|
HC INSERT PICC 5 YEARS OR ABOVE W IMAGING
|
Facility
|
IP
|
$2,293.98
|
|
|
Service Code
|
CPT 36573
|
| Hospital Charge Code |
36100553
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,445.21 |
| Max. Negotiated Rate |
$2,064.58 |
| Rate for Payer: Aetna Commercial |
$1,949.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,491.09
|
| Rate for Payer: Cash Price |
$1,835.18
|
| Rate for Payer: Cofinity Advantage |
$1,605.79
|
| Rate for Payer: Cofinity Commercial |
$1,972.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,835.18
|
| Rate for Payer: Healthscope Commercial |
$2,064.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,949.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,720.48
|
| Rate for Payer: PHP Commercial |
$1,949.88
|
| Rate for Payer: Priority Health SBD |
$1,445.21
|
|
|
HC INSERT PICC 5 YEARS OR ABOVE W IMAGING
|
Facility
|
OP
|
$2,293.98
|
|
|
Service Code
|
CPT 36573
|
| Hospital Charge Code |
36100553
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$820.32 |
| Max. Negotiated Rate |
$5,072.36 |
| Rate for Payer: Aetna Commercial |
$1,949.88
|
| Rate for Payer: Aetna Medicare |
$1,631.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,491.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.61
|
| Rate for Payer: BCBS Complete |
$861.41
|
| Rate for Payer: BCBS MAPPO |
$1,568.49
|
| Rate for Payer: BCBS Trust/PPO |
$867.09
|
| Rate for Payer: BCN Commercial |
$867.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.49
|
| Rate for Payer: Cash Price |
$1,835.18
|
| Rate for Payer: Cash Price |
$1,835.18
|
| Rate for Payer: Cash Price |
$1,835.18
|
| Rate for Payer: Cofinity Advantage |
$1,605.79
|
| Rate for Payer: Cofinity Commercial |
$1,972.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,835.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.49
|
| Rate for Payer: Healthscope Commercial |
$2,064.58
|
| Rate for Payer: Mclaren Medicaid |
$820.32
|
| Rate for Payer: Mclaren Medicare |
$1,568.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.91
|
| Rate for Payer: Meridian Medicaid |
$1,646.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,725.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,949.88
|
| Rate for Payer: Nomi Health Commercial |
$4,705.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,720.48
|
| Rate for Payer: PACE Medicare |
$1,490.07
|
| Rate for Payer: PACE SWMI |
$1,568.49
|
| Rate for Payer: PHP Commercial |
$1,949.88
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$820.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,072.36
|
| Rate for Payer: Priority Health Medicare |
$1,568.49
|
| Rate for Payer: Priority Health SBD |
$1,445.21
|
| Rate for Payer: Priority Health Tiered Network |
$4,057.89
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,568.49
|
| Rate for Payer: UHC Medicaid |
$820.32
|
| Rate for Payer: UHCCP Medicaid |
$820.32
|
| Rate for Payer: VA VA |
$1,568.49
|
|
|
HC INSERT PICC LESS THAN 5 YRS W IMAGING
|
Facility
|
IP
|
$2,025.84
|
|
|
Service Code
|
CPT 36572
|
| Hospital Charge Code |
36100552
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,276.28 |
| Max. Negotiated Rate |
$1,823.26 |
| Rate for Payer: Aetna Commercial |
$1,721.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,316.80
|
| Rate for Payer: Cash Price |
$1,620.67
|
| Rate for Payer: Cofinity Advantage |
$1,418.09
|
| Rate for Payer: Cofinity Commercial |
$1,742.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,620.67
|
| Rate for Payer: Healthscope Commercial |
$1,823.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,721.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,519.38
|
| Rate for Payer: PHP Commercial |
$1,721.96
|
| Rate for Payer: Priority Health SBD |
$1,276.28
|
|
|
HC INSERT PICC LESS THAN 5 YRS W IMAGING
|
Facility
|
OP
|
$2,025.84
|
|
|
Service Code
|
CPT 36572
|
| Hospital Charge Code |
36100552
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$326.90 |
| Max. Negotiated Rate |
$2,021.35 |
| Rate for Payer: Aetna Commercial |
$1,721.96
|
| Rate for Payer: Aetna Medicare |
$650.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,316.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.31
|
| Rate for Payer: BCBS Complete |
$343.28
|
| Rate for Payer: BCBS MAPPO |
$625.05
|
| Rate for Payer: BCBS Trust/PPO |
