|
HC IMPELLA RP FLEX
|
Facility
|
OP
|
$31,250.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800162
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$28,125.00 |
| Rate for Payer: Aetna Commercial |
$26,562.50
|
| Rate for Payer: Aetna Medicare |
$15,625.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20,312.50
|
| Rate for Payer: BCBS Complete |
$12,500.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$25,000.00
|
| Rate for Payer: Cash Price |
$25,000.00
|
| Rate for Payer: Cofinity Advantage |
$21,875.00
|
| Rate for Payer: Cofinity Commercial |
$26,875.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25,000.00
|
| Rate for Payer: Healthscope Commercial |
$28,125.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,562.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23,437.50
|
| Rate for Payer: PHP Commercial |
$26,562.50
|
| Rate for Payer: Priority Health SBD |
$19,687.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,312.50
|
| Rate for Payer: UHC Core |
$16,281.25
|
| Rate for Payer: UHC Exchange |
$12,281.25
|
|
|
HC IMPLANTABLE PRESSURE SENSOR W ANGIO
|
Facility
|
IP
|
$6,326.68
|
|
|
Service Code
|
CPT 33289
|
| Hospital Charge Code |
48100105
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,985.81 |
| Max. Negotiated Rate |
$5,694.01 |
| Rate for Payer: Aetna Commercial |
$5,377.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,112.34
|
| Rate for Payer: Cash Price |
$5,061.34
|
| Rate for Payer: Cofinity Advantage |
$4,428.68
|
| Rate for Payer: Cofinity Commercial |
$5,440.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,061.34
|
| Rate for Payer: Healthscope Commercial |
$5,694.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,377.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,745.01
|
| Rate for Payer: PHP Commercial |
$5,377.68
|
| Rate for Payer: Priority Health SBD |
$3,985.81
|
|
|
HC IMPLANTABLE PRESSURE SENSOR W ANGIO
|
Facility
|
OP
|
$6,326.68
|
|
|
Service Code
|
CPT 33289
|
| Hospital Charge Code |
48100105
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,985.81 |
| Max. Negotiated Rate |
$92,425.85 |
| Rate for Payer: Aetna Commercial |
$5,377.68
|
| Rate for Payer: Aetna Medicare |
$29,723.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,112.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35,725.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35,725.26
|
| Rate for Payer: BCBS Complete |
$15,696.25
|
| Rate for Payer: BCBS MAPPO |
$28,580.21
|
| Rate for Payer: BCN Medicare Advantage |
$28,580.21
|
| Rate for Payer: Cash Price |
$5,061.34
|
| Rate for Payer: Cash Price |
$5,061.34
|
| Rate for Payer: Cofinity Advantage |
$4,428.68
|
| Rate for Payer: Cofinity Commercial |
$5,440.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,061.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28,580.21
|
| Rate for Payer: Healthscope Commercial |
$5,694.01
|
| Rate for Payer: Mclaren Medicaid |
$14,947.45
|
| Rate for Payer: Mclaren Medicare |
$28,580.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30,009.22
|
| Rate for Payer: Meridian Medicaid |
$30,009.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32,867.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$31,438.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,377.68
|
| Rate for Payer: Nomi Health Commercial |
$85,740.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,745.01
|
| Rate for Payer: PACE Medicare |
$27,151.20
|
| Rate for Payer: PACE SWMI |
$28,580.21
|
| Rate for Payer: PHP Commercial |
$5,377.68
|
| Rate for Payer: PHP Medicare Advantage |
$28,580.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,947.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$92,425.85
|
| Rate for Payer: Priority Health Medicare |
$28,580.21
|
| Rate for Payer: Priority Health SBD |
$3,985.81
|
| Rate for Payer: Priority Health Tiered Network |
$73,940.68
|
| Rate for Payer: Railroad Medicare Medicare |
$28,580.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$28,580.21
|
| Rate for Payer: UHC Medicaid |
$14,947.45
|
| Rate for Payer: UHCCP Medicaid |
$14,947.45
|
| Rate for Payer: VA VA |
$28,580.21
|
|
|
HC IMPLANTABLE PRESSURE SENSOR WO LEAD
|
Facility
|
IP
|
$73,582.69
|
|
|
Service Code
|
HCPCS C2624
|
| Hospital Charge Code |
27800103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46,357.09 |
