|
HC PIGWEED IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200098
|
|
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 PIGWEED IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200098
|
|
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 |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| 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 PI LINKED ANTIGEN
|
Facility
|
IP
|
$167.43
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31000004
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$105.48 |
| Max. Negotiated Rate |
$150.69 |
| Rate for Payer: Aetna Commercial |
$142.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.83
|
| Rate for Payer: Cash Price |
$133.94
|
| Rate for Payer: Cofinity Commercial |
$117.20
|
| Rate for Payer: Cofinity Commercial |
$143.99
|
| Rate for Payer: Healthscope Commercial |
$150.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$142.32
|
| Rate for Payer: PHP Commercial |
$142.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.20
|
| Rate for Payer: Priority Health SBD |
$105.48
|
|
|
HC PI LINKED ANTIGEN
|
Facility
|
OP
|
$167.43
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31000004
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$906.83 |
| Rate for Payer: Aetna Commercial |
$142.32
|
| Rate for Payer: Aetna Medicare |
$332.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$399.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$399.80
|
| Rate for Payer: BCBS Complete |
$183.72
|
| Rate for Payer: BCBS MAPPO |
$319.84
|
| Rate for Payer: BCBS Trust/PPO |
$91.84
|
| Rate for Payer: BCN Medicare Advantage |
$319.84
|
| Rate for Payer: Cash Price |
$133.94
|
| Rate for Payer: Cash Price |
$133.94
|
| Rate for Payer: Cofinity Commercial |
$117.20
|
| Rate for Payer: Cofinity Commercial |
$143.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$319.84
|
| Rate for Payer: Healthscope Commercial |
$150.69
|
| Rate for Payer: Mclaren Medicaid |
$174.95
|
| Rate for Payer: Mclaren Medicare |
$319.84
|
| Rate for Payer: Meridian Medicaid |
$183.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$335.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$367.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$142.32
|
| Rate for Payer: PACE Medicare |
$303.85
|
| Rate for Payer: PACE SWMI |
$319.84
|
| Rate for Payer: PHP Commercial |
$142.32
|
| Rate for Payer: PHP Medicare Advantage |
$319.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$906.83
|
| Rate for Payer: Priority Health Medicare |
$319.84
|
| Rate for Payer: Priority Health Narrow Network |
$725.46
|
| Rate for Payer: Priority Health SBD |
$105.48
|
| Rate for Payer: Railroad Medicare Medicare |
$319.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.28
|
| Rate for Payer: UHC Core |
$20.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$319.84
|
| Rate for Payer: UHC Exchange |
$76.62
|
| Rate for Payer: UHC Medicare Advantage |
$329.44
|
| Rate for Payer: VA VA |
$319.84
|
|
|
HC PI LINKED ANTIGEN CMPT
|
Facility
|
IP
|
$167.43
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31000005
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$105.48 |
| Max. Negotiated Rate |
$150.69 |
| Rate for Payer: Aetna Commercial |
$142.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.83
|
| Rate for Payer: Cash Price |
$133.94
|
| Rate for Payer: Cofinity Commercial |
$117.20
|
| Rate for Payer: Cofinity Commercial |
$143.99
|
| Rate for Payer: Healthscope Commercial |
$150.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$142.32
|
| Rate for Payer: PHP Commercial |
$142.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.20
|
| Rate for Payer: Priority Health SBD |
$105.48
|
|
|
HC PI LINKED ANTIGEN CMPT
|
Facility
|
OP
|
$167.43
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31000005
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$906.83 |
| Rate for Payer: Aetna Commercial |
$142.32
|
| Rate for Payer: Aetna Medicare |
$332.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$399.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$399.80