$417.63
|
| Rate for Payer: BCN Commercial |
$417.63
|
| Rate for Payer: BCN Medicare Advantage |
$625.05
|
| Rate for Payer: Cash Price |
$1,620.67
|
| Rate for Payer: Cash Price |
$1,620.67
|
| Rate for Payer: Cash Price |
$1,620.67
|
| Rate for Payer: Cofinity Advantage |
$1,418.09
|
| Rate for Payer: Cofinity Commercial |
$1,742.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,620.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.05
|
| Rate for Payer: Healthscope Commercial |
$1,823.26
|
| Rate for Payer: Mclaren Medicaid |
$326.90
|
| Rate for Payer: Mclaren Medicare |
$625.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$656.30
|
| Rate for Payer: Meridian Medicaid |
$656.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$718.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$687.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,721.96
|
| Rate for Payer: Nomi Health Commercial |
$1,875.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,519.38
|
| Rate for Payer: PACE Medicare |
$593.80
|
| Rate for Payer: PACE SWMI |
$625.05
|
| Rate for Payer: PHP Commercial |
$1,721.96
|
| Rate for Payer: PHP Medicare Advantage |
$625.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$326.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,021.35
|
| Rate for Payer: Priority Health Medicare |
$625.05
|
| Rate for Payer: Priority Health SBD |
$1,276.28
|
| Rate for Payer: Priority Health Tiered Network |
$1,617.08
|
| Rate for Payer: Railroad Medicare Medicare |
$625.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$625.05
|
| Rate for Payer: UHC Medicaid |
$326.90
|
| Rate for Payer: UHCCP Medicaid |
$326.90
|
| Rate for Payer: VA VA |
$625.05
|
|
|
HC INSERT/REPLACE ICD W/SUBSTERNAL ELECTRODES
|
Facility
|
IP
|
$72,138.55
|
|
|
Service Code
|
CPT 0571T
|
| Hospital Charge Code |
48100134
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$45,447.29 |
| Max. Negotiated Rate |
$64,924.69 |
| Rate for Payer: Aetna Commercial |
$61,317.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46,890.06
|
| Rate for Payer: Cash Price |
$57,710.84
|
| Rate for Payer: Cofinity Advantage |
$50,496.99
|
| Rate for Payer: Cofinity Commercial |
$62,039.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57,710.84
|
| Rate for Payer: Healthscope Commercial |
$64,924.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61,317.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54,103.91
|
| Rate for Payer: PHP Commercial |
$61,317.77
|
| Rate for Payer: Priority Health SBD |
$45,447.29
|
|
|
HC INSERT/REPLACE ICD W/SUBSTERNAL ELECTRODES
|
Facility
|
OP
|
$72,138.55
|
|
|
Service Code
|
CPT 0571T
|
| Hospital Charge Code |
48100134
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$16,357.34 |
| Max. Negotiated Rate |
$101,143.75 |
| Rate for Payer: Aetna Commercial |
$61,317.77
|
| Rate for Payer: Aetna Medicare |
$32,527.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46,890.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39,094.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39,094.99
|
| Rate for Payer: BCBS Complete |
$17,176.77
|
| Rate for Payer: BCBS MAPPO |
$31,275.99
|
| Rate for Payer: BCBS Trust/PPO |
$21,147.81
|
| Rate for Payer: BCN Commercial |
$21,147.81
|
| Rate for Payer: BCN Medicare Advantage |
$31,275.99
|
| Rate for Payer: Cash Price |
$57,710.84
|
| Rate for Payer: Cash Price |
$57,710.84
|
| Rate for Payer: Cash Price |
$57,710.84
|
| Rate for Payer: Cofinity Advantage |
$50,496.99
|
| Rate for Payer: Cofinity Commercial |
$62,039.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57,710.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31,275.99
|
| Rate for Payer: Healthscope Commercial |
$64,924.69
|
| Rate for Payer: Mclaren Medicaid |
$16,357.34
|
| Rate for Payer: Mclaren Medicare |
$31,275.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32,839.79
|
| Rate for Payer: Meridian Medicaid |
$32,839.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35,967.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$34,403.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61,317.77
|
| Rate for Payer: Nomi Health Commercial |
$93,827.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54,103.91
|
| Rate for Payer: PACE Medicare |
$29,712.19
|
