|
HC HAI PICC FLUSH
|
Facility
|
IP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.87 |
| Max. Negotiated Rate |
$121.24 |
| Rate for Payer: Aetna Commercial |
$114.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.56
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cofinity Commercial |
$115.85
|
| Rate for Payer: Cofinity Commercial |
$94.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.77
|
| Rate for Payer: Healthscope Commercial |
$121.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.50
|
| Rate for Payer: PHP Commercial |
$114.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.56
|
| Rate for Payer: Priority Health SBD |
$84.87
|
|
|
HC HAI PORTA CATH ACCESS
|
Facility
|
IP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000058
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.87 |
| Max. Negotiated Rate |
$121.24 |
| Rate for Payer: Aetna Commercial |
$114.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.56
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cofinity Commercial |
$115.85
|
| Rate for Payer: Cofinity Commercial |
$94.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.77
|
| Rate for Payer: Healthscope Commercial |
$121.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.50
|
| Rate for Payer: PHP Commercial |
$114.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.56
|
| Rate for Payer: Priority Health SBD |
$84.87
|
|
|
HC HAI PORTA CATH ACCESS
|
Facility
|
OP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000058
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.88 |
| Max. Negotiated Rate |
$121.24 |
| Rate for Payer: Aetna Commercial |
$114.50
|
| Rate for Payer: Aetna Medicare |
$67.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.56
|
| Rate for Payer: BCBS Complete |
$53.88
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cofinity Commercial |
$115.85
|
| Rate for Payer: Cofinity Commercial |
$94.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.77
|
| Rate for Payer: Healthscope Commercial |
$121.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.50
|
| Rate for Payer: PHP Commercial |
$114.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.56
|
| Rate for Payer: Priority Health SBD |
$84.87
|
|
|
HC HALOPERIDOL LEVEL
|
Facility
|
OP
|
$106.08
|
|
|
Service Code
|
CPT 80173
|
| Hospital Charge Code |
30100031
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$95.47 |
| Rate for Payer: Aetna Commercial |
$90.17
|
| Rate for Payer: Aetna Medicare |
$16.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.73
|
| Rate for Payer: BCBS Complete |
$8.88
|
| Rate for Payer: BCBS MAPPO |
$15.78
|
| Rate for Payer: BCN Medicare Advantage |
$15.78
|
| Rate for Payer: Cash Price |
$84.86
|
| Rate for Payer: Cash Price |
$84.86
|
| Rate for Payer: Cofinity Commercial |
$91.23
|
| Rate for Payer: Cofinity Commercial |
$74.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.78
|
| Rate for Payer: Healthscope Commercial |
$95.47
|
| Rate for Payer: Mclaren Medicaid |
$8.46
|
| Rate for Payer: Mclaren Medicare |
$15.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.57
|
| Rate for Payer: Meridian Medicaid |
$8.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.17
|
| Rate for Payer: PACE Medicare |
$14.99
|
| Rate for Payer: PACE SWMI |
$15.78
|
| Rate for Payer: PHP Commercial |
$90.17
|
| Rate for Payer: PHP Medicare Advantage |
$15.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.95
|
| Rate for Payer: Priority Health Medicare |
$15.78
|
| Rate for Payer: Priority Health SBD |
$66.83
|
| Rate for Payer: Railroad Medicare Medicare |
$15.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.78
|
| Rate for Payer: UHC Medicare Advantage |
$15.78
|
| Rate for Payer: UHCCP Medicaid |
$8.88
|
| Rate for Payer: VA VA |
$15.78
|
|
|
HC HALOPERIDOL LEVEL
|
Facility
|
IP
|
$106.08
|
|
|
Service Code
|
CPT 80173
|
| Hospital Charge Code |
30100031
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.83 |
| Max. Negotiated Rate |
$95.47 |
| Rate for Payer: Aetna Commercial |
$90.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.95
|
| Rate for Payer: Cash Price |
$84.86
|
| Rate for Payer: Cofinity Commercial |
$74.26
|
| Rate for Payer: Cofinity Commercial |
$91.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.86