|
| Rate for Payer: BCBS Complete |
$183.72
|
| Rate for Payer: BCBS MAPPO |
$319.84
|
| Rate for Payer: BCBS Trust/PPO |
$91.84
|
| Rate for Payer: BCN Medicare Advantage |
$319.84
|
| Rate for Payer: Cash Price |
$133.94
|
| Rate for Payer: Cash Price |
$133.94
|
| Rate for Payer: Cofinity Commercial |
$117.20
|
| Rate for Payer: Cofinity Commercial |
$143.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$319.84
|
| Rate for Payer: Healthscope Commercial |
$150.69
|
| Rate for Payer: Mclaren Medicaid |
$174.95
|
| Rate for Payer: Mclaren Medicare |
$319.84
|
| Rate for Payer: Meridian Medicaid |
$183.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$335.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$367.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$142.32
|
| Rate for Payer: PACE Medicare |
$303.85
|
| Rate for Payer: PACE SWMI |
$319.84
|
| Rate for Payer: PHP Commercial |
$142.32
|
| Rate for Payer: PHP Medicare Advantage |
$319.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$906.83
|
| Rate for Payer: Priority Health Medicare |
$319.84
|
| Rate for Payer: Priority Health Narrow Network |
$725.46
|
| Rate for Payer: Priority Health SBD |
$105.48
|
| Rate for Payer: Railroad Medicare Medicare |
$319.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.28
|
| Rate for Payer: UHC Core |
$20.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$319.84
|
| Rate for Payer: UHC Exchange |
$76.62
|
| Rate for Payer: UHC Medicare Advantage |
$329.44
|
| Rate for Payer: VA VA |
$319.84
|
|
|
HC PI LINKED ANTIGEN CMPT2
|
Facility
|
IP
|
$53.75
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000011
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$33.86 |
| Max. Negotiated Rate |
$48.38 |
| Rate for Payer: Aetna Commercial |
$45.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.94
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cofinity Commercial |
$46.22
|
| Rate for Payer: Cofinity Commercial |
$37.62
|
| Rate for Payer: Healthscope Commercial |
$48.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.69
|
| Rate for Payer: PHP Commercial |
$45.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.62
|
| Rate for Payer: Priority Health SBD |
$33.86
|
|
|
HC PI LINKED ANTIGEN CMPT2
|
Facility
|
OP
|
$53.75
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000011
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$48.38 |
| Rate for Payer: Aetna Commercial |
$45.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.94
|
| Rate for Payer: BCBS Complete |
$21.50
|
| Rate for Payer: BCBS Trust/PPO |
$29.37
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cofinity Commercial |
$46.22
|
| Rate for Payer: Cofinity Commercial |
$37.62
|
| Rate for Payer: Healthscope Commercial |
$48.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.69
|
| Rate for Payer: PHP Commercial |
$45.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.62
|
| Rate for Payer: Priority Health SBD |
$33.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.58
|
| Rate for Payer: UHC Core |
$20.50
|
| Rate for Payer: UHC Exchange |
$23.25
|
|
|
HC PINWORM EXAM
|
Facility
|
OP
|
$54.40
|
|
|
Service Code
|
CPT 87172
|
| Hospital Charge Code |
30600094
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$48.96 |
| Rate for Payer: Aetna Commercial |
$46.24
|
| Rate for Payer: Aetna Medicare |
$4.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.34
|
| Rate for Payer: BCBS Complete |
$2.45
|
| Rate for Payer: BCBS MAPPO |
$4.27
|
| Rate for Payer: BCBS Trust/PPO |
$3.34
|
| Rate for Payer: BCN Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$43.52
|
| Rate for Payer: Cash Price |
$43.52
|
| Rate for Payer: Cofinity Commercial |
$38.08
|
| Rate for Payer: Cofinity Commercial |
$46.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.27
|
| Rate for Payer: Healthscope Commercial |
$48.96
|
| Rate for Payer: Mclaren Medicaid |
$2.34
|
| Rate for Payer: Mclaren Medicare |
$4.27
|
| Rate for Payer: Meridian Medicaid |
