|
HC PERC CHOLECYSTOSTOMY
|
Facility
|
IP
|
$5,063.57
|
|
|
Service Code
|
CPT 47490
|
| Hospital Charge Code |
36100200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,190.05 |
| Max. Negotiated Rate |
$4,557.21 |
| Rate for Payer: Aetna Commercial |
$4,304.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,291.32
|
| Rate for Payer: Cash Price |
$4,050.86
|
| Rate for Payer: Cofinity Commercial |
$3,544.50
|
| Rate for Payer: Cofinity Commercial |
$4,354.67
|
| Rate for Payer: Healthscope Commercial |
$4,557.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,304.03
|
| Rate for Payer: PHP Commercial |
$4,304.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,544.50
|
| Rate for Payer: Priority Health SBD |
$3,190.05
|
|
|
HC PERCH OCEAN IGE
|
Facility
|
IP
|
$71.40
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200481
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$44.98 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.41
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$49.98
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.69
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.98
|
| Rate for Payer: Priority Health SBD |
$44.98
|
|
|
HC PERCH OCEAN IGE
|
Facility
|
OP
|
$71.40
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200481
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.09
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Cofinity Commercial |
$49.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.69
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.98
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$44.98
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC PERC IMPLANT OF NEUROSTIM EPIDURAL
|
Facility
|
OP
|
$13,824.57
|
|
|
Service Code
|
CPT 63650
|
| Hospital Charge Code |
36100610
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$406.68 |
| Max. Negotiated Rate |
$12,442.11 |
| Rate for Payer: Aetna Commercial |
$11,750.88
|
| Rate for Payer: Aetna Medicare |
$6,328.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,985.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,606.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,606.78
|
| Rate for Payer: BCBS Complete |
$3,495.47
|
| Rate for Payer: BCBS MAPPO |
$6,085.42
|
| Rate for Payer: BCBS Trust/PPO |
$3,811.62
|
| Rate for Payer: BCN Medicare Advantage |
$6,085.42
|
| Rate for Payer: Cash Price |
$11,059.66
|
| Rate for Payer: Cash Price |
$11,059.66
|
| Rate for Payer: Cofinity Commercial |
$9,677.20
|
| Rate for Payer: Cofinity Commercial |
$11,889.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,085.42
|
| Rate for Payer: Healthscope Commercial |
$12,442.11
|
| Rate for Payer: Mclaren Medicaid |
$3,328.72
|
| Rate for Payer: Mclaren Medicare |
$6,085.42
|
| Rate for Payer: Meridian Medicaid |
$3,495.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,389.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,998.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,750.88
|
| Rate for Payer: PACE Medicare |
$5,781.15
|
| Rate for Payer: PACE SWMI |
$6,085.42
|
| Rate for Payer: PHP Commercial |
$11,750.88
|
| Rate for Payer: PHP Medicare Advantage |
$6,085.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,328.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,677.20
|
| Rate for Payer: Priority Health Medicare |
$6,085.42
|
| Rate for Payer: Priority Health SBD |
$8,709.48
|
| Rate for Payer: Railroad Medicare Medicare |
$6,085.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$447.35
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,085.42
|
| Rate for Payer: UHC Exchange |
$406.68
|
| Rate for Payer: UHC Medicare Advantage |
$6,267.98
|
| Rate for Payer: VA VA |
$6,085.42
|
|
|
HC PERC IMPLANT OF NEUROSTIM EPIDURAL
|
Facility
|
IP
|
$13,824.57
|
|
|
Service Code
|
CPT 63650
|
| Hospital Charge Code |
36100610
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,709.48 |
| Max. Negotiated Rate |
$12,442.11 |
| Rate for Payer: Aetna Commercial |
$11,750.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,985.97
|
| Rate for Payer: Cash Price |
$11,059.66
|
| Rate for Payer: Cofinity Commercial |
$9,677.20
|
| Rate for Payer: Cofinity Commercial |
$11,889.13
|
| Rate for Payer: Healthscope Commercial |
$12,442.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,750.88
|
| Rate for Payer: PHP Commercial |