|
| Rate for Payer: Healthscope Commercial |
$95.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.17
|
| Rate for Payer: PHP Commercial |
$90.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.95
|
| Rate for Payer: Priority Health SBD |
$66.83
|
|
|
HC HALO RING APPLICATION
|
Facility
|
IP
|
$2,509.98
|
|
| Hospital Charge Code |
27000085
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,581.29 |
| Max. Negotiated Rate |
$2,258.98 |
| Rate for Payer: Aetna Commercial |
$2,133.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,631.49
|
| Rate for Payer: Cash Price |
$2,007.98
|
| Rate for Payer: Cofinity Commercial |
$1,756.99
|
| Rate for Payer: Cofinity Commercial |
$2,158.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,756.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,007.98
|
| Rate for Payer: Healthscope Commercial |
$2,258.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,133.48
|
| Rate for Payer: PHP Commercial |
$2,133.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,631.49
|
| Rate for Payer: Priority Health SBD |
$1,581.29
|
|
|
HC HALO RING APPLICATION
|
Facility
|
OP
|
$2,509.98
|
|
| Hospital Charge Code |
27000085
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,003.99 |
| Max. Negotiated Rate |
$2,258.98 |
| Rate for Payer: Aetna Commercial |
$2,133.48
|
| Rate for Payer: Aetna Medicare |
$1,254.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,631.49
|
| Rate for Payer: BCBS Complete |
$1,003.99
|
| Rate for Payer: Cash Price |
$2,007.98
|
| Rate for Payer: Cofinity Commercial |
$1,756.99
|
| Rate for Payer: Cofinity Commercial |
$2,158.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,756.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,007.98
|
| Rate for Payer: Healthscope Commercial |
$2,258.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,133.48
|
| Rate for Payer: PHP Commercial |
$2,133.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,631.49
|
| Rate for Payer: Priority Health SBD |
$1,581.29
|
|
|
HC HALO RING & VEST
|
Facility
|
IP
|
$6,285.33
|
|
| Hospital Charge Code |
27000084
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3,959.76 |
| Max. Negotiated Rate |
$5,656.80 |
| Rate for Payer: Aetna Commercial |
$5,342.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,085.46
|
| Rate for Payer: Cash Price |
$5,028.26
|
| Rate for Payer: Cofinity Commercial |
$4,399.73
|
| Rate for Payer: Cofinity Commercial |
$5,405.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,399.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,028.26
|
| Rate for Payer: Healthscope Commercial |
$5,656.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,342.53
|
| Rate for Payer: PHP Commercial |
$5,342.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,085.46
|
| Rate for Payer: Priority Health SBD |
$3,959.76
|
|
|
HC HALO RING & VEST
|
Facility
|
OP
|
$6,285.33
|
|
| Hospital Charge Code |
27000084
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,514.13 |
| Max. Negotiated Rate |
$5,656.80 |
| Rate for Payer: Aetna Commercial |
$5,342.53
|
| Rate for Payer: Aetna Medicare |
$3,142.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,085.46
|
| Rate for Payer: BCBS Complete |
$2,514.13
|
| Rate for Payer: Cash Price |
$5,028.26
|
| Rate for Payer: Cofinity Commercial |
$4,399.73
|
| Rate for Payer: Cofinity Commercial |
$5,405.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,399.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,028.26
|
| Rate for Payer: Healthscope Commercial |
$5,656.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,342.53
|
| Rate for Payer: PHP Commercial |
$5,342.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,085.46
|
| Rate for Payer: Priority Health SBD |
$3,959.76
|
|
|
HC HALO VEST APPLICATION
|
Facility
|
OP
|
$5,766.18
|
|
| Hospital Charge Code |
27000086
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,306.47 |
| Max. Negotiated Rate |
$5,189.56 |
| Rate for Payer: Aetna Commercial |
$4,901.25
|
| Rate for Payer: Aetna Medicare |
$2,883.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,748.02
|
| Rate for Payer: BCBS Complete |
$2,306.47
|
| Rate for Payer: Cash Price |
$4,612.94
|
| Rate for Payer: Cofinity Commercial |
$4,036.33
|
| Rate for Payer: Cofinity Commercial |