| Rate for Payer: PACE SWMI |
$31,275.99
|
| Rate for Payer: PHP Commercial |
$61,317.77
|
| Rate for Payer: PHP Medicare Advantage |
$31,275.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,357.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$101,143.75
|
| Rate for Payer: Priority Health Medicare |
$31,275.99
|
| Rate for Payer: Priority Health SBD |
$45,447.29
|
| Rate for Payer: Priority Health Tiered Network |
$80,915.00
|
| Rate for Payer: Railroad Medicare Medicare |
$31,275.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$31,275.99
|
| Rate for Payer: UHC Medicaid |
$16,357.34
|
| Rate for Payer: UHCCP Medicaid |
$16,357.34
|
| Rate for Payer: VA VA |
$31,275.99
|
|
|
HC INSERT/REPLACE SQ ICD W ELECTRODES
|
Facility
|
OP
|
$86,596.51
|
|
|
Service Code
|
CPT 33270
|
| Hospital Charge Code |
48100113
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$16,357.34 |
| Max. Negotiated Rate |
$101,143.75 |
| Rate for Payer: Aetna Commercial |
$73,607.03
|
| Rate for Payer: Aetna Medicare |
$32,527.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56,287.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39,094.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39,094.99
|
| Rate for Payer: BCBS Complete |
$17,176.77
|
| Rate for Payer: BCBS MAPPO |
$31,275.99
|
| Rate for Payer: BCBS Trust/PPO |
$35,523.39
|
| Rate for Payer: BCN Commercial |
$35,523.39
|
| Rate for Payer: BCN Medicare Advantage |
$31,275.99
|
| Rate for Payer: Cash Price |
$69,277.21
|
| Rate for Payer: Cash Price |
$69,277.21
|
| Rate for Payer: Cash Price |
$69,277.21
|
| Rate for Payer: Cofinity Advantage |
$60,617.56
|
| Rate for Payer: Cofinity Commercial |
$74,473.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69,277.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31,275.99
|
| Rate for Payer: Healthscope Commercial |
$77,936.86
|
| Rate for Payer: Mclaren Medicaid |
$16,357.34
|
| Rate for Payer: Mclaren Medicare |
$31,275.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32,839.79
|
| Rate for Payer: Meridian Medicaid |
$32,839.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35,967.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$34,403.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73,607.03
|
| Rate for Payer: Nomi Health Commercial |
$93,827.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64,947.38
|
| Rate for Payer: PACE Medicare |
$29,712.19
|
| Rate for Payer: PACE SWMI |
$31,275.99
|
| Rate for Payer: PHP Commercial |
$73,607.03
|
| Rate for Payer: PHP Medicare Advantage |
$31,275.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,357.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$101,143.75
|
| Rate for Payer: Priority Health Medicare |
$31,275.99
|
| Rate for Payer: Priority Health SBD |
$54,555.80
|
| Rate for Payer: Priority Health Tiered Network |
$80,915.00
|
| Rate for Payer: Railroad Medicare Medicare |
$31,275.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$31,275.99
|
| Rate for Payer: UHC Medicaid |
$16,357.34
|
| Rate for Payer: UHCCP Medicaid |
$16,357.34
|
| Rate for Payer: VA VA |
$31,275.99
|
|
|
HC INSERT/REPLACE SQ ICD W ELECTRODES
|
Facility
|
IP
|
$86,596.51
|
|
|
Service Code
|
CPT 33270
|
| Hospital Charge Code |
48100113
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$54,555.80 |
| Max. Negotiated Rate |
$77,936.86 |
| Rate for Payer: Aetna Commercial |
$73,607.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56,287.73
|
| Rate for Payer: Cash Price |
$69,277.21
|
| Rate for Payer: Cofinity Advantage |
$60,617.56
|
| Rate for Payer: Cofinity Commercial |
$74,473.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69,277.21
|
| Rate for Payer: Healthscope Commercial |
$77,936.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73,607.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64,947.38
|
| Rate for Payer: PHP Commercial |
$73,607.03
|
| Rate for Payer: Priority Health SBD |
$54,555.80
|
|
|
HC INSERT STRAIGHT CATH
|
Facility
|
IP
|
$189.01
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
45000003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.08 |
| Max. Negotiated Rate |
$170.11 |
| Rate for Payer: Aetna Commercial |
$160.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.86
|
| Rate for Payer: Cash Price |
$151.21
|