| Max. Negotiated Rate |
$66,224.42 |
| Rate for Payer: Aetna Commercial |
$62,545.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47,828.75
|
| Rate for Payer: Cash Price |
$58,866.15
|
| Rate for Payer: Cofinity Advantage |
$51,507.88
|
| Rate for Payer: Cofinity Commercial |
$63,281.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58,866.15
|
| Rate for Payer: Healthscope Commercial |
$66,224.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62,545.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55,187.02
|
| Rate for Payer: PHP Commercial |
$62,545.29
|
| Rate for Payer: Priority Health SBD |
$46,357.09
|
|
|
HC IMPLANTABLE PRESSURE SENSOR WO LEAD
|
Facility
|
OP
|
$73,582.69
|
|
|
Service Code
|
HCPCS C2624
|
| Hospital Charge Code |
27800103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$66,224.42 |
| Rate for Payer: Aetna Commercial |
$62,545.29
|
| Rate for Payer: Aetna Medicare |
$36,791.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47,828.75
|
| Rate for Payer: BCBS Complete |
$29,433.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$58,866.15
|
| Rate for Payer: Cash Price |
$58,866.15
|
| Rate for Payer: Cofinity Advantage |
$51,507.88
|
| Rate for Payer: Cofinity Commercial |
$63,281.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58,866.15
|
| Rate for Payer: Healthscope Commercial |
$66,224.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58,866.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62,545.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55,187.02
|
| Rate for Payer: PHP Commercial |
$62,545.29
|
| Rate for Payer: Priority Health SBD |
$46,357.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47,828.75
|
| Rate for Payer: UHC Core |
$38,336.58
|
| Rate for Payer: UHC Exchange |
$28,918.00
|
|
|
HC IMPLANT HORMONE SUBCUTANEOUS
|
Facility
|
OP
|
$554.20
|
|
|
Service Code
|
CPT 11980
|
| Hospital Charge Code |
76100178
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.80 |
| Max. Negotiated Rate |
$1,439.47 |
| Rate for Payer: Aetna Commercial |
$471.07
|
| Rate for Payer: Aetna Medicare |
$462.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$360.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$556.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$556.40
|
| Rate for Payer: BCBS Complete |
$244.46
|
| Rate for Payer: BCBS MAPPO |
$445.12
|
| Rate for Payer: BCBS Trust/PPO |
$311.31
|
| Rate for Payer: BCN Commercial |
$311.31
|
| Rate for Payer: BCN Medicare Advantage |
$445.12
|
| Rate for Payer: Cash Price |
$443.36
|
| Rate for Payer: Cash Price |
$443.36
|
| Rate for Payer: Cash Price |
$443.36
|
| Rate for Payer: Cofinity Advantage |
$387.94
|
| Rate for Payer: Cofinity Commercial |
$476.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$443.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$445.12
|
| Rate for Payer: Healthscope Commercial |
$498.78
|
| Rate for Payer: Mclaren Medicaid |
$232.80
|
| Rate for Payer: Mclaren Medicare |
$445.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$467.38
|
| Rate for Payer: Meridian Medicaid |
$467.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$511.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$489.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$471.07
|
| Rate for Payer: Nomi Health Commercial |
$1,335.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$415.65
|
| Rate for Payer: PACE Medicare |
$422.86
|
| Rate for Payer: PACE SWMI |
$445.12
|
| Rate for Payer: PHP Commercial |
$471.07
|
| Rate for Payer: PHP Medicare Advantage |
$445.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$232.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,439.47
|
| Rate for Payer: Priority Health Medicare |
$445.12
|
| Rate for Payer: Priority Health SBD |
$349.15
|
| Rate for Payer: Priority Health Tiered Network |
$1,151.58
|
| Rate for Payer: Railroad Medicare Medicare |
$445.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$360.23
|
| Rate for Payer: UHC Core |
$288.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$445.12
|
| Rate for Payer: UHC Exchange |
$217.80
|
| Rate for Payer: UHC Medicaid |
$232.80
|
| Rate for Payer: UHCCP Medicaid |
$232.80
|
| Rate for Payer: VA VA |
$445.12
|
|
|
HC IMPLANT HORMONE SUBCUTANEOUS
|
Facility
|
IP
|
$554.20
|
|
|
Service Code
|
CPT 11980