$11,750.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,677.20
|
| Rate for Payer: Priority Health SBD |
$8,709.48
|
|
|
HC PERCLOSE
|
Facility
|
IP
|
$1,031.60
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27200060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$649.91 |
| Max. Negotiated Rate |
$928.44 |
| Rate for Payer: Aetna Commercial |
$876.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$670.54
|
| Rate for Payer: Cash Price |
$825.28
|
| Rate for Payer: Cofinity Commercial |
$887.18
|
| Rate for Payer: Cofinity Commercial |
$722.12
|
| Rate for Payer: Healthscope Commercial |
$928.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$876.86
|
| Rate for Payer: PHP Commercial |
$876.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$722.12
|
| Rate for Payer: Priority Health SBD |
$649.91
|
|
|
HC PERCLOSE
|
Facility
|
OP
|
$1,031.60
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27200060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$412.64 |
| Max. Negotiated Rate |
$928.44 |
| Rate for Payer: Aetna Commercial |
$876.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$670.54
|
| Rate for Payer: BCBS Complete |
$412.64
|
| Rate for Payer: Cash Price |
$825.28
|
| Rate for Payer: Cofinity Commercial |
$722.12
|
| Rate for Payer: Cofinity Commercial |
$887.18
|
| Rate for Payer: Healthscope Commercial |
$928.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$876.86
|
| Rate for Payer: PHP Commercial |
$876.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$722.12
|
| Rate for Payer: Priority Health SBD |
$649.91
|
|
|
HC PERC THROMBECTOMY OR INFUSION DIALYSIS CIRCUIT W IMAGING
|
Facility
|
IP
|
$6,381.71
|
|
|
Service Code
|
CPT 36904
|
| Hospital Charge Code |
36100528
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,020.48 |
| Max. Negotiated Rate |
$5,743.54 |
| Rate for Payer: Aetna Commercial |
$5,424.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,148.11
|
| Rate for Payer: Cash Price |
$5,105.37
|
| Rate for Payer: Cofinity Commercial |
$4,467.20
|
| Rate for Payer: Cofinity Commercial |
$5,488.27
|
| Rate for Payer: Healthscope Commercial |
$5,743.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,424.45
|
| Rate for Payer: PHP Commercial |
$5,424.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,467.20
|
| Rate for Payer: Priority Health SBD |
$4,020.48
|
|
|
HC PERC THROMBECTOMY OR INFUSION DIALYSIS CIRCUIT W IMAGING
|
Facility
|
OP
|
$6,381.71
|
|
|
Service Code
|
CPT 36904
|
| Hospital Charge Code |
36100528
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$351.02 |
| Max. Negotiated Rate |
$15,432.16 |
| Rate for Payer: Aetna Commercial |
$5,424.45
|
| Rate for Payer: Aetna Medicare |
$5,289.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,148.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,357.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,357.20
|
| Rate for Payer: BCBS Complete |
$2,921.26
|
| Rate for Payer: BCBS MAPPO |
$5,085.76
|
| Rate for Payer: BCBS Trust/PPO |
$3,019.64
|
| Rate for Payer: BCN Medicare Advantage |
$5,085.76
|
| Rate for Payer: Cash Price |
$5,105.37
|
| Rate for Payer: Cash Price |
$5,105.37
|
| Rate for Payer: Cofinity Commercial |
$4,467.20
|
| Rate for Payer: Cofinity Commercial |
$5,488.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,085.76
|
| Rate for Payer: Healthscope Commercial |
$5,743.54
|
| Rate for Payer: Mclaren Medicaid |
$2,781.91
|
| Rate for Payer: Mclaren Medicare |
$5,085.76
|
| Rate for Payer: Meridian Medicaid |
$2,921.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,340.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,848.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,424.45
|
| Rate for Payer: PACE Medicare |
$4,831.47
|
| Rate for Payer: PACE SWMI |
$5,085.76
|
| Rate for Payer: PHP Commercial |
$5,424.45
|
| Rate for Payer: PHP Medicare Advantage |
$5,085.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,781.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,467.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,432.16
|
| Rate for Payer: Priority Health Medicare |
$5,085.76
|
| Rate for Payer: Priority Health Narrow Network |
$12,345.73
|
| Rate for Payer: Priority Health SBD |
$4,020.48
|
| Rate for Payer: Railroad Medicare Medicare |
$5,085.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$386.12
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,085.76