| Rate for Payer: Cofinity Advantage |
$132.31
|
| Rate for Payer: Cofinity Commercial |
$162.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.21
|
| Rate for Payer: Healthscope Commercial |
$170.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.76
|
| Rate for Payer: PHP Commercial |
$160.66
|
| Rate for Payer: Priority Health SBD |
$119.08
|
|
|
HC INSERT STRAIGHT CATH
|
Facility
|
OP
|
$189.01
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
45000003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$428.73 |
| Rate for Payer: Aetna Commercial |
$160.66
|
| Rate for Payer: Aetna Medicare |
$137.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.86
|
| 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 |
$95.73
|
| Rate for Payer: BCN Commercial |
$95.73
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$151.21
|
| Rate for Payer: Cash Price |
$151.21
|
| Rate for Payer: Cash Price |
$151.21
|
| Rate for Payer: Cofinity Advantage |
$132.31
|
| Rate for Payer: Cofinity Commercial |
$162.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$170.11
|
| 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 |
$160.66
|
| Rate for Payer: Nomi Health Commercial |
$397.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.76
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$160.66
|
| 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 |
$119.08
|
| 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) |
$122.86
|
| Rate for Payer: UHC Core |
$98.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$74.28
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
HC INSERT TUNNELED CENTRAL LINE WO PORT OR PUMP ABOVE 5 YRS AGE
|
Facility
|
IP
|
$4,280.84
|
|
|
Service Code
|
CPT 36558
|
| Hospital Charge Code |
36100123
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,696.93 |
| Max. Negotiated Rate |
$3,852.76 |
| Rate for Payer: Aetna Commercial |
$3,638.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,782.55
|
| Rate for Payer: Cash Price |
$3,424.67
|
| Rate for Payer: Cofinity Advantage |
$2,996.59
|
| Rate for Payer: Cofinity Commercial |
$3,681.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,424.67
|
| Rate for Payer: Healthscope Commercial |
$3,852.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,638.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,210.63
|
| Rate for Payer: PHP Commercial |
$3,638.71
|
| Rate for Payer: Priority Health SBD |
$2,696.93
|
|
|
HC INSERT TUNNELED CENTRAL LINE WO PORT OR PUMP ABOVE 5 YRS AGE
|
Facility
|
OP
|
$4,280.84
|
|
|
Service Code
|
CPT 36558
|
| Hospital Charge Code |
36100123
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,623.57 |
| Max. Negotiated Rate |
$10,174.29 |
| Rate for Payer: Aetna Commercial |
$3,638.71
|
| Rate for Payer: Aetna Medicare |
$3,271.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,782.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,623.57
|
| Rate for Payer: BCN Commercial |
$1,623.57
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$3,424.67
|
| Rate for Payer: Cash Price |
$3,424.67
|
| Rate for Payer: Cash Price |
$3,424.67
|
| Rate for Payer: Cofinity Advantage |
$2,996.59
|
| Rate for Payer: Cofinity Commercial |
$3,681.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,424.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$3,852.76
|
| Rate for Payer: Mclaren Medicaid |
$1,645.43
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$3,303.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,638.71
|
| Rate for Payer: Nomi Health Commercial |
$9,438.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,210.63
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$3,638.71
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,174.29
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health SBD |
$2,696.93
|
| Rate for Payer: Priority Health Tiered Network |
$8,139.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
HC INSERT TUNNELED CENTRAL LINE WO PORT OR PUMP LESS THAN 5 YRS AGE
|
Facility
|
IP
|
$4,222.35
|
|
|
Service Code
|
CPT 36557
|
| Hospital Charge Code |
36100122
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,660.08 |
| Max. Negotiated Rate |
$3,800.11 |
| Rate for Payer: Aetna Commercial |
$3,589.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,744.53
|
