Rate for Payer: Aetna Commercial |
$143.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.55
|
| Rate for Payer: Cash Price |
$134.83
|
| Rate for Payer: Cofinity Commercial |
$117.98
|
| Rate for Payer: Cofinity Commercial |
$144.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$117.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.83
|
| Rate for Payer: Healthscope Commercial |
$151.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.26
|
| Rate for Payer: PHP Commercial |
$143.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.55
|
| Rate for Payer: Priority Health SBD |
$106.18
|
|
|
HC FISH PRENATAL ANEUPLOIDY
|
Facility
|
OP
|
$168.54
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000034
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.44 |
| Max. Negotiated Rate |
$151.69 |
| Rate for Payer: Aetna Commercial |
$143.26
|
| Rate for Payer: Aetna Medicare |
$53.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.99
|
| Rate for Payer: BCBS Complete |
$28.81
|
| Rate for Payer: BCBS MAPPO |
$51.19
|
| Rate for Payer: BCBS Trust/PPO |
$45.31
|
| Rate for Payer: BCN Commercial |
$45.31
|
| Rate for Payer: BCN Medicare Advantage |
$51.19
|
| Rate for Payer: Cash Price |
$134.83
|
| Rate for Payer: Cash Price |
$134.83
|
| Rate for Payer: Cofinity Commercial |
$144.94
|
| Rate for Payer: Cofinity Commercial |
$117.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$117.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.19
|
| Rate for Payer: Healthscope Commercial |
$151.69
|
| Rate for Payer: Mclaren Medicaid |
$27.44
|
| Rate for Payer: Mclaren Medicare |
$51.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.75
|
| Rate for Payer: Meridian Medicaid |
$28.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.26
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: PACE Medicare |
$48.63
|
| Rate for Payer: PACE SWMI |
$51.19
|
| Rate for Payer: PHP Commercial |
$143.26
|
| Rate for Payer: PHP Medicare Advantage |
$51.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.19
|
| Rate for Payer: Priority Health Medicare |
$51.19
|
| Rate for Payer: Priority Health Narrow Network |
$40.95
|
| Rate for Payer: Priority Health SBD |
$106.18
|
| Rate for Payer: Railroad Medicare Medicare |
$51.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.19
|
| Rate for Payer: UHC Medicare Advantage |
$51.19
|
| Rate for Payer: UHCCP Medicaid |
$28.82
|
| Rate for Payer: VA VA |
$51.19
|
|
|
HC FISH PROBES
|
Facility
|
OP
|
$77.87
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000067
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.44 |
| Max. Negotiated Rate |
$76.78 |
| Rate for Payer: Aetna Commercial |
$66.19
|
| Rate for Payer: Aetna Medicare |
$53.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.99
|
| Rate for Payer: BCBS Complete |
$28.81
|
| Rate for Payer: BCBS MAPPO |
$51.19
|
| Rate for Payer: BCBS Trust/PPO |
$45.31
|
| Rate for Payer: BCN Commercial |
$45.31
|
| Rate for Payer: BCN Medicare Advantage |
$51.19
|
| Rate for Payer: Cash Price |
$62.30
|
| Rate for Payer: Cash Price |
$62.30
|
| Rate for Payer: Cofinity Commercial |
$66.97
|
| Rate for Payer: Cofinity Commercial |
$54.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.19
|
| Rate for Payer: Healthscope Commercial |
$70.08
|
| Rate for Payer: Mclaren Medicaid |
$27.44
|
| Rate for Payer: Mclaren Medicare |
$51.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.75
|
| Rate for Payer: Meridian Medicaid |
$28.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.19
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: PACE Medicare |
$48.63
|
| Rate for Payer: PACE SWMI |
$51.19
|
| Rate for Payer: PHP Commercial |
$66.19
|
| Rate for Payer: PHP Medicare Advantage |
$51.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.19
|
| Rate for Payer: Priority Health Medicare |
$51.19
|
| Rate for Payer: Priority Health Narrow Network |
$40.95
|
| Rate for Payer: Priority Health SBD |
$49.06
|
| Rate for Payer: Railroad Medicare Medicare |
$51.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.19
|
| Rate for Payer: UHC Medicare Advantage |
$51.19
|
| Rate for Payer: UHCCP Medicaid |
$28.82
|
| Rate for Payer: VA VA |
$51.19
|
|
|
HC FISH PROBES
|
Facility
|
IP
|
$77.87
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000067
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$49.06 |
| Max. Negotiated Rate |
$70.08 |
| Rate for Payer: Aetna Commercial |
$66.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.62
|
| Rate for Payer: Cash Price |
$62.30
|
| Rate for Payer: Cofinity Commercial |
$54.51
|
| Rate for Payer: Cofinity Commercial |
$66.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.30
|
| Rate for Payer: Healthscope Commercial |