|
| Rate for Payer: UHC Exchange |
$351.02
|
| Rate for Payer: UHC Medicare Advantage |
$5,238.33
|
| Rate for Payer: VA VA |
$5,085.76
|
|
|
HC PERC THROMBECT OR INF W ANGIOPLASTY PERIPH DIALYSIS W IMAGING
|
Facility
|
OP
|
$17,345.63
|
|
|
Service Code
|
CPT 36905
|
| Hospital Charge Code |
36100529
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$421.42 |
| Max. Negotiated Rate |
$31,275.01 |
| Rate for Payer: Aetna Commercial |
$14,743.79
|
| Rate for Payer: Aetna Medicare |
$10,180.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,274.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,235.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,235.94
|
| Rate for Payer: BCBS Complete |
$5,622.66
|
| Rate for Payer: BCBS MAPPO |
$9,788.75
|
| Rate for Payer: BCBS Trust/PPO |
$5,721.77
|
| Rate for Payer: BCN Medicare Advantage |
$9,788.75
|
| Rate for Payer: Cash Price |
$13,876.50
|
| Rate for Payer: Cash Price |
$13,876.50
|
| Rate for Payer: Cofinity Commercial |
$12,141.94
|
| Rate for Payer: Cofinity Commercial |
$14,917.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,788.75
|
| Rate for Payer: Healthscope Commercial |
$15,611.07
|
| Rate for Payer: Mclaren Medicaid |
$5,354.45
|
| Rate for Payer: Mclaren Medicare |
$9,788.75
|
| Rate for Payer: Meridian Medicaid |
$5,622.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,278.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,257.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,743.79
|
| Rate for Payer: PACE Medicare |
$9,299.31
|
| Rate for Payer: PACE SWMI |
$9,788.75
|
| Rate for Payer: PHP Commercial |
$14,743.79
|
| Rate for Payer: PHP Medicare Advantage |
$9,788.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,354.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,141.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31,275.01
|
| Rate for Payer: Priority Health Medicare |
$9,788.75
|
| Rate for Payer: Priority Health Narrow Network |
$25,020.01
|
| Rate for Payer: Priority Health SBD |
$10,927.75
|
| Rate for Payer: Railroad Medicare Medicare |
$9,788.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$463.56
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,788.75
|
| Rate for Payer: UHC Exchange |
$421.42
|
| Rate for Payer: UHC Medicare Advantage |
$10,082.41
|
| Rate for Payer: VA VA |
$9,788.75
|
|
|
HC PERC THROMBECT OR INF W ANGIOPLASTY PERIPH DIALYSIS W IMAGING
|
Facility
|
IP
|
$17,345.63
|
|
|
Service Code
|
CPT 36905
|
| Hospital Charge Code |
36100529
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,927.75 |
| Max. Negotiated Rate |
$15,611.07 |
| Rate for Payer: Aetna Commercial |
$14,743.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,274.66
|
| Rate for Payer: Cash Price |
$13,876.50
|
| Rate for Payer: Cofinity Commercial |
$12,141.94
|
| Rate for Payer: Cofinity Commercial |
$14,917.24
|
| Rate for Payer: Healthscope Commercial |
$15,611.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,743.79
|
| Rate for Payer: PHP Commercial |
$14,743.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,141.94
|
| Rate for Payer: Priority Health SBD |
$10,927.75
|
|
|
HC PERC THROMBECT OR INF W STENT PERIPH DIALYSIS W IMAGING
|
Facility
|
OP
|
$27,544.40
|
|
|
Service Code
|
CPT 36906
|
| Hospital Charge Code |
36100530
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$486.58 |
| Max. Negotiated Rate |
$51,507.72 |
| Rate for Payer: Aetna Commercial |
$23,412.74
|
| Rate for Payer: Aetna Medicare |
$16,226.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,903.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,503.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,503.28
|
| Rate for Payer: BCBS Complete |
$8,962.14
|
| Rate for Payer: BCBS MAPPO |
$15,602.62
|
| Rate for Payer: BCBS Trust/PPO |
$8,957.83
|
| Rate for Payer: BCN Medicare Advantage |
$15,602.62
|
| Rate for Payer: Cash Price |
$22,035.52
|
| Rate for Payer: Cash Price |
$22,035.52
|
| Rate for Payer: Cofinity Commercial |
$23,688.18
|
| Rate for Payer: Cofinity Commercial |
$19,281.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,602.62
|
| Rate for Payer: Healthscope Commercial |
$24,789.96
|
| Rate for Payer: Mclaren Medicaid |
$8,534.63
|
| Rate for Payer: Mclaren Medicare |
$15,602.62
|
| Rate for Payer: Meridian Medicaid |