| Rate for Payer: Cash Price |
$3,377.88
|
| Rate for Payer: Cofinity Advantage |
$2,955.64
|
| Rate for Payer: Cofinity Commercial |
$3,631.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,377.88
|
| Rate for Payer: Healthscope Commercial |
$3,800.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,589.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,166.76
|
| Rate for Payer: PHP Commercial |
$3,589.00
|
| Rate for Payer: Priority Health SBD |
$2,660.08
|
|
|
HC INSERT TUNNELED CENTRAL LINE WO PORT OR PUMP LESS THAN 5 YRS AGE
|
Facility
|
OP
|
$4,222.35
|
|
|
Service Code
|
CPT 36557
|
| Hospital Charge Code |
36100122
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,427.99 |
| Max. Negotiated Rate |
$17,930.33 |
| Rate for Payer: Aetna Commercial |
$3,589.00
|
| Rate for Payer: Aetna Medicare |
$5,766.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,744.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,930.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,930.60
|
| Rate for Payer: BCBS Complete |
$3,045.03
|
| Rate for Payer: BCBS MAPPO |
$5,544.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,427.99
|
| Rate for Payer: BCN Commercial |
$2,427.99
|
| Rate for Payer: BCN Medicare Advantage |
$5,544.48
|
| Rate for Payer: Cash Price |
$3,377.88
|
| Rate for Payer: Cash Price |
$3,377.88
|
| Rate for Payer: Cash Price |
$3,377.88
|
| Rate for Payer: Cofinity Advantage |
$2,955.64
|
| Rate for Payer: Cofinity Commercial |
$3,631.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,377.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,544.48
|
| Rate for Payer: Healthscope Commercial |
$3,800.11
|
| Rate for Payer: Mclaren Medicaid |
$2,899.76
|
| Rate for Payer: Mclaren Medicare |
$5,544.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,821.70
|
| Rate for Payer: Meridian Medicaid |
$5,821.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,376.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,098.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,589.00
|
| Rate for Payer: Nomi Health Commercial |
$16,633.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,166.76
|
| Rate for Payer: PACE Medicare |
$5,267.26
|
| Rate for Payer: PACE SWMI |
$5,544.48
|
| Rate for Payer: PHP Commercial |
$3,589.00
|
| Rate for Payer: PHP Medicare Advantage |
$5,544.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,899.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,930.33
|
| Rate for Payer: Priority Health Medicare |
$5,544.48
|
| Rate for Payer: Priority Health SBD |
$2,660.08
|
| Rate for Payer: Priority Health Tiered Network |
$14,344.26
|
| Rate for Payer: Railroad Medicare Medicare |
$5,544.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,544.48
|
| Rate for Payer: UHC Medicaid |
$2,899.76
|
| Rate for Payer: UHCCP Medicaid |
$2,899.76
|
| Rate for Payer: VA VA |
$5,544.48
|
|
|
HC IN SITU HYBRID EA ADDL PROBE STAIN PER SPECIMEN
|
Facility
|
OP
|
$275.53
|
|
|
Service Code
|
CPT 88364
|
| Hospital Charge Code |
31000120
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$110.21 |
| Max. Negotiated Rate |
$247.98 |
| Rate for Payer: Aetna Commercial |
$234.20
|
| Rate for Payer: Aetna Medicare |
$137.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.09
|
| Rate for Payer: BCBS Complete |
$110.21
|
| Rate for Payer: BCBS Trust/PPO |
$164.11
|
| Rate for Payer: BCCCP Commercial |
$119.98
|
| Rate for Payer: BCN Commercial |
$164.11
|
| Rate for Payer: Cash Price |
$220.42
|
| Rate for Payer: Cash Price |
$220.42
|
| Rate for Payer: Cofinity Advantage |
$192.87
|
| Rate for Payer: Cofinity Commercial |
$236.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.42
|
| Rate for Payer: Healthscope Commercial |
$247.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$220.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.65
|
| Rate for Payer: PHP Commercial |
$234.20
|
| Rate for Payer: Priority Health SBD |
$173.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.22
|
| Rate for Payer: UHC Core |
$140.22
|
| Rate for Payer: UHC Exchange |
$140.22
|
|
|
HC IN SITU HYBRID EA ADDL PROBE STAIN PER SPECIMEN
|
Facility
|
IP
|
$275.53
|
|
|
Service Code
|
CPT 88364
|
| Hospital Charge Code |
31000120
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$173.58 |
| Max. Negotiated Rate |
