|
HC INJ SELECT R VENT/ATRIAL ANGIO HRT CATH
|
Facility
|
OP
|
$697.21
|
|
|
Service Code
|
CPT 93566
|
| Hospital Charge Code |
36000110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$26.66 |
| Max. Negotiated Rate |
$627.49 |
| Rate for Payer: Aetna Commercial |
$592.63
|
| Rate for Payer: Aetna Medicare |
$348.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$453.19
|
| Rate for Payer: BCBS Complete |
$278.88
|
| Rate for Payer: BCBS Trust/PPO |
$26.66
|
| Rate for Payer: BCN Commercial |
$26.66
|
| Rate for Payer: Cash Price |
$557.77
|
| Rate for Payer: Cash Price |
$557.77
|
| Rate for Payer: Cofinity Advantage |
$488.05
|
| Rate for Payer: Cofinity Commercial |
$599.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.77
|
| Rate for Payer: Healthscope Commercial |
$627.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$557.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$592.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$522.91
|
| Rate for Payer: PHP Commercial |
$592.63
|
| Rate for Payer: Priority Health SBD |
$439.24
|
|
|
HC INJ SELECT R VENT/ATRIAL ANGIO HRT CATH
|
Facility
|
IP
|
$697.21
|
|
|
Service Code
|
CPT 93566
|
| Hospital Charge Code |
36000110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$439.24 |
| Max. Negotiated Rate |
$627.49 |
| Rate for Payer: Aetna Commercial |
$592.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$453.19
|
| Rate for Payer: Cash Price |
$557.77
|
| Rate for Payer: Cofinity Advantage |
$488.05
|
| Rate for Payer: Cofinity Commercial |
$599.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.77
|
| Rate for Payer: Healthscope Commercial |
$627.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$592.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$522.91
|
| Rate for Payer: PHP Commercial |
$592.63
|
| Rate for Payer: Priority Health SBD |
$439.24
|
|
|
HC INJ TIXAGEVIMAB AND CILGAVIMAB
|
Facility
|
OP
|
$212.24
|
|
|
Service Code
|
HCPCS M0220
|
| Hospital Charge Code |
77100033
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$83.41 |
| Max. Negotiated Rate |
$191.02 |
| Rate for Payer: Aetna Commercial |
$180.40
|
| Rate for Payer: Aetna Medicare |
$106.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.96
|
| Rate for Payer: BCBS Complete |
$84.90
|
| Rate for Payer: Cash Price |
$169.79
|
| Rate for Payer: Cofinity Advantage |
$148.57
|
| Rate for Payer: Cofinity Commercial |
$182.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.79
|
| Rate for Payer: Healthscope Commercial |
$191.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.18
|
| Rate for Payer: PHP Commercial |
$180.40
|
| Rate for Payer: Priority Health SBD |
$133.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.96
|
| Rate for Payer: UHC Core |
$110.58
|
| Rate for Payer: UHC Exchange |
$83.41
|
|
|
HC INJ TIXAGEVIMAB AND CILGAVIMAB
|
Facility
|
IP
|
$212.24
|
|
|
Service Code
|
HCPCS M0220
|
| Hospital Charge Code |
77100033
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$133.71 |
| Max. Negotiated Rate |
$191.02 |
| Rate for Payer: Aetna Commercial |
$180.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.96
|
| Rate for Payer: Cash Price |
$169.79
|
| Rate for Payer: Cofinity Advantage |
$148.57
|
| Rate for Payer: Cofinity Commercial |
$182.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.79
|
| Rate for Payer: Healthscope Commercial |
$191.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.18
|
| Rate for Payer: PHP Commercial |
$180.40
|
| Rate for Payer: Priority Health SBD |
$133.71
|
|
|
HC INJ, TRIAMCINOLONE ACETONIDE, NOT SPECIFIED, 10 MG
|
Facility
|
IP
|
$10.61
|
|
|
Service Code
|
CPT J3301
|
| Hospital Charge Code |
63600103
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$9.55 |
| Rate for Payer: Aetna Commercial |
$9.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.90
|
| Rate for Payer: Cash Price |
$8.49
|
| Rate for Payer: Cofinity Advantage |
$7.43
|
| Rate for Payer: Cofinity Commercial |
$9.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.49
|
| Rate for Payer: Healthscope Commercial |
$9.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.96
|
| Rate for Payer: PHP Commercial |
$9.02
|
| Rate for Payer: Priority Health SBD |
$6.68
|
|
|
HC INJ, TRIAMCINOLONE ACETONIDE, NOT SPECIFIED, 10 MG
|
Facility
|
OP
|
$10.61
|
|
|
Service Code
|
CPT J3301
|