$8,962.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,382.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,943.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23,412.74
|
| Rate for Payer: PACE Medicare |
$14,822.49
|
| Rate for Payer: PACE SWMI |
$15,602.62
|
| Rate for Payer: PHP Commercial |
$23,412.74
|
| Rate for Payer: PHP Medicare Advantage |
$15,602.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,534.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,281.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51,507.72
|
| Rate for Payer: Priority Health Medicare |
$15,602.62
|
| Rate for Payer: Priority Health Narrow Network |
$41,206.18
|
| Rate for Payer: Priority Health SBD |
$17,352.97
|
| Rate for Payer: Railroad Medicare Medicare |
$15,602.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$535.24
|
| Rate for Payer: UHC Core |
$11,194.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,602.62
|
| Rate for Payer: UHC Exchange |
$486.58
|
| Rate for Payer: UHC Medicare Advantage |
$16,070.70
|
| Rate for Payer: VA VA |
$15,602.62
|
|
|
HC PERC THROMBECT OR INF W STENT PERIPH DIALYSIS W IMAGING
|
Facility
|
IP
|
$27,544.40
|
|
|
Service Code
|
CPT 36906
|
| Hospital Charge Code |
36100530
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$17,352.97 |
| Max. Negotiated Rate |
$24,789.96 |
| Rate for Payer: Aetna Commercial |
$23,412.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,903.86
|
| Rate for Payer: Cash Price |
$22,035.52
|
| Rate for Payer: Cofinity Commercial |
$19,281.08
|
| Rate for Payer: Cofinity Commercial |
$23,688.18
|
| Rate for Payer: Healthscope Commercial |
$24,789.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23,412.74
|
| Rate for Payer: PHP Commercial |
$23,412.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,281.08
|
| Rate for Payer: Priority Health SBD |
$17,352.97
|
|
|
HC PERCUTANEOUS NEEDLE
|
Facility
|
OP
|
$13.42
|
|
| Hospital Charge Code |
27200144
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.37 |
| Max. Negotiated Rate |
$12.08 |
| Rate for Payer: Aetna Commercial |
$11.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.72
|
| Rate for Payer: BCBS Complete |
$5.37
|
| Rate for Payer: Cash Price |
$10.74
|
| Rate for Payer: Cofinity Commercial |
$11.54
|
| Rate for Payer: Cofinity Commercial |
$9.39
|
| Rate for Payer: Healthscope Commercial |
$12.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.41
|
| Rate for Payer: PHP Commercial |
$11.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.39
|
| Rate for Payer: Priority Health SBD |
$8.45
|
|
|
HC PERCUTANEOUS NEEDLE
|
Facility
|
IP
|
$13.42
|
|
| Hospital Charge Code |
27200144
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$12.08 |
| Rate for Payer: Aetna Commercial |
$11.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.72
|
| Rate for Payer: Cash Price |
$10.74
|
| Rate for Payer: Cofinity Commercial |
$11.54
|
| Rate for Payer: Cofinity Commercial |
$9.39
|
| Rate for Payer: Healthscope Commercial |
$12.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.41
|
| Rate for Payer: PHP Commercial |
$11.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.39
|
| Rate for Payer: Priority Health SBD |
$8.45
|
|
|
HC PERCUTANEOUS TRACHEOSTOMY
|
Facility
|
IP
|
$4,449.05
|
|
|
Service Code
|
CPT 31600
|
| Hospital Charge Code |
36000001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,802.90 |
| Max. Negotiated Rate |
$4,004.14 |
| Rate for Payer: Aetna Commercial |
$3,781.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,891.88
|
| Rate for Payer: Cash Price |
$3,559.24
|
| Rate for Payer: Cofinity Commercial |
$3,114.34
|
| Rate for Payer: Cofinity Commercial |
$3,826.18
|
| Rate for Payer: Healthscope Commercial |
$4,004.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,781.69
|
| Rate for Payer: PHP Commercial |
$3,781.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,114.34
|
| Rate for Payer: Priority Health SBD |
$2,802.90
|
|
|
HC PERCUTANEOUS TRACHEOSTOMY
|
Facility
|
OP
|
$4,449.05
|
|
|
Service Code
|
CPT 31600
|
| Hospital Charge Code |
36000001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$296.99 |
| Max. Negotiated Rate |
$8,530.92 |
| Rate for Payer: Aetna Commercial |
$3,781.69
|
| Rate for Payer: Aetna Medicare |
$2,979.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,891.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,580.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,580.99