$70.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.19
|
| Rate for Payer: PHP Commercial |
$66.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.62
|
| Rate for Payer: Priority Health SBD |
$49.06
|
|
|
HC FISTULA SHUNTOGRAM
|
Facility
|
IP
|
$2,254.14
|
|
| Hospital Charge Code |
32000264
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,420.11 |
| Max. Negotiated Rate |
$2,028.73 |
| Rate for Payer: Aetna Commercial |
$1,916.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,465.19
|
| Rate for Payer: Cash Price |
$1,803.31
|
| Rate for Payer: Cofinity Commercial |
$1,577.90
|
| Rate for Payer: Cofinity Commercial |
$1,938.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,577.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,803.31
|
| Rate for Payer: Healthscope Commercial |
$2,028.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,916.02
|
| Rate for Payer: PHP Commercial |
$1,916.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,465.19
|
| Rate for Payer: Priority Health SBD |
$1,420.11
|
|
|
HC FISTULA SHUNTOGRAM
|
Facility
|
OP
|
$2,254.14
|
|
| Hospital Charge Code |
32000264
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$901.66 |
| Max. Negotiated Rate |
$2,028.73 |
| Rate for Payer: Aetna Commercial |
$1,916.02
|
| Rate for Payer: Aetna Medicare |
$1,127.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,465.19
|
| Rate for Payer: BCBS Complete |
$901.66
|
| Rate for Payer: Cash Price |
$1,803.31
|
| Rate for Payer: Cofinity Commercial |
$1,577.90
|
| Rate for Payer: Cofinity Commercial |
$1,938.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,577.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,803.31
|
| Rate for Payer: Healthscope Commercial |
$2,028.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,916.02
|
| Rate for Payer: PHP Commercial |
$1,916.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,465.19
|
| Rate for Payer: Priority Health SBD |
$1,420.11
|
|
|
HC FIT INSERT INTRAVAG SUPPORT DEVICE
|
Facility
|
IP
|
$258.96
|
|
|
Service Code
|
CPT 57150
|
| Hospital Charge Code |
76100203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$163.14 |
| Max. Negotiated Rate |
$233.06 |
| Rate for Payer: Aetna Commercial |
$220.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.32
|
| Rate for Payer: Cash Price |
$207.17
|
| Rate for Payer: Cofinity Commercial |
$181.27
|
| Rate for Payer: Cofinity Commercial |
$222.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$181.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.17
|
| Rate for Payer: Healthscope Commercial |
$233.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.12
|
| Rate for Payer: PHP Commercial |
$220.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.32
|
| Rate for Payer: Priority Health SBD |
$163.14
|
|
|
HC FIT INSERT INTRAVAG SUPPORT DEVICE
|
Facility
|
OP
|
$258.96
|
|
|
Service Code
|
CPT 57150
|
| Hospital Charge Code |
76100203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.62 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$220.12
|
| Rate for Payer: Aetna Medicare |
$60.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.75
|
| Rate for Payer: BCBS Complete |
$32.75
|
| Rate for Payer: BCBS MAPPO |
$58.20
|
| Rate for Payer: BCBS Trust/PPO |
$53.61
|
| Rate for Payer: BCN Commercial |
$53.61
|
| Rate for Payer: BCN Medicare Advantage |
$58.20
|
| Rate for Payer: Cash Price |
$207.17
|
| Rate for Payer: Cash Price |
$207.17
|
| Rate for Payer: Cash Price |
$207.17
|
| Rate for Payer: Cofinity Commercial |
$181.27
|
| Rate for Payer: Cofinity Commercial |
$222.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$181.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.20
|
| Rate for Payer: Healthscope Commercial |
$233.06
|
| Rate for Payer: Mclaren Medicaid |
$31.20
|
| Rate for Payer: Mclaren Medicare |
$58.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.11
|
| Rate for Payer: Meridian Medicaid |
$32.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.12
|
| Rate for Payer: Nomi Health Commercial |
$174.60
|
| Rate for Payer: PACE Medicare |
$55.29
|
| Rate for Payer: PACE SWMI |
$58.20
|
| Rate for Payer: PHP Commercial |
$220.12
|
| Rate for Payer: PHP Medicare Advantage |
$58.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.90
|
| Rate for Payer: Priority Health Medicare |
$58.20
|
| Rate for Payer: Priority Health Narrow Network |
$146.32
|
| Rate for Payer: Priority Health SBD |
$163.14
|
| Rate for Payer: Railroad Medicare Medicare |
$58.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.62
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.20
|
| Rate for Payer: UHC Medicare Advantage |
$58.20
|
| Rate for Payer: UHCCP Medicaid |
$32.77
|
| Rate for Payer: VA VA |
$58.20
|
|