| Hospital Charge Code |
63600103
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$9.55 |
| Rate for Payer: Aetna Commercial |
$9.02
|
| Rate for Payer: Aetna Medicare |
$5.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.90
|
| Rate for Payer: BCBS Complete |
$4.24
|
| Rate for Payer: BCBS Trust/PPO |
$1.85
|
| Rate for Payer: BCN Commercial |
$1.85
|
| Rate for Payer: Cash Price |
$8.49
|
| Rate for Payer: Cash Price |
$8.49
|
| Rate for Payer: Cofinity Advantage |
$7.43
|
| Rate for Payer: Cofinity Commercial |
$9.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.49
|
| Rate for Payer: Healthscope Commercial |
$9.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.96
|
| Rate for Payer: PHP Commercial |
$9.02
|
| Rate for Payer: Priority Health SBD |
$6.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.22
|
| Rate for Payer: UHC Core |
$1.22
|
| Rate for Payer: UHC Exchange |
$1.22
|
|
|
HC INJ, VIT B12 CYANCOBALAMIN, UP TO 1000MCG
|
Facility
|
OP
|
$5.30
|
|
|
Service Code
|
CPT J3420
|
| Hospital Charge Code |
63600104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$4.77 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Aetna Medicare |
$2.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.44
|
| Rate for Payer: BCBS Complete |
$2.12
|
| Rate for Payer: BCBS Trust/PPO |
$1.60
|
| Rate for Payer: BCN Commercial |
$1.60
|
| Rate for Payer: Cash Price |
$4.24
|
| Rate for Payer: Cash Price |
$4.24
|
| Rate for Payer: Cofinity Advantage |
$3.71
|
| Rate for Payer: Cofinity Commercial |
$4.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.24
|
| Rate for Payer: Healthscope Commercial |
$4.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.98
|
| Rate for Payer: PHP Commercial |
$4.50
|
| Rate for Payer: Priority Health SBD |
$3.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.06
|
| Rate for Payer: UHC Core |
$1.06
|
| Rate for Payer: UHC Exchange |
$1.06
|
|
|
HC INJ, VIT B12 CYANCOBALAMIN, UP TO 1000MCG
|
Facility
|
IP
|
$5.30
|
|
|
Service Code
|
CPT J3420
|
| Hospital Charge Code |
63600104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$4.77 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.44
|
| Rate for Payer: Cash Price |
$4.24
|
| Rate for Payer: Cofinity Advantage |
$3.71
|
| Rate for Payer: Cofinity Commercial |
$4.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.24
|
| Rate for Payer: Healthscope Commercial |
$4.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.98
|
| Rate for Payer: PHP Commercial |
$4.50
|
| Rate for Payer: Priority Health SBD |
$3.34
|
|
|
HC INSECT VENOM ALLERGY PANEL
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200115
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC INSECT VENOM ALLERGY PANEL
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200115
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
|
|
HC INSERT CATH COMPLICATED
|
Facility
|
IP
|
$510.33
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
45000005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$321.51 |
| Max. Negotiated Rate |
$459.30 |
| Rate for Payer: Aetna Commercial |
$433.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.71
|
| Rate for Payer: Cash Price |
$408.26
|
| Rate for Payer: Cofinity Advantage |
$357.23
|
| Rate for Payer: Cofinity Commercial |
$438.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.26
|
| Rate for Payer: Healthscope Commercial |
$459.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$382.75
|
| Rate for Payer: PHP Commercial |
$433.78
|
| Rate for Payer: Priority Health SBD |
$321.51
|
|
|
HC INSERT CATH COMPLICATED
|
Facility
|
OP
|
$510.33
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
45000005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.83 |
| Max. Negotiated Rate |
$459.30 |
| Rate for Payer: Aetna Commercial |
$433.78
|
| Rate for Payer: Aetna Medicare |
$133.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$160.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$160.26
|
| Rate for Payer: BCBS Complete |
$70.41
|
| Rate for Payer: BCBS MAPPO |
$128.21
|
| Rate for Payer: BCBS Trust/PPO |
$66.83
|
| Rate for Payer: BCN Commercial |
$66.83
|
| Rate for Payer: BCN Medicare Advantage |
$128.21
|
| Rate for Payer: Cash Price |
$408.26
|
| Rate for Payer: Cash Price |
$408.26
|
| Rate for Payer: Cash Price |
$408.26
|
