|
HC HYSTEROSCOPY RESECT SEPTUM
|
Facility
|
IP
|
$13,353.53
|
|
|
Service Code
|
CPT 58560
|
| Hospital Charge Code |
76100337
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$8,412.72 |
| Max. Negotiated Rate |
$12,018.18 |
| Rate for Payer: Aetna Commercial |
$11,350.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,679.79
|
| Rate for Payer: Cash Price |
$10,682.82
|
| Rate for Payer: Cofinity Commercial |
$11,484.04
|
| Rate for Payer: Cofinity Commercial |
$9,347.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,347.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,682.82
|
| Rate for Payer: Healthscope Commercial |
$12,018.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,350.50
|
| Rate for Payer: PHP Commercial |
$11,350.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,679.79
|
| Rate for Payer: Priority Health SBD |
$8,412.72
|
|
|
HC HYSTEROSCOPY W BX AND/OR POLYPECTOMY W OR WO D&C
|
Facility
|
OP
|
$4,093.79
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
76100304
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.14 |
| Max. Negotiated Rate |
$9,791.14 |
| Rate for Payer: Aetna Commercial |
$3,479.72
|
| Rate for Payer: Aetna Medicare |
$3,239.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,660.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,852.76
|
| Rate for Payer: BCN Commercial |
$1,852.76
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Cash Price |
$3,275.03
|
| Rate for Payer: Cash Price |
$3,275.03
|
| Rate for Payer: Cash Price |
$3,275.03
|
| Rate for Payer: Cofinity Commercial |
$3,520.66
|
| Rate for Payer: Cofinity Commercial |
$2,865.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,865.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,275.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Healthscope Commercial |
$3,684.41
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,479.72
|
| Rate for Payer: Nomi Health Commercial |
$6,542.00
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Commercial |
$3,479.72
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,660.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,791.14
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,832.91
|
| Rate for Payer: Priority Health SBD |
$2,579.09
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.14
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,753.88
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
HC HYSTEROSCOPY W BX AND/OR POLYPECTOMY W OR WO D&C
|
Facility
|
IP
|
$4,093.79
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
76100304
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,579.09 |
| Max. Negotiated Rate |
$3,684.41 |
| Rate for Payer: Aetna Commercial |
$3,479.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,660.96
|
| Rate for Payer: Cash Price |
$3,275.03
|
| Rate for Payer: Cofinity Commercial |
$2,865.65
|
| Rate for Payer: Cofinity Commercial |
$3,520.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,865.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,275.03
|
| Rate for Payer: Healthscope Commercial |
$3,684.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,479.72
|
| Rate for Payer: PHP Commercial |
$3,479.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,660.96
|
| Rate for Payer: Priority Health SBD |
$2,579.09
|
|
|
HC I-123 CAPSULE PER 100 UCI
|
Facility
|
IP
|
$105.67
|
|
|
Service Code
|
HCPCS A9516
|
| Hospital Charge Code |
34300009
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$66.57 |
| Max. Negotiated Rate |
$95.10 |
| Rate for Payer: Aetna Commercial |
$89.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.69
|
| Rate for Payer: Cash Price |
$84.54
|
| Rate for Payer: Cofinity Commercial |
$73.97
|
| Rate for Payer: Cofinity Commercial |
$90.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.54
|
| Rate for Payer: Healthscope Commercial |
$95.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.82
|
| Rate for Payer: PHP Commercial |
$89.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.69
|
| Rate for Payer: Priority Health SBD |
$66.57
|
|
|
HC I-123 CAPSULE PER 100 UCI
|
Facility
|
OP
|
$105.67
|
|
|
Service Code
|
HCPCS A9516
|
| Hospital Charge Code |
34300009
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$42.27 |
| Max. Negotiated Rate |
$95.10 |
| Rate for Payer: Aetna Commercial |
$89.82
|
| Rate for Payer: Aetna Medicare |
$52.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.69
|