$247.98 |
| Rate for Payer: Aetna Commercial |
$234.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.09
|
| Rate for Payer: Cash Price |
$220.42
|
| Rate for Payer: Cofinity Advantage |
$192.87
|
| Rate for Payer: Cofinity Commercial |
$236.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.42
|
| Rate for Payer: Healthscope Commercial |
$247.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.65
|
| Rate for Payer: PHP Commercial |
$234.20
|
| Rate for Payer: Priority Health SBD |
$173.58
|
|
|
HC IN SITU HYBRID MULTIPLX MRPH QUANT OR SEMI-QUANT
|
Facility
|
OP
|
$668.56
|
|
|
Service Code
|
CPT 88377
|
| Hospital Charge Code |
31000119
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$88.78 |
| Max. Negotiated Rate |
$601.70 |
| Rate for Payer: Aetna Commercial |
$568.28
|
| Rate for Payer: Aetna Medicare |
$176.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$212.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$212.20
|
| Rate for Payer: BCBS Complete |
$93.23
|
| Rate for Payer: BCBS MAPPO |
$169.76
|
| Rate for Payer: BCBS Trust/PPO |
$554.24
|
| Rate for Payer: BCCCP Commercial |
$359.30
|
| Rate for Payer: BCN Commercial |
$554.24
|
| Rate for Payer: BCN Medicare Advantage |
$169.76
|
| Rate for Payer: Cash Price |
$534.85
|
| Rate for Payer: Cash Price |
$534.85
|
| Rate for Payer: Cofinity Advantage |
$467.99
|
| Rate for Payer: Cofinity Commercial |
$574.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$534.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.76
|
| Rate for Payer: Healthscope Commercial |
$601.70
|
| Rate for Payer: Mclaren Medicaid |
$88.78
|
| Rate for Payer: Mclaren Medicare |
$169.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.25
|
| Rate for Payer: Meridian Medicaid |
$178.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$186.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.28
|
| Rate for Payer: Nomi Health Commercial |
$509.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$501.42
|
| Rate for Payer: PACE Medicare |
$161.27
|
| Rate for Payer: PACE SWMI |
$169.76
|
| Rate for Payer: PHP Commercial |
$568.28
|
| Rate for Payer: PHP Medicare Advantage |
$169.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$548.99
|
| Rate for Payer: Priority Health Medicare |
$169.76
|
| Rate for Payer: Priority Health SBD |
$421.19
|
| Rate for Payer: Priority Health Tiered Network |
$439.19
|
| Rate for Payer: Railroad Medicare Medicare |
$169.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.04
|
| Rate for Payer: UHC Core |
$257.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$169.76
|
| Rate for Payer: UHC Exchange |
$257.04
|
| Rate for Payer: UHC Medicaid |
$88.78
|
| Rate for Payer: UHCCP Medicaid |
$88.78
|
| Rate for Payer: VA VA |
$169.76
|
|
|
HC IN SITU HYBRID MULTIPLX MRPH QUANT OR SEMI-QUANT
|
Facility
|
IP
|
$668.56
|
|
|
Service Code
|
CPT 88377
|
| Hospital Charge Code |
31000119
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$421.19 |
| Max. Negotiated Rate |
$601.70 |
| Rate for Payer: Aetna Commercial |
$568.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.56
|
| Rate for Payer: Cash Price |
$534.85
|
| Rate for Payer: Cofinity Advantage |
$467.99
|
| Rate for Payer: Cofinity Commercial |
$574.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$534.85
|
| Rate for Payer: Healthscope Commercial |
$601.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$501.42
|
| Rate for Payer: PHP Commercial |
$568.28
|
| Rate for Payer: Priority Health SBD |
$421.19
|
|
|
HC INSTILL ANTICARCIN BLADDER
|
Facility
|
OP
|
$761.46
|
|
|
Service Code
|
CPT 51720
|
| Hospital Charge Code |
36100449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$299.25 |
| Max. Negotiated Rate |
$2,246.88 |
| Rate for Payer: Aetna Commercial |
$647.24
|
| Rate for Payer: Aetna Medicare |
$722.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$494.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$868.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$868.49
|
| Rate for Payer: BCBS Complete |
$381.58
|
| Rate for Payer: BCBS MAPPO |
$694.79
|
| Rate for Payer: BCBS Trust/PPO |
$515.59
|
| Rate for Payer: BCN Commercial |
$515.59
|
| Rate for Payer: BCN Medicare Advantage |
$694.79
|
| Rate for Payer: Cash Price |
$609.17
|
| Rate for Payer: Cash Price |