| Rate for Payer: Cofinity Advantage |
$357.23
|
| Rate for Payer: Cofinity Commercial |
$438.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.21
|
| Rate for Payer: Healthscope Commercial |
$459.30
|
| Rate for Payer: Mclaren Medicaid |
$67.05
|
| Rate for Payer: Mclaren Medicare |
$128.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.62
|
| Rate for Payer: Meridian Medicaid |
$134.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$147.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$141.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.78
|
| Rate for Payer: Nomi Health Commercial |
$384.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$382.75
|
| Rate for Payer: PACE Medicare |
$121.80
|
| Rate for Payer: PACE SWMI |
$128.21
|
| Rate for Payer: PHP Commercial |
$433.78
|
| Rate for Payer: PHP Medicare Advantage |
$128.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$414.63
|
| Rate for Payer: Priority Health Medicare |
$128.21
|
| Rate for Payer: Priority Health SBD |
$321.51
|
| Rate for Payer: Priority Health Tiered Network |
$331.70
|
| Rate for Payer: Railroad Medicare Medicare |
$128.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$331.71
|
| Rate for Payer: UHC Core |
$265.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$128.21
|
| Rate for Payer: UHC Exchange |
$200.56
|
| Rate for Payer: UHC Medicaid |
$67.05
|
| Rate for Payer: UHCCP Medicaid |
$67.05
|
| Rate for Payer: VA VA |
$128.21
|
|
|
HC INSERT CERVICAL DILATOR
|
Facility
|
IP
|
$431.70
|
|
|
Service Code
|
CPT 59200
|
| Hospital Charge Code |
36100397
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.97 |
| Max. Negotiated Rate |
$388.53 |
| Rate for Payer: Aetna Commercial |
$366.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.61
|
| Rate for Payer: Cash Price |
$345.36
|
| Rate for Payer: Cofinity Advantage |
$302.19
|
| Rate for Payer: Cofinity Commercial |
$371.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.36
|
| Rate for Payer: Healthscope Commercial |
$388.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.77
|
| Rate for Payer: PHP Commercial |
$366.94
|
| Rate for Payer: Priority Health SBD |
$271.97
|
|
|
HC INSERT CERVICAL DILATOR
|
Facility
|
OP
|
$431.70
|
|
|
Service Code
|
CPT 59200
|
| Hospital Charge Code |
36100397
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.80 |
| Max. Negotiated Rate |
$981.93 |
| Rate for Payer: Aetna Commercial |
$366.94
|
| Rate for Payer: Aetna Medicare |
$315.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.54
|
| Rate for Payer: BCBS Complete |
$166.75
|
| Rate for Payer: BCBS MAPPO |
$303.63
|
| Rate for Payer: BCBS Trust/PPO |
$240.72
|
| Rate for Payer: BCN Commercial |
$240.72
|
| Rate for Payer: BCN Medicare Advantage |
$303.63
|
| Rate for Payer: Cash Price |
$345.36
|
| Rate for Payer: Cash Price |
$345.36
|
| Rate for Payer: Cash Price |
$345.36
|
| Rate for Payer: Cofinity Advantage |
$302.19
|
| Rate for Payer: Cofinity Commercial |
$371.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.63
|
| Rate for Payer: Healthscope Commercial |
$388.53
|
| Rate for Payer: Mclaren Medicaid |
$158.80
|
| Rate for Payer: Mclaren Medicare |
$303.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.81
|
| Rate for Payer: Meridian Medicaid |
$318.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$333.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.94
|
| Rate for Payer: Nomi Health Commercial |
$910.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.77
|
| Rate for Payer: PACE Medicare |
$288.45
|
| Rate for Payer: PACE SWMI |
$303.63
|
| Rate for Payer: PHP Commercial |
$366.94
|
| Rate for Payer: PHP Medicare Advantage |
$303.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$158.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$981.93
|
| Rate for Payer: Priority Health Medicare |
$303.63
|
| Rate for Payer: Priority Health SBD |
$271.97
|
| Rate for Payer: Priority Health Tiered Network |
$785.54
|
| Rate for Payer: Railroad Medicare Medicare |
$303.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$280.61
|
| Rate for Payer: UHC Core |
$224.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$303.63
|
| Rate for Payer: UHC Exchange |
$169.66
|
| Rate for Payer: UHC Medicaid |
$158.80
|
| Rate for Payer: UHCCP Medicaid |
$158.80
|
| Rate for Payer: VA VA |
$303.63
|
|
|