| Rate for Payer: BCBS Complete |
$42.27
|
| Rate for Payer: BCBS Trust/PPO |
$68.02
|
| Rate for Payer: BCN Commercial |
$68.02
|
| Rate for Payer: Cash Price |
$84.54
|
| Rate for Payer: Cash Price |
$84.54
|
| Rate for Payer: Cofinity Commercial |
$73.97
|
| Rate for Payer: Cofinity Commercial |
$90.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.54
|
| Rate for Payer: Healthscope Commercial |
$95.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.82
|
| Rate for Payer: PHP Commercial |
$89.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.69
|
| Rate for Payer: Priority Health SBD |
$66.57
|
|
|
HC I-123 MIBG PER STUDY
|
Facility
|
OP
|
$12,176.80
|
|
|
Service Code
|
HCPCS A9582
|
| Hospital Charge Code |
34300010
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,112.10 |
| Max. Negotiated Rate |
$10,959.12 |
| Rate for Payer: Aetna Commercial |
$10,350.28
|
| Rate for Payer: Aetna Medicare |
$2,157.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,914.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,593.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,593.51
|
| Rate for Payer: BCBS Complete |
$1,167.70
|
| Rate for Payer: BCBS MAPPO |
$2,074.81
|
| Rate for Payer: BCBS Trust/PPO |
$5,914.60
|
| Rate for Payer: BCN Commercial |
$5,914.60
|
| Rate for Payer: BCN Medicare Advantage |
$2,074.81
|
| Rate for Payer: Cash Price |
$9,741.44
|
| Rate for Payer: Cash Price |
$9,741.44
|
| Rate for Payer: Cofinity Commercial |
$8,523.76
|
| Rate for Payer: Cofinity Commercial |
$10,472.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,523.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,741.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,074.81
|
| Rate for Payer: Healthscope Commercial |
$10,959.12
|
| Rate for Payer: Mclaren Medicaid |
$1,112.10
|
| Rate for Payer: Mclaren Medicare |
$2,074.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,178.55
|
| Rate for Payer: Meridian Medicaid |
$1,167.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,386.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,350.28
|
| Rate for Payer: Nomi Health Commercial |
$6,224.43
|
| Rate for Payer: PACE Medicare |
$1,971.07
|
| Rate for Payer: PACE SWMI |
$2,074.81
|
| Rate for Payer: PHP Commercial |
$10,350.28
|
| Rate for Payer: PHP Medicare Advantage |
$2,074.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,112.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,914.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,971.34
|
| Rate for Payer: Priority Health Medicare |
$2,074.81
|
| Rate for Payer: Priority Health Narrow Network |
$4,777.07
|
| Rate for Payer: Priority Health SBD |
$7,671.38
|
| Rate for Payer: Railroad Medicare Medicare |
$2,074.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,840.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,074.81
|
| Rate for Payer: UHC Medicare Advantage |
$2,074.81
|
| Rate for Payer: UHCCP Medicaid |
$1,168.12
|
| Rate for Payer: VA VA |
$2,074.81
|
|
|
HC I-123 MIBG PER STUDY
|
Facility
|
IP
|
$12,176.80
|
|
|
Service Code
|
HCPCS A9582
|
| Hospital Charge Code |
34300010
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$7,671.38 |
| Max. Negotiated Rate |
$10,959.12 |
| Rate for Payer: Aetna Commercial |
$10,350.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,914.92
|
| Rate for Payer: Cash Price |
$9,741.44
|
| Rate for Payer: Cofinity Commercial |
$10,472.05
|
| Rate for Payer: Cofinity Commercial |
$8,523.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,523.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,741.44
|
| Rate for Payer: Healthscope Commercial |
$10,959.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,350.28
|
| Rate for Payer: PHP Commercial |
$10,350.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,914.92
|
| Rate for Payer: Priority Health SBD |
$7,671.38
|
|
|
HC I-131 CAP (DX) PER MCI
|
Facility
|
IP
|
$74.94
|
|
|
Service Code
|
HCPCS A9528
|
| Hospital Charge Code |
34300011
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$47.21 |
| Max. Negotiated Rate |
$67.45 |
| Rate for Payer: Aetna Commercial |
$63.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.71
|
| Rate for Payer: Cash Price |
$59.95
|
| Rate for Payer: Cofinity Commercial |
$52.46
|
| Rate for Payer: Cofinity Commercial |
$64.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.95
|
| Rate for Payer: Healthscope Commercial |
$67.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.70