$4,958.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,036.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,612.94
|
| Rate for Payer: Healthscope Commercial |
$5,189.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,901.25
|
| Rate for Payer: PHP Commercial |
$4,901.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,748.02
|
| Rate for Payer: Priority Health SBD |
$3,632.69
|
|
|
HC HALO VEST APPLICATION
|
Facility
|
IP
|
$5,766.18
|
|
| Hospital Charge Code |
27000086
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3,632.69 |
| Max. Negotiated Rate |
$5,189.56 |
| Rate for Payer: Aetna Commercial |
$4,901.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,748.02
|
| Rate for Payer: Cash Price |
$4,612.94
|
| Rate for Payer: Cofinity Commercial |
$4,036.33
|
| Rate for Payer: Cofinity Commercial |
$4,958.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,036.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,612.94
|
| Rate for Payer: Healthscope Commercial |
$5,189.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,901.25
|
| Rate for Payer: PHP Commercial |
$4,901.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,748.02
|
| Rate for Payer: Priority Health SBD |
$3,632.69
|
|
|
HC HAPTOGLOGIN
|
Facility
|
IP
|
$84.66
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
30100234
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.34 |
| Max. Negotiated Rate |
$76.19 |
| Rate for Payer: Aetna Commercial |
$71.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.03
|
| Rate for Payer: Cash Price |
$67.73
|
| Rate for Payer: Cofinity Commercial |
$59.26
|
| Rate for Payer: Cofinity Commercial |
$72.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.73
|
| Rate for Payer: Healthscope Commercial |
$76.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.96
|
| Rate for Payer: PHP Commercial |
$71.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.03
|
| Rate for Payer: Priority Health SBD |
$53.34
|
|
|
HC HAPTOGLOGIN
|
Facility
|
OP
|
$84.66
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
30100234
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$76.19 |
| Rate for Payer: Aetna Commercial |
$71.96
|
| Rate for Payer: Aetna Medicare |
$13.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.72
|
| Rate for Payer: BCBS Complete |
$7.08
|
| Rate for Payer: BCBS MAPPO |
$12.58
|
| Rate for Payer: BCN Medicare Advantage |
$12.58
|
| Rate for Payer: Cash Price |
$67.73
|
| Rate for Payer: Cash Price |
$67.73
|
| Rate for Payer: Cofinity Commercial |
$72.81
|
| Rate for Payer: Cofinity Commercial |
$59.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.58
|
| Rate for Payer: Healthscope Commercial |
$76.19
|
| Rate for Payer: Mclaren Medicaid |
$6.74
|
| Rate for Payer: Mclaren Medicare |
$12.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.21
|
| Rate for Payer: Meridian Medicaid |
$7.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.96
|
| Rate for Payer: PACE Medicare |
$11.95
|
| Rate for Payer: PACE SWMI |
$12.58
|
| Rate for Payer: PHP Commercial |
$71.96
|
| Rate for Payer: PHP Medicare Advantage |
$12.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.03
|
| Rate for Payer: Priority Health Medicare |
$12.58
|
| Rate for Payer: Priority Health SBD |
$53.34
|
| Rate for Payer: Railroad Medicare Medicare |
$12.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.58
|
| Rate for Payer: UHC Medicare Advantage |
$12.58
|
| Rate for Payer: UHCCP Medicaid |
$7.08
|
| Rate for Payer: VA VA |
$12.58
|
|
|
HC HAZELNUT FILBERT IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200043
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
|
|
HC HAZELNUT FILBERT IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200043
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC HBO PER 30 MINUTES
|
Facility
|
IP
|
$654.23
|
|
|
Service Code
|
HCPCS G0277
|
| Hospital Charge Code |
41300001
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$412.16 |
| Max. Negotiated Rate |
$588.81 |
| Rate for Payer: Aetna Commercial |
$556.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$425.25
|
| Rate for Payer: Cash Price |
$523.38
|
| Rate for Payer: Cofinity Commercial |
$457.96
|
| Rate for Payer: Cofinity Commercial |