HC INSERT EMERGENCY AIRWAY
|
Facility
|
OP
|
$587.84
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
45000012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$123.43 |
| Max. Negotiated Rate |
$763.21 |
| Rate for Payer: Aetna Commercial |
$499.66
|
| Rate for Payer: Aetna Medicare |
$245.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.10
|
| 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 |
$171.36
|
| Rate for Payer: BCN Commercial |
$171.36
|
| Rate for Payer: BCN Medicare Advantage |
$236.00
|
| Rate for Payer: Cash Price |
$470.27
|
| Rate for Payer: Cash Price |
$470.27
|
| Rate for Payer: Cash Price |
$470.27
|
| Rate for Payer: Cofinity Advantage |
$411.49
|
| Rate for Payer: Cofinity Commercial |
$505.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.00
|
| Rate for Payer: Healthscope Commercial |
$529.06
|
| 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 |
$499.66
|
| Rate for Payer: Nomi Health Commercial |
$708.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$440.88
|
| Rate for Payer: PACE Medicare |
$224.20
|
| Rate for Payer: PACE SWMI |
$236.00
|
| Rate for Payer: PHP Commercial |
$499.66
|
| 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 |
$370.34
|
| Rate for Payer: Priority Health Tiered Network |
$610.57
|
| Rate for Payer: Railroad Medicare Medicare |
$236.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$236.00
|
| Rate for Payer: UHC Medicaid |
$123.43
|
| Rate for Payer: UHCCP Medicaid |
$123.43
|
| Rate for Payer: VA VA |
$236.00
|
|
|
HC INSERT EMERGENCY AIRWAY
|
Facility
|
IP
|
$587.84
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
45000012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$370.34 |
| Max. Negotiated Rate |
$529.06 |
| Rate for Payer: Aetna Commercial |
$499.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.10
|
| Rate for Payer: Cash Price |
$470.27
|
| Rate for Payer: Cofinity Advantage |
$411.49
|
| Rate for Payer: Cofinity Commercial |
$505.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.27
|
| Rate for Payer: Healthscope Commercial |
$529.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$440.88
|
| Rate for Payer: PHP Commercial |
$499.66
|
| Rate for Payer: Priority Health SBD |
$370.34
|
|
|
HC INSERT INDWELLING CATH
|
Facility
|
IP
|
$203.24
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
45000004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$182.92 |
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.43
|
| Rate for Payer: Aetna Commercial |
$172.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.11
|
| Rate for Payer: Cash Price |
$162.59
|
| Rate for Payer: Cofinity Advantage |
$142.27
|
| Rate for Payer: Cofinity Commercial |
$174.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.59
|
| Rate for Payer: Healthscope Commercial |
$182.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.75
|
| Rate for Payer: PHP Commercial |
$172.75
|
| Rate for Payer: Priority Health SBD |
$128.04
|
|
|
HC INSERT INDWELLING CATH
|
Facility
|
OP
|
$203.24
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
45000004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$428.73 |
| Rate for Payer: Aetna Commercial |
$172.75
|
| Rate for Payer: Aetna Medicare |
$137.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$186.68
|
| Rate for Payer: BCN Commercial |
$186.68
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$162.59
|
| Rate for Payer: Cash Price |
$162.59
|
| Rate for Payer: Cash Price |
$162.59
|
| Rate for Payer: Cofinity Advantage |
$142.27
|
| Rate for Payer: Cofinity Commercial |
$174.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$182.92
|
| Rate for Payer: Mclaren Medicaid |
$69.33
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$139.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.75
|
| Rate for Payer: Nomi Health Commercial |
$397.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.43
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$172.75
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.73
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health SBD |
$128.04
|
| Rate for Payer: Priority Health Tiered Network |
$342.98
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.11
|
| Rate for Payer: UHC Core |
$105.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$79.87
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