|
| Hospital Charge Code |
76100178
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$349.15 |
| Max. Negotiated Rate |
$498.78 |
| Rate for Payer: Aetna Commercial |
$471.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$360.23
|
| Rate for Payer: Cash Price |
$443.36
|
| Rate for Payer: Cofinity Advantage |
$387.94
|
| Rate for Payer: Cofinity Commercial |
$476.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$443.36
|
| Rate for Payer: Healthscope Commercial |
$498.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$471.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$415.65
|
| Rate for Payer: PHP Commercial |
$471.07
|
| Rate for Payer: Priority Health SBD |
$349.15
|
|
|
HC IMRT PLAN
|
Facility
|
IP
|
$7,268.21
|
|
|
Service Code
|
CPT 77301
|
| Hospital Charge Code |
33300006
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$4,578.97 |
| Max. Negotiated Rate |
$6,541.39 |
| Rate for Payer: Aetna Commercial |
$6,177.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,724.34
|
| Rate for Payer: Cash Price |
$5,814.57
|
| Rate for Payer: Cofinity Advantage |
$5,087.75
|
| Rate for Payer: Cofinity Commercial |
$6,250.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,814.57
|
| Rate for Payer: Healthscope Commercial |
$6,541.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,177.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,451.16
|
| Rate for Payer: PHP Commercial |
$6,177.98
|
| Rate for Payer: Priority Health SBD |
$4,578.97
|
|
|
HC IMRT PLAN
|
Facility
|
OP
|
$7,268.21
|
|
|
Service Code
|
CPT 77301
|
| Hospital Charge Code |
33300006
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$721.30 |
| Max. Negotiated Rate |
$6,541.39 |
| Rate for Payer: Aetna Commercial |
$6,177.98
|
| Rate for Payer: Aetna Medicare |
$1,434.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,724.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,723.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,723.94
|
| Rate for Payer: BCBS Complete |
$757.43
|
| Rate for Payer: BCBS MAPPO |
$1,379.15
|
| Rate for Payer: BCBS Trust/PPO |
$3,378.02
|
| Rate for Payer: BCN Commercial |
$3,378.02
|
| Rate for Payer: BCN Medicare Advantage |
$1,379.15
|
| Rate for Payer: Cash Price |
$5,814.57
|
| Rate for Payer: Cash Price |
$5,814.57
|
| Rate for Payer: Cofinity Advantage |
$5,087.75
|
| Rate for Payer: Cofinity Commercial |
$6,250.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,814.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,379.15
|
| Rate for Payer: Healthscope Commercial |
$6,541.39
|
| Rate for Payer: Mclaren Medicaid |
$721.30
|
| Rate for Payer: Mclaren Medicare |
$1,379.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,448.11
|
| Rate for Payer: Meridian Medicaid |
$1,448.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,586.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,517.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,177.98
|
| Rate for Payer: Nomi Health Commercial |
$4,137.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,451.16
|
| Rate for Payer: PACE Medicare |
$1,310.19
|
| Rate for Payer: PACE SWMI |
$1,379.15
|
| Rate for Payer: PHP Commercial |
$6,177.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,379.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$721.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,460.05
|
| Rate for Payer: Priority Health Medicare |
$1,379.15
|
| Rate for Payer: Priority Health SBD |
$4,578.97
|
| Rate for Payer: Priority Health Tiered Network |
$3,568.04
|
| Rate for Payer: Railroad Medicare Medicare |
$1,379.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,724.34
|
| Rate for Payer: UHC Core |
$3,786.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,379.15
|
| Rate for Payer: UHC Exchange |
$2,856.41
|
| Rate for Payer: UHC Medicaid |
$721.30
|
| Rate for Payer: UHCCP Medicaid |
$721.30
|
| Rate for Payer: VA VA |
$1,379.15
|
|
|
HC IN 111 AUTOLOG WBC PER STUDY
|
Facility
|
OP
|
$4,131.00
|
|
|
Service Code
|
HCPCS A9570
|
| Hospital Charge Code |
34300013
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$576.97 |
| Max. Negotiated Rate |
$3,717.90 |
| Rate for Payer: Aetna Commercial |
$3,511.35
|
| Rate for Payer: Aetna Medicare |
$1,147.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,685.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,378.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,378.99