|
HC FIT & INSERT PESSARY/OTHER DEVICE
|
Facility
|
IP
|
$524.95
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
76100357
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.72 |
| Max. Negotiated Rate |
$472.46 |
| Rate for Payer: Aetna Commercial |
$446.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$341.22
|
| Rate for Payer: Cash Price |
$419.96
|
| Rate for Payer: Cofinity Commercial |
$367.46
|
| Rate for Payer: Cofinity Commercial |
$451.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$367.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.96
|
| Rate for Payer: Healthscope Commercial |
$472.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$446.21
|
| Rate for Payer: PHP Commercial |
$446.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.22
|
| Rate for Payer: Priority Health SBD |
$330.72
|
|
|
HC FIT & INSERT PESSARY/OTHER DEVICE
|
Facility
|
OP
|
$524.95
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
76100357
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.13 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$446.21
|
| Rate for Payer: Aetna Medicare |
$204.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$341.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$246.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$246.38
|
| Rate for Payer: BCBS Complete |
$110.93
|
| Rate for Payer: BCBS MAPPO |
$197.10
|
| Rate for Payer: BCBS Trust/PPO |
$114.66
|
| Rate for Payer: BCN Commercial |
$114.66
|
| Rate for Payer: BCN Medicare Advantage |
$197.10
|
| Rate for Payer: Cash Price |
$419.96
|
| Rate for Payer: Cash Price |
$419.96
|
| Rate for Payer: Cash Price |
$419.96
|
| Rate for Payer: Cofinity Commercial |
$451.46
|
| Rate for Payer: Cofinity Commercial |
$367.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$367.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.10
|
| Rate for Payer: Healthscope Commercial |
$472.46
|
| Rate for Payer: Mclaren Medicaid |
$105.65
|
| Rate for Payer: Mclaren Medicare |
$197.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.96
|
| Rate for Payer: Meridian Medicaid |
$110.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$226.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$446.21
|
| Rate for Payer: Nomi Health Commercial |
$413.91
|
| Rate for Payer: PACE Medicare |
$187.24
|
| Rate for Payer: PACE SWMI |
$197.10
|
| Rate for Payer: PHP Commercial |
$446.21
|
| Rate for Payer: PHP Medicare Advantage |
$197.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$619.50
|
| Rate for Payer: Priority Health Medicare |
$197.10
|
| Rate for Payer: Priority Health Narrow Network |
$495.60
|
| Rate for Payer: Priority Health SBD |
$330.72
|
| Rate for Payer: Railroad Medicare Medicare |
$197.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.13
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$197.10
|
| Rate for Payer: UHC Medicare Advantage |
$197.10
|
| Rate for Payer: UHCCP Medicaid |
$110.97
|
| Rate for Payer: VA VA |
$197.10
|
|
|
HC FLEXIBLE SIGMOIDOSCOPY
|
Facility
|
IP
|
$1,777.90
|
|
| Hospital Charge Code |
36000044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,120.08 |
| Max. Negotiated Rate |
$1,600.11 |
| Rate for Payer: Aetna Commercial |
$1,511.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,155.64
|
| Rate for Payer: Cash Price |
$1,422.32
|
| Rate for Payer: Cofinity Commercial |
$1,244.53
|
| Rate for Payer: Cofinity Commercial |
$1,528.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,244.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,422.32
|
| Rate for Payer: Healthscope Commercial |
$1,600.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,511.22
|
| Rate for Payer: PHP Commercial |
$1,511.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,155.64
|
| Rate for Payer: Priority Health SBD |
$1,120.08
|
|
|
HC FLEXIBLE SIGMOIDOSCOPY
|
Facility
|
OP
|
$1,777.90
|
|
| Hospital Charge Code |
36000044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$711.16 |
| Max. Negotiated Rate |
$1,600.11 |
| Rate for Payer: Aetna Commercial |
$1,511.22
|
| Rate for Payer: Aetna Medicare |
$888.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,155.64
|
| Rate for Payer: BCBS Complete |
$711.16
|
| Rate for Payer: Cash Price |
$1,422.32
|
| Rate for Payer: Cofinity Commercial |
$1,244.53
|
| Rate for Payer: Cofinity Commercial |
$1,528.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,244.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,422.32
|
| Rate for Payer: Healthscope Commercial |
$1,600.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,511.22
|
| Rate for Payer: PHP Commercial |
$1,511.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,155.64
|
| Rate for Payer: Priority Health SBD |
$1,120.08
|
|