HC INSERT INFUSION PUMP
|
Facility
|
OP
|
$1,094.92
|
|
| Hospital Charge Code |
36100438
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$437.97 |
| Max. Negotiated Rate |
$985.43 |
| Rate for Payer: Aetna Commercial |
$930.68
|
| Rate for Payer: Aetna Medicare |
$547.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$711.70
|
| Rate for Payer: BCBS Complete |
$437.97
|
| Rate for Payer: Cash Price |
$875.94
|
| Rate for Payer: Cofinity Advantage |
$766.44
|
| Rate for Payer: Cofinity Commercial |
$941.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$875.94
|
| Rate for Payer: Healthscope Commercial |
$985.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$875.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$930.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$821.19
|
| Rate for Payer: PHP Commercial |
$930.68
|
| Rate for Payer: Priority Health SBD |
$689.80
|
|
|
HC INSERT INFUSION PUMP
|
Facility
|
IP
|
$1,094.92
|
|
| Hospital Charge Code |
36100438
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$689.80 |
| Max. Negotiated Rate |
$985.43 |
| Rate for Payer: Aetna Commercial |
$930.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$711.70
|
| Rate for Payer: Cash Price |
$875.94
|
| Rate for Payer: Cofinity Advantage |
$766.44
|
| Rate for Payer: Cofinity Commercial |
$941.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$875.94
|
| Rate for Payer: Healthscope Commercial |
$985.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$930.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$821.19
|
| Rate for Payer: PHP Commercial |
$930.68
|
| Rate for Payer: Priority Health SBD |
$689.80
|
|
|
HC INSERTION CECO TUBE W FLUORO
|
Facility
|
IP
|
$1,499.55
|
|
|
Service Code
|
CPT 49442
|
| Hospital Charge Code |
36100227
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$944.72 |
| Max. Negotiated Rate |
$1,349.60 |
| Rate for Payer: Aetna Commercial |
$1,274.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$974.71
|
| Rate for Payer: Cash Price |
$1,199.64
|
| Rate for Payer: Cofinity Advantage |
$1,049.68
|
| Rate for Payer: Cofinity Commercial |
$1,289.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,199.64
|
| Rate for Payer: Healthscope Commercial |
$1,349.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,274.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,124.66
|
| Rate for Payer: PHP Commercial |
$1,274.62
|
| Rate for Payer: Priority Health SBD |
$944.72
|
|
|
HC INSERTION CECO TUBE W FLUORO
|
Facility
|
OP
|
$1,499.55
|
|
|
Service Code
|
CPT 49442
|
| Hospital Charge Code |
36100227
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$623.59 |
| Max. Negotiated Rate |
$3,855.91 |
| Rate for Payer: Aetna Commercial |
$1,274.62
|
| Rate for Payer: Aetna Medicare |
$1,240.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$974.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,490.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,490.42
|
| Rate for Payer: BCBS Complete |
$654.83
|
| Rate for Payer: BCBS MAPPO |
$1,192.34
|
| Rate for Payer: BCBS Trust/PPO |
$797.37
|
| Rate for Payer: BCN Commercial |
$797.37
|
| Rate for Payer: BCN Medicare Advantage |
$1,192.34
|
| Rate for Payer: Cash Price |
$1,199.64
|
| Rate for Payer: Cash Price |
$1,199.64
|
| Rate for Payer: Cash Price |
$1,199.64
|
| Rate for Payer: Cofinity Advantage |
$1,049.68
|
| Rate for Payer: Cofinity Commercial |
$1,289.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,199.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,192.34
|
| Rate for Payer: Healthscope Commercial |
$1,349.60
|
| Rate for Payer: Mclaren Medicaid |
$623.59
|
| Rate for Payer: Mclaren Medicare |
$1,192.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,251.96
|
| Rate for Payer: Meridian Medicaid |
$1,251.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,371.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,311.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,274.62
|
| Rate for Payer: Nomi Health Commercial |
$3,577.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,124.66
|
| Rate for Payer: PACE Medicare |
$1,132.72
|
| Rate for Payer: PACE SWMI |
$1,192.34
|
| Rate for Payer: PHP Commercial |
$1,274.62
|
| Rate for Payer: PHP Medicare Advantage |
$1,192.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$623.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,855.91