$562.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$457.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$523.38
|
| Rate for Payer: Healthscope Commercial |
$588.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$556.10
|
| Rate for Payer: PHP Commercial |
$556.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$425.25
|
| Rate for Payer: Priority Health SBD |
$412.16
|
|
|
HC HBO PER 30 MINUTES
|
Facility
|
OP
|
$654.23
|
|
|
Service Code
|
HCPCS G0277
|
| Hospital Charge Code |
41300001
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$72.09 |
| Max. Negotiated Rate |
$588.81 |
| Rate for Payer: Aetna Commercial |
$556.10
|
| Rate for Payer: Aetna Medicare |
$139.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$425.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$168.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$168.11
|
| Rate for Payer: BCBS Complete |
$75.69
|
| Rate for Payer: BCBS MAPPO |
$134.49
|
| Rate for Payer: BCN Medicare Advantage |
$134.49
|
| Rate for Payer: Cash Price |
$523.38
|
| Rate for Payer: Cash Price |
$523.38
|
| Rate for Payer: Cofinity Commercial |
$562.64
|
| Rate for Payer: Cofinity Commercial |
$457.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$457.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$523.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.49
|
| Rate for Payer: Healthscope Commercial |
$588.81
|
| Rate for Payer: Mclaren Medicaid |
$72.09
|
| Rate for Payer: Mclaren Medicare |
$134.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.21
|
| Rate for Payer: Meridian Medicaid |
$75.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$556.10
|
| Rate for Payer: PACE Medicare |
$127.77
|
| Rate for Payer: PACE SWMI |
$134.49
|
| Rate for Payer: PHP Commercial |
$556.10
|
| Rate for Payer: PHP Medicare Advantage |
$134.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$425.25
|
| Rate for Payer: Priority Health Medicare |
$134.49
|
| Rate for Payer: Priority Health SBD |
$412.16
|
| Rate for Payer: Railroad Medicare Medicare |
$134.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.58
|
| Rate for Payer: UHC Core |
$484.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.49
|
| Rate for Payer: UHC Exchange |
$484.13
|
| Rate for Payer: UHC Medicare Advantage |
$134.49
|
| Rate for Payer: UHCCP Medicaid |
$75.72
|
| Rate for Payer: VA VA |
$134.49
|
|
|
HC HBO TCPO2 ARTERIAL STUDY COMPLETE
|
Facility
|
OP
|
$835.42
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
92100005
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$751.88 |
| Rate for Payer: Aetna Commercial |
$710.11
|
| Rate for Payer: Aetna Medicare |
$158.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$543.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.74
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$152.59
|
| Rate for Payer: BCN Medicare Advantage |
$152.59
|
| Rate for Payer: Cash Price |
$668.34
|
| Rate for Payer: Cash Price |
$668.34
|
| Rate for Payer: Cofinity Commercial |
$718.46
|
| Rate for Payer: Cofinity Commercial |
$584.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$584.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$668.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$751.88
|
| Rate for Payer: Mclaren Medicaid |
$81.79
|
| Rate for Payer: Mclaren Medicare |
$152.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.22
|
| Rate for Payer: Meridian Medicaid |
$85.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$710.11
|
| Rate for Payer: PACE Medicare |
$144.96
|
| Rate for Payer: PACE SWMI |
$152.59
|
| Rate for Payer: PHP Commercial |
$710.11
|
| Rate for Payer: PHP Medicare Advantage |
$152.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$543.02
|
| Rate for Payer: Priority Health Medicare |
$152.59
|
| Rate for Payer: Priority Health SBD |
$526.31
|
| Rate for Payer: Railroad Medicare Medicare |
$152.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.53
|
| Rate for Payer: UHC Core |
$618.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.59
|
| Rate for Payer: UHC Exchange |
$618.21
|
| Rate for Payer: UHC Medicare Advantage |
$152.59
|
| Rate for Payer: UHCCP Medicaid |
$85.91
|
| Rate for Payer: VA VA |
$152.59
|
|
|
HC HBO TCPO2 ARTERIAL STUDY COMPLETE
|
Facility
|
IP
|
$835.42
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