|
| Rate for Payer: BCBS Complete |
$1,645.54
|
| Rate for Payer: BCBS MAPPO |
$2,864.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,131.49
|
| Rate for Payer: BCN Medicare Advantage |
$2,864.79
|
| Rate for Payer: Cash Price |
$3,559.24
|
| Rate for Payer: Cash Price |
$3,559.24
|
| Rate for Payer: Cofinity Commercial |
$3,826.18
|
| Rate for Payer: Cofinity Commercial |
$3,114.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,864.79
|
| Rate for Payer: Healthscope Commercial |
$4,004.14
|
| Rate for Payer: Mclaren Medicaid |
$1,567.04
|
| Rate for Payer: Mclaren Medicare |
$2,864.79
|
| Rate for Payer: Meridian Medicaid |
$1,645.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,008.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,294.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,781.69
|
| Rate for Payer: PACE Medicare |
$2,721.55
|
| Rate for Payer: PACE SWMI |
$2,864.79
|
| Rate for Payer: PHP Commercial |
$3,781.69
|
| Rate for Payer: PHP Medicare Advantage |
$2,864.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,567.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,114.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,530.92
|
| Rate for Payer: Priority Health Medicare |
$2,864.79
|
| Rate for Payer: Priority Health Narrow Network |
$6,824.74
|
| Rate for Payer: Priority Health SBD |
$2,802.90
|
| Rate for Payer: Railroad Medicare Medicare |
$2,864.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.69
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,864.79
|
| Rate for Payer: UHC Exchange |
$296.99
|
| Rate for Payer: UHC Medicare Advantage |
$2,950.73
|
| Rate for Payer: VA VA |
$2,864.79
|
|
|
HC PERENNIAL RYE IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200097
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
|
|
HC PERENNIAL RYE IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200097
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.09
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC PERFUSION OPEN HEART
|
Facility
|
IP
|
$6,397.73
|
|
| Hospital Charge Code |
27000107
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4,030.57 |
| Max. Negotiated Rate |
$5,757.96 |
| Rate for Payer: Aetna Commercial |
$5,438.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,158.52
|
| Rate for Payer: Cash Price |
$5,118.18
|
| Rate for Payer: Cofinity Commercial |
$4,478.41
|
| Rate for Payer: Cofinity Commercial |
$5,502.05
|
| Rate for Payer: Healthscope Commercial |
$5,757.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,438.07
|
| Rate for Payer: PHP Commercial |
$5,438.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,478.41
|
| Rate for Payer: Priority Health SBD |
$4,030.57
|
|
|
HC PERFUSION OPEN HEART
|
Facility
|
OP
|
$6,397.73
|
|
| Hospital Charge Code |
27000107
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,559.09 |
| Max. Negotiated Rate |
$5,757.96 |
| Rate for Payer: Aetna Commercial |
$5,438.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,158.52
|
| Rate for Payer: BCBS Complete |
$2,559.09
|
| Rate for Payer: Cash Price |
$5,118.18
|
| Rate for Payer: Cofinity Commercial |
$4,478.41
|
| Rate for Payer: Cofinity Commercial |
$5,502.05
|
| Rate for Payer: Healthscope Commercial |
$5,757.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,438.07
|
| Rate for Payer: PHP Commercial |
$5,438.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,478.41
|
| Rate for Payer: Priority Health SBD |
$4,030.57
|
|
|
HC PERIDARDIOCENTESIS WITH GUIDANCE
|
Facility
|
IP
|
$2,495.36
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
36100582
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,572.08 |
| Max. Negotiated Rate |
$2,245.82 |
| Rate for Payer: Aetna Commercial |
$2,121.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,621.98
|
| Rate for Payer: Cash Price |
$1,996.29
|
| Rate for Payer: Cofinity Commercial |
$1,746.75
|
| Rate for Payer: Cofinity Commercial |
$2,146.01
|
| Rate for Payer: Healthscope Commercial |
$2,245.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,121.06
|
| Rate for Payer: PHP Commercial |
$2,121.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,746.75
|
| Rate for Payer: Priority Health SBD |
$1,572.08
|
|
|
HC PERIDARDIOCENTESIS WITH GUIDANCE
|
Facility
|
OP
|
$2,495.36
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
36100582