|
| Rate for Payer: BCBS Complete |
$605.87
|
| Rate for Payer: BCBS MAPPO |
$1,103.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,466.22
|
| Rate for Payer: BCN Commercial |
$1,466.22
|
| Rate for Payer: BCN Medicare Advantage |
$1,103.19
|
| Rate for Payer: Cash Price |
$3,304.80
|
| Rate for Payer: Cash Price |
$3,304.80
|
| Rate for Payer: Cofinity Advantage |
$2,891.70
|
| Rate for Payer: Cofinity Commercial |
$3,552.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,304.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,103.19
|
| Rate for Payer: Healthscope Commercial |
$3,717.90
|
| Rate for Payer: Mclaren Medicaid |
$576.97
|
| Rate for Payer: Mclaren Medicare |
$1,103.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,158.35
|
| Rate for Payer: Meridian Medicaid |
$1,158.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,268.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,213.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,511.35
|
| Rate for Payer: Nomi Health Commercial |
$3,309.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,098.25
|
| Rate for Payer: PACE Medicare |
$1,048.03
|
| Rate for Payer: PACE SWMI |
$1,103.19
|
| Rate for Payer: PHP Commercial |
$3,511.35
|
| Rate for Payer: PHP Medicare Advantage |
$1,103.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$576.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,479.42
|
| Rate for Payer: Priority Health Medicare |
$1,103.19
|
| Rate for Payer: Priority Health SBD |
$2,602.53
|
| Rate for Payer: Priority Health Tiered Network |
$2,783.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,103.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,820.26
|
| Rate for Payer: UHC Core |
$1,820.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,103.19
|
| Rate for Payer: UHC Exchange |
$1,820.26
|
| Rate for Payer: UHC Medicaid |
$576.97
|
| Rate for Payer: UHCCP Medicaid |
$576.97
|
| Rate for Payer: VA VA |
$1,103.19
|
|
|
HC IN 111 AUTOLOG WBC PER STUDY
|
Facility
|
IP
|
$4,131.00
|
|
|
Service Code
|
HCPCS A9570
|
| Hospital Charge Code |
34300013
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$2,602.53 |
| Max. Negotiated Rate |
$3,717.90 |
| Rate for Payer: Aetna Commercial |
$3,511.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,685.15
|
| Rate for Payer: Cash Price |
$3,304.80
|
| Rate for Payer: Cofinity Advantage |
$2,891.70
|
| Rate for Payer: Cofinity Commercial |
$3,552.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,304.80
|
| Rate for Payer: Healthscope Commercial |
$3,717.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,511.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,098.25
|
| Rate for Payer: PHP Commercial |
$3,511.35
|
| Rate for Payer: Priority Health SBD |
$2,602.53
|
|
|
HC IN 111 OCTEO PER STUDY UP TO 6 MCI
|
Facility
|
OP
|
$5,519.76
|
|
|
Service Code
|
HCPCS A9572
|
| Hospital Charge Code |
34300014
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,046.49 |
| Max. Negotiated Rate |
$6,310.89 |
| Rate for Payer: Aetna Commercial |
$4,691.80
|
| Rate for Payer: Aetna Medicare |
$2,080.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,587.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,501.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,501.18
|
| Rate for Payer: BCBS Complete |
$1,098.92
|
| Rate for Payer: BCBS MAPPO |
$2,000.94
|
| Rate for Payer: BCBS Trust/PPO |
$2,721.81
|
| Rate for Payer: BCN Commercial |
$2,721.81
|
| Rate for Payer: BCN Medicare Advantage |
$2,000.94
|
| Rate for Payer: Cash Price |
$4,415.81
|
| Rate for Payer: Cash Price |
$4,415.81
|
| Rate for Payer: Cofinity Advantage |
$3,863.83
|
| Rate for Payer: Cofinity Commercial |
$4,746.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,415.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,000.94
|
| Rate for Payer: Healthscope Commercial |
$4,967.78
|
| Rate for Payer: Mclaren Medicaid |
$1,046.49
|
| Rate for Payer: Mclaren Medicare |
$2,000.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,100.99
|
| Rate for Payer: Meridian Medicaid |
$2,100.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,301.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,201.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,691.80