$2.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.24
|
| Rate for Payer: PACE Medicare |
$4.06
|
| Rate for Payer: PACE SWMI |
$4.27
|
| Rate for Payer: PHP Commercial |
$46.24
|
| Rate for Payer: PHP Medicare Advantage |
$4.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.08
|
| Rate for Payer: Priority Health Medicare |
$4.27
|
| Rate for Payer: Priority Health SBD |
$34.27
|
| Rate for Payer: Railroad Medicare Medicare |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.12
|
| Rate for Payer: UHC Core |
$7.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.27
|
| Rate for Payer: UHC Exchange |
$4.27
|
| Rate for Payer: UHC Medicare Advantage |
$4.40
|
| Rate for Payer: VA VA |
$4.27
|
|
|
HC PINWORM EXAM
|
Facility
|
IP
|
$54.40
|
|
|
Service Code
|
CPT 87172
|
| Hospital Charge Code |
30600094
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.27 |
| Max. Negotiated Rate |
$48.96 |
| Rate for Payer: Aetna Commercial |
$46.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.36
|
| Rate for Payer: Cash Price |
$43.52
|
| Rate for Payer: Cofinity Commercial |
$38.08
|
| Rate for Payer: Cofinity Commercial |
$46.78
|
| Rate for Payer: Healthscope Commercial |
$48.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.24
|
| Rate for Payer: PHP Commercial |
$46.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.08
|
| Rate for Payer: Priority Health SBD |
$34.27
|
|
|
HC PIONEER RE-ENTRY CATHETER
|
Facility
|
OP
|
$9,134.11
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200063
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,653.64 |
| Max. Negotiated Rate |
$8,220.70 |
| Rate for Payer: Aetna Commercial |
$7,763.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,937.17
|
| Rate for Payer: BCBS Complete |
$3,653.64
|
| Rate for Payer: Cash Price |
$7,307.29
|
| Rate for Payer: Cofinity Commercial |
$6,393.88
|
| Rate for Payer: Cofinity Commercial |
$7,855.33
|
| Rate for Payer: Healthscope Commercial |
$8,220.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,763.99
|
| Rate for Payer: PHP Commercial |
$7,763.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,393.88
|
| Rate for Payer: Priority Health SBD |
$5,754.49
|
|
|
HC PIONEER RE-ENTRY CATHETER
|
Facility
|
IP
|
$9,134.11
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200063
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,754.49 |
| Max. Negotiated Rate |
$8,220.70 |
| Rate for Payer: Aetna Commercial |
$7,763.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,937.17
|
| Rate for Payer: Cash Price |
$7,307.29
|
| Rate for Payer: Cofinity Commercial |
$6,393.88
|
| Rate for Payer: Cofinity Commercial |
$7,855.33
|
| Rate for Payer: Healthscope Commercial |
$8,220.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,763.99
|
| Rate for Payer: PHP Commercial |
$7,763.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,393.88
|
| Rate for Payer: Priority Health SBD |
$5,754.49
|
|
|
HC PIPELINE EMBOLIZATION DEVICE
|
Facility
|
OP
|
$19,187.64
|
|
| Hospital Charge Code |
27800081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,675.06 |
| Max. Negotiated Rate |
$17,268.88 |
| Rate for Payer: Aetna Commercial |
$16,309.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,471.97
|
| Rate for Payer: BCBS Complete |
$7,675.06
|
| Rate for Payer: Cash Price |
$15,350.11
|
| Rate for Payer: Cofinity Commercial |
$13,431.35
|
| Rate for Payer: Cofinity Commercial |
$16,501.37
|
| Rate for Payer: Healthscope Commercial |
$17,268.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16,309.49
|
| Rate for Payer: PHP Commercial |
$16,309.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,431.35
|
| Rate for Payer: Priority Health SBD |
$12,088.21
|
|
|
HC PIPELINE EMBOLIZATION DEVICE
|
Facility
|
IP
|
$19,187.64
|
|
| Hospital Charge Code |
27800081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,088.21 |
| Max. Negotiated Rate |
$17,268.88 |
| Rate for Payer: Aetna Commercial |
$16,309.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,471.97
|