92100005
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$526.31 |
| Max. Negotiated Rate |
$751.88 |
| Rate for Payer: Aetna Commercial |
$710.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$543.02
|
| Rate for Payer: Cash Price |
$668.34
|
| Rate for Payer: Cofinity Commercial |
$584.79
|
| Rate for Payer: Cofinity Commercial |
$718.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$584.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$668.34
|
| Rate for Payer: Healthscope Commercial |
$751.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$710.11
|
| Rate for Payer: PHP Commercial |
$710.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$543.02
|
| Rate for Payer: Priority Health SBD |
$526.31
|
|
|
HC HBO TCPO2 ARTERIAL STUDY UNILATERAL OR LIMITED
|
Facility
|
OP
|
$535.76
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
92100033
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$67.38 |
| Max. Negotiated Rate |
$482.18 |
| Rate for Payer: Aetna Commercial |
$455.40
|
| Rate for Payer: Aetna Medicare |
$130.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.14
|
| Rate for Payer: BCBS Complete |
$70.75
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| Rate for Payer: Cash Price |
$428.61
|
| Rate for Payer: Cash Price |
$428.61
|
| Rate for Payer: Cofinity Commercial |
$460.75
|
| Rate for Payer: Cofinity Commercial |
$375.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$375.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.71
|
| Rate for Payer: Healthscope Commercial |
$482.18
|
| Rate for Payer: Mclaren Medicaid |
$67.38
|
| Rate for Payer: Mclaren Medicare |
$125.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.00
|
| Rate for Payer: Meridian Medicaid |
$70.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.40
|
| Rate for Payer: PACE Medicare |
$119.42
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Commercial |
$455.40
|
| Rate for Payer: PHP Medicare Advantage |
$125.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.24
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: Priority Health SBD |
$337.53
|
| Rate for Payer: Railroad Medicare Medicare |
$125.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.86
|
| Rate for Payer: UHC Core |
$396.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.71
|
| Rate for Payer: UHC Exchange |
$396.46
|
| Rate for Payer: UHC Medicare Advantage |
$125.71
|
| Rate for Payer: UHCCP Medicaid |
$70.77
|
| Rate for Payer: VA VA |
$125.71
|
|
|
HC HBO TCPO2 ARTERIAL STUDY UNILATERAL OR LIMITED
|
Facility
|
IP
|
$535.76
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
92100033
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$337.53 |
| Max. Negotiated Rate |
$482.18 |
| Rate for Payer: Aetna Commercial |
$455.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.24
|
| Rate for Payer: Cash Price |
$428.61
|
| Rate for Payer: Cofinity Commercial |
$375.03
|
| Rate for Payer: Cofinity Commercial |
$460.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$375.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.61
|
| Rate for Payer: Healthscope Commercial |
$482.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.40
|
| Rate for Payer: PHP Commercial |
$455.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.24
|
| Rate for Payer: Priority Health SBD |
$337.53
|
|
|
HC HCCORO/CABG ANGIOS ONLY
|
Facility
|
IP
|
$6,486.08
|
|
|
Service Code
|
CPT 93455
|
| Hospital Charge Code |
48100014
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,086.23 |
| Max. Negotiated Rate |
$5,837.47 |
| Rate for Payer: Aetna Commercial |
$5,513.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,215.95
|
| Rate for Payer: Cash Price |
$5,188.86
|
| Rate for Payer: Cofinity Commercial |
$4,540.26
|
| Rate for Payer: Cofinity Commercial |
$5,578.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,540.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,188.86
|
| Rate for Payer: Healthscope Commercial |
$5,837.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,513.17
|
| Rate for Payer: PHP Commercial |
$5,513.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,215.95
|
| Rate for Payer: Priority Health SBD |
$4,086.23
|
|
|
HC HCCORO/CABG ANGIOS ONLY
|
Facility
|
OP
|
$6,486.08
|