|
| Rate for Payer: Nomi Health Commercial |
$6,002.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,139.82
|
| Rate for Payer: PACE Medicare |
$1,900.89
|
| Rate for Payer: PACE SWMI |
$2,000.94
|
| Rate for Payer: PHP Commercial |
$4,691.80
|
| Rate for Payer: PHP Medicare Advantage |
$2,000.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,046.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,310.89
|
| Rate for Payer: Priority Health Medicare |
$2,000.94
|
| Rate for Payer: Priority Health SBD |
$3,477.45
|
| Rate for Payer: Priority Health Tiered Network |
$5,048.71
|
| Rate for Payer: Railroad Medicare Medicare |
$2,000.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,301.55
|
| Rate for Payer: UHC Core |
$3,301.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,000.94
|
| Rate for Payer: UHC Exchange |
$3,301.55
|
| Rate for Payer: UHC Medicaid |
$1,046.49
|
| Rate for Payer: UHCCP Medicaid |
$1,046.49
|
| Rate for Payer: VA VA |
$2,000.94
|
|
|
HC IN 111 OCTEO PER STUDY UP TO 6 MCI
|
Facility
|
IP
|
$5,519.76
|
|
|
Service Code
|
HCPCS A9572
|
| Hospital Charge Code |
34300014
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$3,477.45 |
| Max. Negotiated Rate |
$4,967.78 |
| Rate for Payer: Aetna Commercial |
$4,691.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,587.84
|
| Rate for Payer: Cash Price |
$4,415.81
|
| Rate for Payer: Cofinity Advantage |
$3,863.83
|
| Rate for Payer: Cofinity Commercial |
$4,746.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,415.81
|
| Rate for Payer: Healthscope Commercial |
$4,967.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,691.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,139.82
|
| Rate for Payer: PHP Commercial |
$4,691.80
|
| Rate for Payer: Priority Health SBD |
$3,477.45
|
|
|
HC INCIS & DRAIN EPIDIDYMIS TESTIS &/OR SCROTUM
|
Facility
|
IP
|
$5,627.68
|
|
|
Service Code
|
CPT 54700
|
| Hospital Charge Code |
76100349
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,545.44 |
| Max. Negotiated Rate |
$5,064.91 |
| Rate for Payer: Aetna Commercial |
$4,783.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,657.99
|
| Rate for Payer: Cash Price |
$4,502.14
|
| Rate for Payer: Cofinity Advantage |
$3,939.38
|
| Rate for Payer: Cofinity Commercial |
$4,839.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,502.14
|
| Rate for Payer: Healthscope Commercial |
$5,064.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,783.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,220.76
|
| Rate for Payer: PHP Commercial |
$4,783.53
|
| Rate for Payer: Priority Health SBD |
$3,545.44
|
|
|
HC INCIS & DRAIN EPIDIDYMIS TESTIS &/OR SCROTUM
|
Facility
|
OP
|
$5,627.68
|
|
|
Service Code
|
CPT 54700
|
| Hospital Charge Code |
76100349
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,089.34 |
| Max. Negotiated Rate |
$6,735.82 |
| Rate for Payer: Aetna Commercial |
$4,783.53
|
| Rate for Payer: Aetna Medicare |
$2,166.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,657.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,096.19
|
| Rate for Payer: BCN Commercial |
$1,096.19
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Cash Price |
$4,502.14
|
| Rate for Payer: Cash Price |
$4,502.14
|
| Rate for Payer: Cash Price |
$4,502.14
|
| Rate for Payer: Cofinity Advantage |
$3,939.38
|
| Rate for Payer: Cofinity Commercial |
$4,839.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,502.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Healthscope Commercial |
$5,064.91
|
| Rate for Payer: Mclaren Medicaid |
$1,089.34
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$2,187.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,783.53
|
| Rate for Payer: Nomi Health Commercial |
$6,248.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,220.76
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Commercial |
$4,783.53
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,735.82
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health SBD |
$3,545.44
|
| Rate for Payer: Priority Health Tiered Network |
$5,388.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,657.99
|
| Rate for Payer: UHC Core |
$2,932.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Exchange |
$2,211.68
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: VA VA |