| Rate for Payer: Cash Price |
$15,350.11
|
| Rate for Payer: Cofinity Commercial |
$13,431.35
|
| Rate for Payer: Cofinity Commercial |
$16,501.37
|
| Rate for Payer: Healthscope Commercial |
$17,268.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16,309.49
|
| Rate for Payer: PHP Commercial |
$16,309.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,431.35
|
| Rate for Payer: Priority Health SBD |
$12,088.21
|
|
|
HC PISTACHIO NUT IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200118
|
|
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 PISTACHIO NUT IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200118
|
|
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 PITOCIN AUGMENTATION
|
Facility
|
OP
|
$465.72
|
|
| Hospital Charge Code |
25800002
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$186.29 |
| Max. Negotiated Rate |
$419.15 |
| Rate for Payer: Aetna Commercial |
$395.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.72
|
| Rate for Payer: BCBS Complete |
$186.29
|
| Rate for Payer: Cash Price |
$372.58
|
| Rate for Payer: Cofinity Commercial |
$326.00
|
| Rate for Payer: Cofinity Commercial |
$400.52
|
| Rate for Payer: Healthscope Commercial |
$419.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$395.86
|
| Rate for Payer: PHP Commercial |
$395.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.00
|
| Rate for Payer: Priority Health SBD |
$293.40
|
|
|
HC PITOCIN AUGMENTATION
|
Facility
|
IP
|
$465.72
|
|
| Hospital Charge Code |
25800002
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$293.40 |
| Max. Negotiated Rate |
$419.15 |
| Rate for Payer: Aetna Commercial |
$395.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.72
|
| Rate for Payer: Cash Price |
$372.58
|
| Rate for Payer: Cofinity Commercial |
$326.00
|
| Rate for Payer: Cofinity Commercial |
$400.52
|
| Rate for Payer: Healthscope Commercial |
$419.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$395.86
|
| Rate for Payer: PHP Commercial |
$395.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.00
|
| Rate for Payer: Priority Health SBD |
$293.40
|
|
|
HC PKU STATE TESTING
|
Facility
|
IP
|
$21.40
|
|
|
Service Code
|
CPT 84030
|
| Hospital Charge Code |
30100387
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.48 |
| Max. Negotiated Rate |
$19.26 |
| Rate for Payer: Aetna Commercial |
$18.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.91
|
| Rate for Payer: Cash Price |
$17.12
|
| Rate for Payer: Cofinity Commercial |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$19.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.19
|
| Rate for Payer: PHP Commercial |
$18.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.98
|
| Rate for Payer: Priority Health SBD |
$13.48
|
|
|
HC PKU STATE TESTING
|
Facility
|
OP
|
$21.40
|
|
|
Service Code
|
CPT 84030
|
| Hospital Charge Code |
30100387
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$19.26 |
| Rate for Payer: Aetna Commercial |
$18.19
|
| Rate for Payer: Aetna Medicare |
$5.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.88
|
| Rate for Payer: BCBS Complete |
$3.16
|
| Rate for Payer: BCBS MAPPO |
$5.50
|
| Rate for Payer: BCBS Trust/PPO |
$4.31
|
| Rate for Payer: BCN Medicare Advantage |
$5.50
|
| Rate for Payer: Cash Price |
$17.12
|
| Rate for Payer: Cash Price |
$17.12
|
| Rate for Payer: Cofinity Commercial |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$18.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.50
|
| Rate for Payer: Healthscope Commercial |
$19.26
|
| Rate for Payer: Mclaren Medicaid |
$3.01
|
| Rate for Payer: Mclaren Medicare |
$5.50
|
| Rate for Payer: Meridian Medicaid |
$3.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.19
|
| Rate for Payer: PACE Medicare |
$5.22
|
| Rate for Payer: PACE SWMI |
$5.50
|
| Rate for Payer: PHP Commercial |
$18.19
|
| Rate for Payer: PHP Medicare Advantage |
$5.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.98
|
| Rate for Payer: Priority Health Medicare |
$5.50
|
| Rate for Payer: Priority Health SBD |