|
| Rate for Payer: PHP Commercial |
$63.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.71
|
| Rate for Payer: Priority Health SBD |
$47.21
|
|
|
HC I-131 CAP (DX) PER MCI
|
Facility
|
OP
|
$74.94
|
|
|
Service Code
|
HCPCS A9528
|
| Hospital Charge Code |
34300011
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$29.98 |
| Max. Negotiated Rate |
$147.54 |
| Rate for Payer: Aetna Commercial |
$63.70
|
| Rate for Payer: Aetna Medicare |
$37.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.71
|
| Rate for Payer: BCBS Complete |
$29.98
|
| Rate for Payer: BCBS Trust/PPO |
$147.54
|
| Rate for Payer: BCN Commercial |
$147.54
|
| Rate for Payer: Cash Price |
$59.95
|
| Rate for Payer: Cash Price |
$59.95
|
| Rate for Payer: Cofinity Commercial |
$52.46
|
| Rate for Payer: Cofinity Commercial |
$64.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.95
|
| Rate for Payer: Healthscope Commercial |
$67.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.70
|
| Rate for Payer: PHP Commercial |
$63.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.71
|
| Rate for Payer: Priority Health SBD |
$47.21
|
|
|
HC I-131 CAP (TX) PER MCI
|
Facility
|
OP
|
$68.13
|
|
|
Service Code
|
HCPCS A9517
|
| Hospital Charge Code |
34400001
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$69.39 |
| Rate for Payer: Aetna Commercial |
$57.91
|
| Rate for Payer: Aetna Medicare |
$24.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.91
|
| Rate for Payer: BCBS Complete |
$13.02
|
| Rate for Payer: BCBS MAPPO |
$23.13
|
| Rate for Payer: BCBS Trust/PPO |
$25.19
|
| Rate for Payer: BCN Commercial |
$25.19
|
| Rate for Payer: BCN Medicare Advantage |
$23.13
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cofinity Commercial |
$47.69
|
| Rate for Payer: Cofinity Commercial |
$58.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.13
|
| Rate for Payer: Healthscope Commercial |
$61.32
|
| Rate for Payer: Mclaren Medicaid |
$12.40
|
| Rate for Payer: Mclaren Medicare |
$23.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.29
|
| Rate for Payer: Meridian Medicaid |
$13.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.91
|
| Rate for Payer: Nomi Health Commercial |
$69.39
|
| Rate for Payer: PACE Medicare |
$21.97
|
| Rate for Payer: PACE SWMI |
$23.13
|
| Rate for Payer: PHP Commercial |
$57.91
|
| Rate for Payer: PHP Medicare Advantage |
$23.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.57
|
| Rate for Payer: Priority Health Medicare |
$23.13
|
| Rate for Payer: Priority Health Narrow Network |
$53.26
|
| Rate for Payer: Priority Health SBD |
$42.92
|
| Rate for Payer: Railroad Medicare Medicare |
$23.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.13
|
| Rate for Payer: UHC Medicare Advantage |
$23.13
|
| Rate for Payer: UHCCP Medicaid |
$13.02
|
| Rate for Payer: VA VA |
$23.13
|
|
|
HC I-131 CAP (TX) PER MCI
|
Facility
|
IP
|
$68.13
|
|
|
Service Code
|
HCPCS A9517
|
| Hospital Charge Code |
34400001
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$42.92 |
| Max. Negotiated Rate |
$61.32 |
| Rate for Payer: Aetna Commercial |
$57.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.28
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cofinity Commercial |
$47.69
|
| Rate for Payer: Cofinity Commercial |
$58.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.50
|
| Rate for Payer: Healthscope Commercial |
$61.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.91
|
| Rate for Payer: PHP Commercial |
$57.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.28
|
| Rate for Payer: Priority Health SBD |
$42.92
|
|
|
HC I-131 SOD IODIDE DIAG PER UCI
|
Facility
|
OP
|
$47.86
|
|
|
Service Code
|
HCPCS A9531
|
| Hospital Charge Code |
34300031
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$12.45 |
| Max. Negotiated Rate |
$43.07 |
| Rate for Payer: Aetna Commercial |
$40.68
|
| Rate for Payer: Aetna Medicare |
$23.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.11
|
| Rate for Payer: BCBS Complete |
$19.14
|
| Rate for Payer: BCBS Trust/PPO |
$12.45
|
| Rate for Payer: BCN Commercial |
$12.45
|
| Rate for Payer: Cash Price |
$38.29
|
| Rate for Payer: Cash Price |
$38.29
|
| Rate for Payer: Cofinity Commercial |
$33.50
|
| Rate for Payer: Cofinity Commercial |
$41.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.29
|
| Rate for Payer: Healthscope Commercial |
$43.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.68