$2,082.87
|
|
|
HC INCISIONAL BIOPSY SKIN ADDL LESION
|
Facility
|
IP
|
$113.55
|
|
|
Service Code
|
CPT 11107
|
| Hospital Charge Code |
76100153
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.54 |
| Max. Negotiated Rate |
$102.19 |
| Rate for Payer: Aetna Commercial |
$96.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.81
|
| Rate for Payer: Cash Price |
$90.84
|
| Rate for Payer: Cofinity Advantage |
$79.48
|
| Rate for Payer: Cofinity Commercial |
$97.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.84
|
| Rate for Payer: Healthscope Commercial |
$102.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.16
|
| Rate for Payer: PHP Commercial |
$96.52
|
| Rate for Payer: Priority Health SBD |
$71.54
|
|
|
HC INCISIONAL BIOPSY SKIN ADDL LESION
|
Facility
|
OP
|
$113.55
|
|
|
Service Code
|
CPT 11107
|
| Hospital Charge Code |
76100153
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$44.63 |
| Max. Negotiated Rate |
$189.31 |
| Rate for Payer: Aetna Commercial |
$96.52
|
| Rate for Payer: Aetna Medicare |
$56.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.81
|
| Rate for Payer: BCBS Complete |
$45.42
|
| Rate for Payer: BCBS Trust/PPO |
$189.31
|
| Rate for Payer: BCN Commercial |
$189.31
|
| Rate for Payer: Cash Price |
$90.84
|
| Rate for Payer: Cash Price |
$90.84
|
| Rate for Payer: Cofinity Advantage |
$79.48
|
| Rate for Payer: Cofinity Commercial |
$97.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.84
|
| Rate for Payer: Healthscope Commercial |
$102.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.16
|
| Rate for Payer: PHP Commercial |
$96.52
|
| Rate for Payer: Priority Health SBD |
$71.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.81
|
| Rate for Payer: UHC Core |
$59.16
|
| Rate for Payer: UHC Exchange |
$44.63
|
|
|
HC INCISIONAL BIOPSY SKIN SINGLE LESION
|
Facility
|
IP
|
$499.83
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
76100152
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$314.89 |
| Max. Negotiated Rate |
$449.85 |
| Rate for Payer: Aetna Commercial |
$424.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.89
|
| Rate for Payer: Cash Price |
$399.86
|
| Rate for Payer: Cofinity Advantage |
$349.88
|
| Rate for Payer: Cofinity Commercial |
$429.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.86
|
| Rate for Payer: Healthscope Commercial |
$449.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$374.87
|
| Rate for Payer: PHP Commercial |
$424.86
|
| Rate for Payer: Priority Health SBD |
$314.89
|
|
|
HC INCISIONAL BIOPSY SKIN SINGLE LESION
|
Facility
|
OP
|
$499.83
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
76100152
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$106.76 |
| Max. Negotiated Rate |
$2,381.49 |
| Rate for Payer: Aetna Commercial |
$424.86
|
| Rate for Payer: Aetna Medicare |
$765.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$920.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$920.51
|
| Rate for Payer: BCBS Complete |
$404.44
|
| Rate for Payer: BCBS MAPPO |
$736.41
|
| Rate for Payer: BCBS Trust/PPO |
$106.76
|
| Rate for Payer: BCN Commercial |
$106.76
|
| Rate for Payer: BCN Medicare Advantage |
$736.41
|
| Rate for Payer: Cash Price |
$399.86
|
| Rate for Payer: Cash Price |
$399.86
|
| Rate for Payer: Cash Price |
$399.86
|
| Rate for Payer: Cofinity Advantage |
$349.88
|
| Rate for Payer: Cofinity Commercial |
$429.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$736.41
|
| Rate for Payer: Healthscope Commercial |
$449.85
|
| Rate for Payer: Mclaren Medicaid |
$385.14
|
| Rate for Payer: Mclaren Medicare |
$736.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$773.23
|
| Rate for Payer: Meridian Medicaid |
$773.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$846.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$810.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.86
|
| Rate for Payer: Nomi Health Commercial |
$2,209.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$374.87
|
| Rate for Payer: PACE Medicare |
$699.59
|
| Rate for Payer: PACE SWMI |
$736.41
|
| Rate for Payer: PHP Commercial |
$424.86
|
| Rate for Payer: PHP Medicare Advantage |
$736.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,381.49
|
| Rate for Payer: Priority Health Medicare |
$736.41
|
| Rate for Payer: Priority Health SBD |