$13.48
|
| Rate for Payer: Railroad Medicare Medicare |
$5.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.60
|
| Rate for Payer: UHC Core |
$9.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.50
|
| Rate for Payer: UHC Exchange |
$5.50
|
| Rate for Payer: UHC Medicare Advantage |
$5.66
|
| Rate for Payer: VA VA |
$5.50
|
|
|
HC PLACE ACCESS BILE TREE RENDEZVOUS PROCEDURE
|
Facility
|
IP
|
$3,610.82
|
|
|
Service Code
|
CPT 47541
|
| Hospital Charge Code |
36100498
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,274.82 |
| Max. Negotiated Rate |
$3,249.74 |
| Rate for Payer: Aetna Commercial |
$3,069.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,347.03
|
| Rate for Payer: Cash Price |
$2,888.66
|
| Rate for Payer: Cofinity Commercial |
$2,527.57
|
| Rate for Payer: Cofinity Commercial |
$3,105.31
|
| Rate for Payer: Healthscope Commercial |
$3,249.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,069.20
|
| Rate for Payer: PHP Commercial |
$3,069.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,527.57
|
| Rate for Payer: Priority Health SBD |
$2,274.82
|
|
|
HC PLACE ACCESS BILE TREE RENDEZVOUS PROCEDURE
|
Facility
|
OP
|
$3,610.82
|
|
|
Service Code
|
CPT 47541
|
| Hospital Charge Code |
36100498
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$318.93 |
| Max. Negotiated Rate |
$8,414.74 |
| Rate for Payer: Aetna Commercial |
$3,069.20
|
| Rate for Payer: Aetna Medicare |
$7,001.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,347.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,414.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,414.74
|
| Rate for Payer: BCBS Complete |
$3,866.74
|
| Rate for Payer: BCBS MAPPO |
$6,731.79
|
| Rate for Payer: BCBS Trust/PPO |
$2,108.16
|
| Rate for Payer: BCN Medicare Advantage |
$6,731.79
|
| Rate for Payer: Cash Price |
$2,888.66
|
| Rate for Payer: Cash Price |
$2,888.66
|
| Rate for Payer: Cofinity Commercial |
$3,105.31
|
| Rate for Payer: Cofinity Commercial |
$2,527.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,731.79
|
| Rate for Payer: Healthscope Commercial |
$3,249.74
|
| Rate for Payer: Mclaren Medicaid |
$3,682.29
|
| Rate for Payer: Mclaren Medicare |
$6,731.79
|
| Rate for Payer: Meridian Medicaid |
$3,866.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,068.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,741.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,069.20
|
| Rate for Payer: PACE Medicare |
$6,395.20
|
| Rate for Payer: PACE SWMI |
$6,731.79
|
| Rate for Payer: PHP Commercial |
$3,069.20
|
| Rate for Payer: PHP Medicare Advantage |
$6,731.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,682.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,527.57
|
| Rate for Payer: Priority Health Medicare |
$6,731.79
|
| Rate for Payer: Priority Health SBD |
$2,274.82
|
| Rate for Payer: Railroad Medicare Medicare |
$6,731.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$350.82
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,731.79
|
| Rate for Payer: UHC Exchange |
$318.93
|
| Rate for Payer: UHC Medicare Advantage |
$6,933.74
|
| Rate for Payer: VA VA |
$6,731.79
|
|
|
HC PLACE BILIARY DRAIN CATH WITH GUIDE INTERNAL EXTERNAL
|
Facility
|
IP
|
$3,610.82
|
|
|
Service Code
|
CPT 47534
|
| Hospital Charge Code |
36100491
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,274.82 |
| Max. Negotiated Rate |
$3,249.74 |
| Rate for Payer: Aetna Commercial |
$3,069.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,347.03
|
| Rate for Payer: Cash Price |
$2,888.66
|
| Rate for Payer: Cofinity Commercial |
$2,527.57
|
| Rate for Payer: Cofinity Commercial |
$3,105.31
|
| Rate for Payer: Healthscope Commercial |
$3,249.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,069.20
|
| Rate for Payer: PHP Commercial |
$3,069.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,527.57
|
| Rate for Payer: Priority Health SBD |
$2,274.82
|
|
|
HC PLACE BILIARY DRAIN CATH WITH GUIDE INTERNAL EXTERNAL
|
Facility
|
OP
|
$3,610.82
|
|
|