|
| Rate for Payer: PHP Commercial |
$40.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.11
|
| Rate for Payer: Priority Health SBD |
$30.15
|
|
|
HC I-131 SOD IODIDE DIAG PER UCI
|
Facility
|
IP
|
$47.86
|
|
|
Service Code
|
HCPCS A9531
|
| Hospital Charge Code |
34300031
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$30.15 |
| Max. Negotiated Rate |
$43.07 |
| Rate for Payer: Aetna Commercial |
$40.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.11
|
| Rate for Payer: Cash Price |
$38.29
|
| Rate for Payer: Cofinity Commercial |
$33.50
|
| Rate for Payer: Cofinity Commercial |
$41.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.29
|
| Rate for Payer: Healthscope Commercial |
$43.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.68
|
| Rate for Payer: PHP Commercial |
$40.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.11
|
| Rate for Payer: Priority Health SBD |
$30.15
|
|
|
HC I-131 SOL (DX) PER MCI
|
Facility
|
IP
|
$47.87
|
|
|
Service Code
|
HCPCS A9529
|
| Hospital Charge Code |
34300012
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$30.16 |
| Max. Negotiated Rate |
$43.08 |
| Rate for Payer: Aetna Commercial |
$40.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.12
|
| Rate for Payer: Cash Price |
$38.30
|
| Rate for Payer: Cofinity Commercial |
$33.51
|
| Rate for Payer: Cofinity Commercial |
$41.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.30
|
| Rate for Payer: Healthscope Commercial |
$43.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.69
|
| Rate for Payer: PHP Commercial |
$40.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.12
|
| Rate for Payer: Priority Health SBD |
$30.16
|
|
|
HC I-131 SOL (DX) PER MCI
|
Facility
|
OP
|
$47.87
|
|
|
Service Code
|
HCPCS A9529
|
| Hospital Charge Code |
34300012
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$43.08 |
| Rate for Payer: Aetna Commercial |
$40.69
|
| Rate for Payer: Aetna Medicare |
$23.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.12
|
| Rate for Payer: BCBS Complete |
$19.15
|
| Rate for Payer: BCBS Trust/PPO |
$8.04
|
| Rate for Payer: BCN Commercial |
$8.04
|
| Rate for Payer: Cash Price |
$38.30
|
| Rate for Payer: Cash Price |
$38.30
|
| Rate for Payer: Cofinity Commercial |
$33.51
|
| Rate for Payer: Cofinity Commercial |
$41.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.30
|
| Rate for Payer: Healthscope Commercial |
$43.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.69
|
| Rate for Payer: PHP Commercial |
$40.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.12
|
| Rate for Payer: Priority Health SBD |
$30.16
|
|
|
HC I-131 SOL (TX) PER MCI
|
Facility
|
IP
|
$47.87
|
|
|
Service Code
|
HCPCS A9530
|
| Hospital Charge Code |
34400002
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$30.16 |
| Max. Negotiated Rate |
$43.08 |
| Rate for Payer: Aetna Commercial |
$40.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.12
|
| Rate for Payer: Cash Price |
$38.30
|
| Rate for Payer: Cofinity Commercial |
$33.51
|
| Rate for Payer: Cofinity Commercial |
$41.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.30
|
| Rate for Payer: Healthscope Commercial |
$43.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.69
|
| Rate for Payer: PHP Commercial |
$40.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.12
|
| Rate for Payer: Priority Health SBD |
$30.16
|
|
|
HC I-131 SOL (TX) PER MCI
|
Facility
|
OP
|
$47.87
|
|
|
Service Code
|
HCPCS A9530
|
| Hospital Charge Code |
34400002
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$11.19 |
| Max. Negotiated Rate |
$62.64 |
| Rate for Payer: Aetna Commercial |
$40.69
|
| Rate for Payer: Aetna Medicare |
$21.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.10
|
| Rate for Payer: BCBS Complete |
$11.75
|
| Rate for Payer: BCBS MAPPO |
$20.88
|
| Rate for Payer: BCBS Trust/PPO |
$24.08
|
| Rate for Payer: BCN Commercial |
$24.08
|
| Rate for Payer: BCN Medicare Advantage |
$20.88
|
| Rate for Payer: Cash Price |
$38.30
|
| Rate for Payer: Cash Price |
$38.30
|
| Rate for Payer: Cofinity Commercial |
$41.17
|
| Rate for Payer: Cofinity Commercial |
$33.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.88
|
| Rate for Payer: Healthscope Commercial |
$43.08
|
| Rate for Payer: Mclaren Medicaid |
$11.19
|
| Rate for Payer: Mclaren Medicare |
$20.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.92
|
| Rate for Payer: Meridian Medicaid |