$314.89
|
| Rate for Payer: Priority Health Tiered Network |
$1,905.19
|
| Rate for Payer: Railroad Medicare Medicare |
$736.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$324.89
|
| Rate for Payer: UHC Core |
$260.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$736.41
|
| Rate for Payer: UHC Exchange |
$196.43
|
| Rate for Payer: UHC Medicaid |
$385.14
|
| Rate for Payer: UHCCP Medicaid |
$385.14
|
| Rate for Payer: VA VA |
$736.41
|
|
|
HC INCISION AND DRAINAGE TISSUE ABSCESS SUBFACIAL
|
Facility
|
OP
|
$2,044.20
|
|
| Hospital Charge Code |
36100439
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$817.68 |
| Max. Negotiated Rate |
$1,839.78 |
| Rate for Payer: Aetna Commercial |
$1,737.57
|
| Rate for Payer: Aetna Medicare |
$1,022.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,328.73
|
| Rate for Payer: BCBS Complete |
$817.68
|
| Rate for Payer: Cash Price |
$1,635.36
|
| Rate for Payer: Cofinity Advantage |
$1,430.94
|
| Rate for Payer: Cofinity Commercial |
$1,758.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,635.36
|
| Rate for Payer: Healthscope Commercial |
$1,839.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,635.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,737.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,533.15
|
| Rate for Payer: PHP Commercial |
$1,737.57
|
| Rate for Payer: Priority Health SBD |
$1,287.85
|
|
|
HC INCISION AND DRAINAGE TISSUE ABSCESS SUBFACIAL
|
Facility
|
IP
|
$2,044.20
|
|
| Hospital Charge Code |
36100439
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,287.85 |
| Max. Negotiated Rate |
$1,839.78 |
| Rate for Payer: Aetna Commercial |
$1,737.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,328.73
|
| Rate for Payer: Cash Price |
$1,635.36
|
| Rate for Payer: Cofinity Advantage |
$1,430.94
|
| Rate for Payer: Cofinity Commercial |
$1,758.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,635.36
|
| Rate for Payer: Healthscope Commercial |
$1,839.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,737.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,533.15
|
| Rate for Payer: PHP Commercial |
$1,737.57
|
| Rate for Payer: Priority Health SBD |
$1,287.85
|
|
|
HC INCISION & DRAIN ABSCESS PERITONSILLAR
|
Facility
|
OP
|
$640.89
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
76100474
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.43 |
| Max. Negotiated Rate |
$763.21 |
| Rate for Payer: Aetna Commercial |
$544.76
|
| Rate for Payer: Aetna Medicare |
$245.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$416.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$295.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$295.00
|
| Rate for Payer: BCBS Complete |
$129.61
|
| Rate for Payer: BCBS MAPPO |
$236.00
|
| Rate for Payer: BCBS Trust/PPO |
$565.92
|
| Rate for Payer: BCN Commercial |
$565.92
|
| Rate for Payer: BCN Medicare Advantage |
$236.00
|
| Rate for Payer: Cash Price |
$512.71
|
| Rate for Payer: Cash Price |
$512.71
|
| Rate for Payer: Cash Price |
$512.71
|
| Rate for Payer: Cofinity Advantage |
$448.62
|
| Rate for Payer: Cofinity Commercial |
$551.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$512.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.00
|
| Rate for Payer: Healthscope Commercial |
$576.80
|
| Rate for Payer: Mclaren Medicaid |
$123.43
|
| Rate for Payer: Mclaren Medicare |
$236.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.80
|
| Rate for Payer: Meridian Medicaid |
$247.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$259.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$544.76
|
| Rate for Payer: Nomi Health Commercial |
$708.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$480.67
|
| Rate for Payer: PACE Medicare |
$224.20
|
| Rate for Payer: PACE SWMI |
$236.00
|
| Rate for Payer: PHP Commercial |
$544.76
|
| Rate for Payer: PHP Medicare Advantage |
$236.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$763.21
|
| Rate for Payer: Priority Health Medicare |
$236.00
|
| Rate for Payer: Priority Health SBD |
$403.76
|
| Rate for Payer: Priority Health Tiered Network |
$610.57
|
| Rate for Payer: Railroad Medicare Medicare |
$236.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$416.58
|
| Rate for Payer: UHC Core |
$333.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$236.00