$609.17
|
| Rate for Payer: Cash Price |
$609.17
|
| Rate for Payer: Cofinity Advantage |
$533.02
|
| Rate for Payer: Cofinity Commercial |
$654.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$609.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$694.79
|
| Rate for Payer: Healthscope Commercial |
$685.31
|
| Rate for Payer: Mclaren Medicaid |
$363.38
|
| Rate for Payer: Mclaren Medicare |
$694.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$729.53
|
| Rate for Payer: Meridian Medicaid |
$729.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$799.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$764.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$647.24
|
| Rate for Payer: Nomi Health Commercial |
$2,084.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$571.10
|
| Rate for Payer: PACE Medicare |
$660.05
|
| Rate for Payer: PACE SWMI |
$694.79
|
| Rate for Payer: PHP Commercial |
$647.24
|
| Rate for Payer: PHP Medicare Advantage |
$694.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,246.88
|
| Rate for Payer: Priority Health Medicare |
$694.79
|
| Rate for Payer: Priority Health SBD |
$479.72
|
| Rate for Payer: Priority Health Tiered Network |
$1,797.50
|
| Rate for Payer: Railroad Medicare Medicare |
$694.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$494.95
|
| Rate for Payer: UHC Core |
$396.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$694.79
|
| Rate for Payer: UHC Exchange |
$299.25
|
| Rate for Payer: UHC Medicaid |
$363.38
|
| Rate for Payer: UHCCP Medicaid |
$363.38
|
| Rate for Payer: VA VA |
$694.79
|
|
|
HC INSTILL ANTICARCIN BLADDER
|
Facility
|
IP
|
$761.46
|
|
|
Service Code
|
CPT 51720
|
| Hospital Charge Code |
36100449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$479.72 |
| Max. Negotiated Rate |
$685.31 |
| Rate for Payer: Aetna Commercial |
$647.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$494.95
|
| Rate for Payer: Cash Price |
$609.17
|
| Rate for Payer: Cofinity Advantage |
$533.02
|
| Rate for Payer: Cofinity Commercial |
$654.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$609.17
|
| Rate for Payer: Healthscope Commercial |
$685.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$647.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$571.10
|
| Rate for Payer: PHP Commercial |
$647.24
|
| Rate for Payer: Priority Health SBD |
$479.72
|
|
|
HC INST THER AGENT RENAL PELVIS/URETER VIA TUB
|
Facility
|
OP
|
$680.24
|
|
|
Service Code
|
CPT 50391
|
| Hospital Charge Code |
36100571
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$46.77 |
| Max. Negotiated Rate |
$805.08 |
| Rate for Payer: Aetna Commercial |
$578.20
|
| Rate for Payer: Aetna Medicare |
$258.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$442.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$311.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$311.19
|
| Rate for Payer: BCBS Complete |
$136.72
|
| Rate for Payer: BCBS MAPPO |
$248.95
|
| Rate for Payer: BCBS Trust/PPO |
$46.77
|
| Rate for Payer: BCN Commercial |
$46.77
|
| Rate for Payer: BCN Medicare Advantage |
$248.95
|
| Rate for Payer: Cash Price |
$544.19
|
| Rate for Payer: Cash Price |
$544.19
|
| Rate for Payer: Cash Price |
$544.19
|
| Rate for Payer: Cofinity Advantage |
$476.17
|
| Rate for Payer: Cofinity Commercial |
$585.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$544.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.95
|
| Rate for Payer: Healthscope Commercial |
$612.22
|
| Rate for Payer: Mclaren Medicaid |
$130.20
|
| Rate for Payer: Mclaren Medicare |
$248.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.40
|
| Rate for Payer: Meridian Medicaid |
$261.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$286.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$273.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$578.20
|
| Rate for Payer: Nomi Health Commercial |
$746.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$510.18
|
| Rate for Payer: PACE Medicare |
$236.50
|
| Rate for Payer: PACE SWMI |
$248.95
|
| Rate for Payer: PHP Commercial |
$578.20
|
| Rate for Payer: PHP Medicare Advantage |
$248.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$805.08
|
| Rate for Payer: Priority Health Medicare |
$248.95
|
| Rate for Payer: Priority Health SBD |