$11.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.69
|
| Rate for Payer: Nomi Health Commercial |
$62.64
|
| Rate for Payer: PACE Medicare |
$19.84
|
| Rate for Payer: PACE SWMI |
$20.88
|
| Rate for Payer: PHP Commercial |
$40.69
|
| Rate for Payer: PHP Medicare Advantage |
$20.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.10
|
| Rate for Payer: Priority Health Medicare |
$20.88
|
| Rate for Payer: Priority Health Narrow Network |
$48.08
|
| Rate for Payer: Priority Health SBD |
$30.16
|
| Rate for Payer: Railroad Medicare Medicare |
$20.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.88
|
| Rate for Payer: UHC Medicare Advantage |
$20.88
|
| Rate for Payer: UHCCP Medicaid |
$11.76
|
| Rate for Payer: VA VA |
$20.88
|
|
|
HC IAAD NOS EACH ORGANISM AG IA
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
30600341
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$66.15 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna Commercial |
$89.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.25
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$73.50
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.00
|
| Rate for Payer: Healthscope Commercial |
$94.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.25
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.25
|
| Rate for Payer: Priority Health SBD |
$66.15
|
|
|
HC IAAD NOS EACH ORGANISM AG IA
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
30600341
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna Commercial |
$89.25
|
| Rate for Payer: Aetna Medicare |
$12.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.98
|
| Rate for Payer: BCBS Complete |
$6.74
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$10.61
|
| Rate for Payer: BCN Commercial |
$10.61
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Cofinity Commercial |
$73.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$94.50
|
| Rate for Payer: Mclaren Medicaid |
$6.42
|
| Rate for Payer: Mclaren Medicare |
$11.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.58
|
| Rate for Payer: Meridian Medicaid |
$6.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.25
|
| Rate for Payer: Nomi Health Commercial |
$17.97
|
| Rate for Payer: PACE Medicare |
$11.38
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.33
|
| Rate for Payer: Priority Health Medicare |
$11.98
|
| Rate for Payer: Priority Health Narrow Network |
$9.86
|
| Rate for Payer: Priority Health SBD |
$66.15
|
| Rate for Payer: Railroad Medicare Medicare |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.98
|
| Rate for Payer: UHC Medicare Advantage |
$11.98
|
| Rate for Payer: UHCCP Medicaid |
$6.74
|
| Rate for Payer: VA VA |
$11.98
|
|
|
HC IAPB MONITORING SERVICES HOURL
|
Facility
|
IP
|
$408.67
|
|
| Hospital Charge Code |
27000118
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$257.46 |
| Max. Negotiated Rate |
$367.80 |
| Rate for Payer: Aetna Commercial |
$347.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.64
|
| Rate for Payer: Cash Price |
$326.94
|
| Rate for Payer: Cofinity Commercial |
$286.07
|
| Rate for Payer: Cofinity Commercial |
$351.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$286.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.94
|
| Rate for Payer: Healthscope Commercial |
$367.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.37
|
| Rate for Payer: PHP Commercial |
$347.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.64
|
| Rate for Payer: Priority Health SBD |
$257.46
|
|
|
HC IAPB MONITORING SERVICES HOURL
|
Facility
|
OP
|
$408.67
|
|
| Hospital Charge Code |
27000118
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$163.47 |
| Max. Negotiated Rate |
$367.80 |
| Rate for Payer: Aetna Commercial |
$347.37
|
| Rate for Payer: Aetna Medicare |
$204.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.64
|
| Rate for Payer: BCBS Complete |
$163.47
|
| Rate for Payer: Cash Price |
$326.94
|
| Rate for Payer: Cofinity Commercial |
$286.07
|
| Rate for Payer: Cofinity Commercial |
$351.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$286.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.94
|
| Rate for Payer: Healthscope Commercial |
$367.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.37
|
| Rate for Payer: PHP Commercial |
$347.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.64
|
| Rate for Payer: Priority Health SBD |
$257.46
|
|
|
HC IAP CHEMO ADMINISTRATON