|
| Rate for Payer: UHC Exchange |
$251.87
|
| Rate for Payer: UHC Medicaid |
$123.43
|
| Rate for Payer: UHCCP Medicaid |
$123.43
|
| Rate for Payer: VA VA |
$236.00
|
|
|
HC INCISION & DRAIN ABSCESS PERITONSILLAR
|
Facility
|
IP
|
$640.89
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
76100474
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$403.76 |
| Max. Negotiated Rate |
$576.80 |
| Rate for Payer: Aetna Commercial |
$544.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$416.58
|
| Rate for Payer: Cash Price |
$512.71
|
| Rate for Payer: Cofinity Advantage |
$448.62
|
| Rate for Payer: Cofinity Commercial |
$551.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$512.71
|
| Rate for Payer: Healthscope Commercial |
$576.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$544.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$480.67
|
| Rate for Payer: PHP Commercial |
$544.76
|
| Rate for Payer: Priority Health SBD |
$403.76
|
|
|
HC INCISION & DRAINAGE COMPLEX PO WOUND INFECTION
|
Facility
|
IP
|
$8,129.40
|
|
|
Service Code
|
CPT 10180
|
| Hospital Charge Code |
76100528
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,121.52 |
| Max. Negotiated Rate |
$7,316.46 |
| Rate for Payer: Aetna Commercial |
$6,909.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,284.11
|
| Rate for Payer: Cash Price |
$6,503.52
|
| Rate for Payer: Cofinity Advantage |
$5,690.58
|
| Rate for Payer: Cofinity Commercial |
$6,991.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,503.52
|
| Rate for Payer: Healthscope Commercial |
$7,316.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,909.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,097.05
|
| Rate for Payer: PHP Commercial |
$6,909.99
|
| Rate for Payer: Priority Health SBD |
$5,121.52
|
|
|
HC INCISION & DRAINAGE COMPLEX PO WOUND INFECTION
|
Facility
|
OP
|
$8,129.40
|
|
|
Service Code
|
CPT 10180
|
| Hospital Charge Code |
76100528
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,513.70 |
| Max. Negotiated Rate |
$9,359.82 |
| Rate for Payer: Aetna Commercial |
$6,909.99
|
| Rate for Payer: Aetna Medicare |
$3,010.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,284.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,617.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,617.84
|
| Rate for Payer: BCBS Complete |
$1,589.53
|
| Rate for Payer: BCBS MAPPO |
$2,894.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,953.29
|
| Rate for Payer: BCN Commercial |
$1,953.29
|
| Rate for Payer: BCN Medicare Advantage |
$2,894.27
|
| Rate for Payer: Cash Price |
$6,503.52
|
| Rate for Payer: Cash Price |
$6,503.52
|
| Rate for Payer: Cash Price |
$6,503.52
|
| Rate for Payer: Cofinity Advantage |
$5,690.58
|
| Rate for Payer: Cofinity Commercial |
$6,991.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,503.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,894.27
|
| Rate for Payer: Healthscope Commercial |
$7,316.46
|
| Rate for Payer: Mclaren Medicaid |
$1,513.70
|
| Rate for Payer: Mclaren Medicare |
$2,894.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,038.98
|
| Rate for Payer: Meridian Medicaid |
$3,038.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,328.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,183.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,909.99
|
| Rate for Payer: Nomi Health Commercial |
$8,682.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,097.05
|
| Rate for Payer: PACE Medicare |
$2,749.56
|
| Rate for Payer: PACE SWMI |
$2,894.27
|
| Rate for Payer: PHP Commercial |
$6,909.99
|
| Rate for Payer: PHP Medicare Advantage |
$2,894.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,513.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9,359.82
|
| Rate for Payer: Priority Health Medicare |
$2,894.27
|
| Rate for Payer: Priority Health SBD |
$5,121.52
|
| Rate for Payer: Priority Health Tiered Network |
$7,487.86
|
| Rate for Payer: Railroad Medicare Medicare |
$2,894.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,284.11
|
| Rate for Payer: UHC Core |
$4,235.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,894.27
|
| Rate for Payer: UHC Exchange |
$3,194.85
|
| Rate for Payer: UHC Medicaid |
$1,513.70
|
| Rate for Payer: UHCCP Medicaid |
$1,513.70
|
| Rate for Payer: VA VA |
$2,894.27
|
|