|
| Rate for Payer: Priority Health Medicare |
$1,192.34
|
| Rate for Payer: Priority Health SBD |
$944.72
|
| Rate for Payer: Priority Health Tiered Network |
$3,084.73
|
| Rate for Payer: Railroad Medicare Medicare |
$1,192.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,192.34
|
| Rate for Payer: UHC Medicaid |
$623.59
|
| Rate for Payer: UHCCP Medicaid |
$623.59
|
| Rate for Payer: VA VA |
$1,192.34
|
|
|
HC INSERTION D OR J TUBE W FLUORO
|
Facility
|
OP
|
$1,551.78
|
|
|
Service Code
|
CPT 49441
|
| Hospital Charge Code |
36100226
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$696.35 |
| Max. Negotiated Rate |
$6,183.25 |
| Rate for Payer: Aetna Commercial |
$1,319.01
|
| Rate for Payer: Aetna Medicare |
$1,988.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,008.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,390.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,390.01
|
| Rate for Payer: BCBS Complete |
$1,050.08
|
| Rate for Payer: BCBS MAPPO |
$1,912.01
|
| Rate for Payer: BCBS Trust/PPO |
$696.35
|
| Rate for Payer: BCN Commercial |
$696.35
|
| Rate for Payer: BCN Medicare Advantage |
$1,912.01
|
| Rate for Payer: Cash Price |
$1,241.42
|
| Rate for Payer: Cash Price |
$1,241.42
|
| Rate for Payer: Cash Price |
$1,241.42
|
| Rate for Payer: Cofinity Advantage |
$1,086.25
|
| Rate for Payer: Cofinity Commercial |
$1,334.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,241.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,912.01
|
| Rate for Payer: Healthscope Commercial |
$1,396.60
|
| Rate for Payer: Mclaren Medicaid |
$999.98
|
| Rate for Payer: Mclaren Medicare |
$1,912.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,007.61
|
| Rate for Payer: Meridian Medicaid |
$2,007.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,198.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,103.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,319.01
|
| Rate for Payer: Nomi Health Commercial |
$5,736.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,163.84
|
| Rate for Payer: PACE Medicare |
$1,816.41
|
| Rate for Payer: PACE SWMI |
$1,912.01
|
| Rate for Payer: PHP Commercial |
$1,319.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,912.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$999.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,183.25
|
| Rate for Payer: Priority Health Medicare |
$1,912.01
|
| Rate for Payer: Priority Health SBD |
$977.62
|
| Rate for Payer: Priority Health Tiered Network |
$4,946.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,912.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,912.01
|
| Rate for Payer: UHC Medicaid |
$999.98
|
| Rate for Payer: UHCCP Medicaid |
$999.98
|
| Rate for Payer: VA VA |
$1,912.01
|
|
|
HC INSERTION D OR J TUBE W FLUORO
|
Facility
|
IP
|
$1,551.78
|
|
|
Service Code
|
CPT 49441
|
| Hospital Charge Code |
36100226
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$977.62 |
| Max. Negotiated Rate |
$1,396.60 |
| Rate for Payer: Aetna Commercial |
$1,319.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,008.66
|
| Rate for Payer: Cash Price |
$1,241.42
|
| Rate for Payer: Cofinity Advantage |
$1,086.25
|
| Rate for Payer: Cofinity Commercial |
$1,334.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,241.42
|
| Rate for Payer: Healthscope Commercial |
$1,396.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,319.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,163.84
|
| Rate for Payer: PHP Commercial |
$1,319.01
|
| Rate for Payer: Priority Health SBD |
$977.62
|
|
|
HC INSERTION DRUG IMPLANT DEVICE
|
Facility
|
IP
|
$169.51
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
76100179
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$106.79 |
| Max. Negotiated Rate |
$152.56 |
| Rate for Payer: Aetna Commercial |
$144.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.18
|
| Rate for Payer: Cash Price |
$135.61
|
| Rate for Payer: Cofinity Advantage |
$118.66
|
| Rate for Payer: Cofinity Commercial |
$145.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.61
|
| Rate for Payer: Healthscope Commercial |
$152.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.13
|
| Rate for Payer: PHP Commercial |
$144.08
|
| Rate for Payer: Priority Health SBD |
$106.79
|
|