|
Facility
|
OP
|
$398.44
|
|
|
Service Code
|
CPT 96420
|
| Hospital Charge Code |
33500010
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$101.52 |
| Max. Negotiated Rate |
$1,021.42 |
| Rate for Payer: Aetna Commercial |
$338.67
|
| Rate for Payer: Aetna Medicare |
$337.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$406.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$406.22
|
| Rate for Payer: BCBS Complete |
$182.90
|
| Rate for Payer: BCBS MAPPO |
$324.98
|
| Rate for Payer: BCBS Trust/PPO |
$409.70
|
| Rate for Payer: BCN Commercial |
$409.70
|
| Rate for Payer: BCN Medicare Advantage |
$324.98
|
| Rate for Payer: Cash Price |
$318.75
|
| Rate for Payer: Cash Price |
$318.75
|
| Rate for Payer: Cofinity Commercial |
$342.66
|
| Rate for Payer: Cofinity Commercial |
$278.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$278.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.98
|
| Rate for Payer: Healthscope Commercial |
$358.60
|
| Rate for Payer: Mclaren Medicaid |
$174.19
|
| Rate for Payer: Mclaren Medicare |
$324.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$341.23
|
| Rate for Payer: Meridian Medicaid |
$182.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$373.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.67
|
| Rate for Payer: Nomi Health Commercial |
$974.94
|
| Rate for Payer: PACE Medicare |
$308.73
|
| Rate for Payer: PACE SWMI |
$324.98
|
| Rate for Payer: PHP Commercial |
$338.67
|
| Rate for Payer: PHP Medicare Advantage |
$324.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,021.42
|
| Rate for Payer: Priority Health Medicare |
$324.98
|
| Rate for Payer: Priority Health Narrow Network |
$817.14
|
| Rate for Payer: Priority Health SBD |
$251.02
|
| Rate for Payer: Railroad Medicare Medicare |
$324.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.98
|
| Rate for Payer: UHC Exchange |
$294.85
|
| Rate for Payer: UHC Medicare Advantage |
$324.98
|
| Rate for Payer: UHCCP Medicaid |
$182.96
|
| Rate for Payer: VA VA |
$324.98
|
|
|
HC IAP CHEMO ADMINISTRATON
|
Facility
|
IP
|
$398.44
|
|
|
Service Code
|
CPT 96420
|
| Hospital Charge Code |
33500010
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$251.02 |
| Max. Negotiated Rate |
$358.60 |
| Rate for Payer: Aetna Commercial |
$338.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.99
|
| Rate for Payer: Cash Price |
$318.75
|
| Rate for Payer: Cofinity Commercial |
$278.91
|
| Rate for Payer: Cofinity Commercial |
$342.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$278.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.75
|
| Rate for Payer: Healthscope Commercial |
$358.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.67
|
| Rate for Payer: PHP Commercial |
$338.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.99
|
| Rate for Payer: Priority Health SBD |
$251.02
|
|
|
HC IBD DIFF
|
Facility
|
IP
|
$62.22
|
|
|
Service Code
|
CPT 86036
|
| Hospital Charge Code |
30200488
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna Commercial |
$52.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.44
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cofinity Commercial |
$43.55
|
| Rate for Payer: Cofinity Commercial |
$53.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.78
|
| Rate for Payer: Healthscope Commercial |
$56.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.89
|
| Rate for Payer: PHP Commercial |
$52.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.44
|
| Rate for Payer: Priority Health SBD |
$39.20
|
|
|
HC IBD DIFF
|
Facility
|
OP
|
$62.22
|
|
|
Service Code
|
CPT 86036
|
| Hospital Charge Code |
30200488
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna Commercial |
$52.89
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$10.67
|
| Rate for Payer: BCN Commercial |
$10.67
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cofinity Commercial |
$53.51
|
| Rate for Payer: Cofinity Commercial |
$43.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$56.00
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.89
|
| Rate for Payer: Nomi Health Commercial |
$18.08
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$52.89
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.05
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$9.64
|
| Rate for Payer: Priority Health SBD |
$39.20
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.78
|
| Rate for Payer: VA VA |
$12.05
|
|