Service Code
|
CPT 47534
|
| Hospital Charge Code |
36100491
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$350.04 |
| Max. Negotiated Rate |
$5,427.00 |
| Rate for Payer: Aetna Commercial |
$3,069.20
|
| Rate for Payer: Aetna Medicare |
$3,201.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,347.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,847.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,847.99
|
| Rate for Payer: BCBS Complete |
$1,768.23
|
| Rate for Payer: BCBS MAPPO |
$3,078.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,108.16
|
| Rate for Payer: BCN Medicare Advantage |
$3,078.39
|
| Rate for Payer: Cash Price |
$2,888.66
|
| Rate for Payer: Cash Price |
$2,888.66
|
| Rate for Payer: Cofinity Commercial |
$3,105.31
|
| Rate for Payer: Cofinity Commercial |
$2,527.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,078.39
|
| Rate for Payer: Healthscope Commercial |
$3,249.74
|
| Rate for Payer: Mclaren Medicaid |
$1,683.88
|
| Rate for Payer: Mclaren Medicare |
$3,078.39
|
| Rate for Payer: Meridian Medicaid |
$1,768.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,232.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,540.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,069.20
|
| Rate for Payer: PACE Medicare |
$2,924.47
|
| Rate for Payer: PACE SWMI |
$3,078.39
|
| Rate for Payer: PHP Commercial |
$3,069.20
|
| Rate for Payer: PHP Medicare Advantage |
$3,078.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,683.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,527.57
|
| Rate for Payer: Priority Health Medicare |
$3,078.39
|
| Rate for Payer: Priority Health SBD |
$2,274.82
|
| Rate for Payer: Railroad Medicare Medicare |
$3,078.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$385.04
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,078.39
|
| Rate for Payer: UHC Exchange |
$350.04
|
| Rate for Payer: UHC Medicare Advantage |
$3,170.74
|
| Rate for Payer: VA VA |
$3,078.39
|
|
|
HC PLACE BILIARY DRAIN WITH GUIDE EXTERNAL
|
Facility
|
OP
|
$3,119.16
|
|
|
Service Code
|
CPT 47533
|
| Hospital Charge Code |
36100490
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$250.17 |
| Max. Negotiated Rate |
$5,427.00 |
| Rate for Payer: Aetna Commercial |
$2,651.29
|
| Rate for Payer: Aetna Medicare |
$3,201.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,027.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,847.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,847.99
|
| Rate for Payer: BCBS Complete |
$1,768.23
|
| Rate for Payer: BCBS MAPPO |
$3,078.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,108.16
|
| Rate for Payer: BCN Medicare Advantage |
$3,078.39
|
| Rate for Payer: Cash Price |
$2,495.33
|
| Rate for Payer: Cash Price |
$2,495.33
|
| Rate for Payer: Cofinity Commercial |
$2,183.41
|
| Rate for Payer: Cofinity Commercial |
$2,682.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,078.39
|
| Rate for Payer: Healthscope Commercial |
$2,807.24
|
| Rate for Payer: Mclaren Medicaid |
$1,683.88
|
| Rate for Payer: Mclaren Medicare |
$3,078.39
|
| Rate for Payer: Meridian Medicaid |
$1,768.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,232.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,540.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,651.29
|
| Rate for Payer: PACE Medicare |
$2,924.47
|
| Rate for Payer: PACE SWMI |
$3,078.39
|
| Rate for Payer: PHP Commercial |
$2,651.29
|
| Rate for Payer: PHP Medicare Advantage |
$3,078.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,683.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,183.41
|
| Rate for Payer: Priority Health Medicare |
$3,078.39
|
| Rate for Payer: Priority Health SBD |
$1,965.07
|
| Rate for Payer: Railroad Medicare Medicare |
$3,078.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$275.19
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,078.39
|
| Rate for Payer: UHC Exchange |
$250.17
|
| Rate for Payer: UHC Medicare Advantage |
$3,170.74
|
| Rate for Payer: VA VA |
$3,078.39
|
|