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$224.95 |
| Max. Negotiated Rate |
$4,378.42 |
| Rate for Payer: Aetna Commercial |
$2,121.06
|
| Rate for Payer: Aetna Medicare |
$1,482.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,621.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,781.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,781.30
|
| Rate for Payer: BCBS Complete |
$818.54
|
| Rate for Payer: BCBS MAPPO |
$1,425.04
|
| Rate for Payer: BCBS Trust/PPO |
$559.23
|
| Rate for Payer: BCN Medicare Advantage |
$1,425.04
|
| Rate for Payer: Cash Price |
$1,996.29
|
| Rate for Payer: Cash Price |
$1,996.29
|
| Rate for Payer: Cofinity Commercial |
$1,746.75
|
| Rate for Payer: Cofinity Commercial |
$2,146.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,425.04
|
| Rate for Payer: Healthscope Commercial |
$2,245.82
|
| Rate for Payer: Mclaren Medicaid |
$779.50
|
| Rate for Payer: Mclaren Medicare |
$1,425.04
|
| Rate for Payer: Meridian Medicaid |
$818.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,496.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,638.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,121.06
|
| Rate for Payer: PACE Medicare |
$1,353.79
|
| Rate for Payer: PACE SWMI |
$1,425.04
|
| Rate for Payer: PHP Commercial |
$2,121.06
|
| Rate for Payer: PHP Medicare Advantage |
$1,425.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$779.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,746.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,378.42
|
| Rate for Payer: Priority Health Medicare |
$1,425.04
|
| Rate for Payer: Priority Health Narrow Network |
$3,502.74
|
| Rate for Payer: Priority Health SBD |
$1,572.08
|
| Rate for Payer: Railroad Medicare Medicare |
$1,425.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.44
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,425.04
|
| Rate for Payer: UHC Exchange |
$224.95
|
| Rate for Payer: UHC Medicare Advantage |
$1,467.79
|
| Rate for Payer: VA VA |
$1,425.04
|
|
|
HC PERIPH ARTERY DISEASE REHAB
|
Facility
|
OP
|
$101.22
|
|
|
Service Code
|
CPT 93668
|
| Hospital Charge Code |
94000006
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$14.38 |
| Max. Negotiated Rate |
$173.33 |
| Rate for Payer: Aetna Commercial |
$86.04
|
| Rate for Payer: Aetna Medicare |
$56.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.04
|
| Rate for Payer: BCBS Complete |
$31.26
|
| Rate for Payer: BCBS MAPPO |
$54.43
|
| Rate for Payer: BCBS Trust/PPO |
$14.38
|
| Rate for Payer: BCN Medicare Advantage |
$54.43
|
| Rate for Payer: Cash Price |
$80.98
|
| Rate for Payer: Cash Price |
$80.98
|
| Rate for Payer: Cofinity Commercial |
$70.85
|
| Rate for Payer: Cofinity Commercial |
$87.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.43
|
| Rate for Payer: Healthscope Commercial |
$91.10
|
| Rate for Payer: Mclaren Medicaid |
$29.77
|
| Rate for Payer: Mclaren Medicare |
$54.43
|
| Rate for Payer: Meridian Medicaid |
$31.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.04
|
| Rate for Payer: PACE Medicare |
$51.71
|
| Rate for Payer: PACE SWMI |
$54.43
|
| Rate for Payer: PHP Commercial |
$86.04
|
| Rate for Payer: PHP Medicare Advantage |
$54.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.33
|
| Rate for Payer: Priority Health Medicare |
$54.43
|
| Rate for Payer: Priority Health Narrow Network |
$138.66
|
| Rate for Payer: Priority Health SBD |
$63.77
|
| Rate for Payer: Railroad Medicare Medicare |
$54.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.43
|
| Rate for Payer: UHC Exchange |
$14.41
|
| Rate for Payer: UHC Medicare Advantage |
$56.06
|
| Rate for Payer: VA VA |
$54.43
|
|
|
HC PERIPH ARTERY DISEASE REHAB
|
Facility
|
IP
|
$101.22
|
|
|
Service Code
|
CPT 93668
|
| Hospital Charge Code |
94000006
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$63.77 |
| Max. Negotiated Rate |
$91.10 |
| Rate for Payer: Aetna Commercial |
$86.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.79
|
| Rate for Payer: Cash Price |
$80.98
|
| Rate for Payer: Cofinity Commercial |
$70.85
|
| Rate for Payer: Cofinity Commercial |
$87.05
|
| Rate for Payer: Healthscope Commercial |
$91.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.04
|
| Rate for Payer: PHP Commercial |
$86.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.85
|
| Rate for Payer: Priority Health SBD |
$63.77
|
|