|
|
Service Code
|
CPT 93455
|
| Hospital Charge Code |
48100014
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,681.38 |
| Max. Negotiated Rate |
$8,830.06 |
| Rate for Payer: Aetna Commercial |
$5,513.17
|
| Rate for Payer: Aetna Medicare |
$3,262.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,215.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,921.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,921.12
|
| Rate for Payer: BCBS Complete |
$1,765.45
|
| Rate for Payer: BCBS MAPPO |
$3,136.90
|
| Rate for Payer: BCN Medicare Advantage |
$3,136.90
|
| Rate for Payer: Cash Price |
$5,188.86
|
| Rate for Payer: Cash Price |
$5,188.86
|
| Rate for Payer: Cofinity Commercial |
$5,578.03
|
| Rate for Payer: Cofinity Commercial |
$4,540.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,540.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,188.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,136.90
|
| Rate for Payer: Healthscope Commercial |
$5,837.47
|
| Rate for Payer: Mclaren Medicaid |
$1,681.38
|
| Rate for Payer: Mclaren Medicare |
$3,136.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,293.74
|
| Rate for Payer: Meridian Medicaid |
$1,765.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,607.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,513.17
|
| Rate for Payer: PACE Medicare |
$2,980.05
|
| Rate for Payer: PACE SWMI |
$3,136.90
|
| Rate for Payer: PHP Commercial |
$5,513.17
|
| Rate for Payer: PHP Medicare Advantage |
$3,136.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,681.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,215.95
|
| Rate for Payer: Priority Health Medicare |
$3,136.90
|
| Rate for Payer: Priority Health SBD |
$4,086.23
|
| Rate for Payer: Railroad Medicare Medicare |
$3,136.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,830.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,136.90
|
| Rate for Payer: UHC Medicare Advantage |
$3,136.90
|
| Rate for Payer: UHCCP Medicaid |
$1,766.07
|
| Rate for Payer: VA VA |
$3,136.90
|
|
|
HC HCG SERUM QUANTITATIVE
|
Facility
|
IP
|
$63.46
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
30100465
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.98 |
| Max. Negotiated Rate |
$57.11 |
| Rate for Payer: Aetna Commercial |
$53.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.25
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cofinity Commercial |
$44.42
|
| Rate for Payer: Cofinity Commercial |
$54.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.77
|
| Rate for Payer: Healthscope Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.94
|
| Rate for Payer: PHP Commercial |
$53.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.25
|
| Rate for Payer: Priority Health SBD |
$39.98
|
|
|
HC HCG SERUM QUANTITATIVE
|
Facility
|
OP
|
$63.46
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
30100465
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$57.11 |
| Rate for Payer: Aetna Commercial |
$53.94
|
| Rate for Payer: Aetna Medicare |
$15.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.81
|
| Rate for Payer: BCBS Complete |
$8.47
|
| Rate for Payer: BCBS MAPPO |
$15.05
|
| Rate for Payer: BCN Medicare Advantage |
$15.05
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cofinity Commercial |
$54.58
|
| Rate for Payer: Cofinity Commercial |
$44.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.05
|
| Rate for Payer: Healthscope Commercial |
$57.11
|
| Rate for Payer: Mclaren Medicaid |
$8.07
|
| Rate for Payer: Mclaren Medicare |
$15.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.80
|
| Rate for Payer: Meridian Medicaid |
$8.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.94
|
| Rate for Payer: PACE Medicare |
$14.30
|
| Rate for Payer: PACE SWMI |
$15.05
|
| Rate for Payer: PHP Commercial |
$53.94
|
| Rate for Payer: PHP Medicare Advantage |
$15.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.25
|
| Rate for Payer: Priority Health Medicare |
$15.05
|
| Rate for Payer: Priority Health SBD |
$39.98
|
| Rate for Payer: Railroad Medicare Medicare |
$15.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.05
|
| Rate for Payer: UHC Medicare Advantage |
$15.05
|
| Rate for Payer: UHCCP Medicaid |
$8.47
|
| Rate for Payer: VA VA |
$15.05
|
|