$428.55
|
| Rate for Payer: Priority Health Tiered Network |
$644.06
|
| Rate for Payer: Railroad Medicare Medicare |
$248.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$248.95
|
| Rate for Payer: UHC Medicaid |
$130.20
|
| Rate for Payer: UHCCP Medicaid |
$130.20
|
| Rate for Payer: VA VA |
$248.95
|
|
|
HC INST THER AGENT RENAL PELVIS/URETER VIA TUB
|
Facility
|
IP
|
$680.24
|
|
|
Service Code
|
CPT 50391
|
| Hospital Charge Code |
36100571
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$428.55 |
| Max. Negotiated Rate |
$612.22 |
| Rate for Payer: Aetna Commercial |
$578.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$442.16
|
| Rate for Payer: Cash Price |
$544.19
|
| Rate for Payer: Cofinity Advantage |
$476.17
|
| Rate for Payer: Cofinity Commercial |
$585.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$544.19
|
| Rate for Payer: Healthscope Commercial |
$612.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$578.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$510.18
|
| Rate for Payer: PHP Commercial |
$578.20
|
| Rate for Payer: Priority Health SBD |
$428.55
|
|
|
HC INSULIN
|
Facility
|
OP
|
$101.96
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
30100266
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$91.76 |
| Rate for Payer: Aetna Commercial |
$86.67
|
| Rate for Payer: Aetna Medicare |
$11.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.29
|
| Rate for Payer: BCBS Complete |
$6.28
|
| Rate for Payer: BCBS MAPPO |
$11.43
|
| Rate for Payer: BCBS Trust/PPO |
$12.18
|
| Rate for Payer: BCN Commercial |
$12.18
|
| Rate for Payer: BCN Medicare Advantage |
$11.43
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cofinity Advantage |
$71.37
|
| Rate for Payer: Cofinity Commercial |
$87.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.43
|
| Rate for Payer: Healthscope Commercial |
$91.76
|
| Rate for Payer: Mclaren Medicaid |
$5.98
|
| Rate for Payer: Mclaren Medicare |
$11.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.00
|
| Rate for Payer: Meridian Medicaid |
$12.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.67
|
| Rate for Payer: Nomi Health Commercial |
$17.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.47
|
| Rate for Payer: PACE Medicare |
$10.86
|
| Rate for Payer: PACE SWMI |
$11.43
|
| Rate for Payer: PHP Commercial |
$86.67
|
| Rate for Payer: PHP Medicare Advantage |
$11.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11.43
|
| Rate for Payer: Priority Health Medicare |
$11.43
|
| Rate for Payer: Priority Health SBD |
$64.23
|
| Rate for Payer: Priority Health Tiered Network |
$9.14
|
| Rate for Payer: Railroad Medicare Medicare |
$11.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.15
|
| Rate for Payer: UHC Core |
$17.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.43
|
| Rate for Payer: UHC Exchange |
$17.15
|
| Rate for Payer: UHC Medicaid |
$5.98
|
| Rate for Payer: UHCCP Medicaid |
$5.98
|
| Rate for Payer: VA VA |
$11.43
|
|
|
HC INSULIN
|
Facility
|
IP
|
$101.96
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
30100266
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.23 |
| Max. Negotiated Rate |
$91.76 |
| Rate for Payer: Aetna Commercial |
$86.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.27
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cofinity Advantage |
$71.37
|
| Rate for Payer: Cofinity Commercial |
$87.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.57
|
| Rate for Payer: Healthscope Commercial |
$91.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.47
|
| Rate for Payer: PHP Commercial |
$86.67
|
| Rate for Payer: Priority Health SBD |
$64.23
|
|
|
HC INSULIN ANTIBODIES
|
Facility
|
IP
|
$70.75
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
30200199
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$44.57 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Aetna Commercial |
$60.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.99
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Advantage |
$49.52
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Healthscope Commercial |
$63.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.06
|
| Rate for Payer: PHP Commercial |
$60.14
|
| Rate for Payer: Priority Health SBD |
$44.57
|
|
