|
HC INTRAORAL I&D TONGUE/FLOOR SUBLNGL SUPFC
|
Facility
|
IP
|
$603.23
|
|
|
Service Code
|
CPT 41005
|
| Hospital Charge Code |
76100557
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$380.03 |
| Max. Negotiated Rate |
$542.91 |
| Rate for Payer: Aetna Commercial |
$512.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$392.10
|
| Rate for Payer: Cash Price |
$482.58
|
| Rate for Payer: Cofinity Advantage |
$422.26
|
| Rate for Payer: Cofinity Commercial |
$518.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$482.58
|
| Rate for Payer: Healthscope Commercial |
$542.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$512.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$452.42
|
| Rate for Payer: PHP Commercial |
$512.75
|
| Rate for Payer: Priority Health SBD |
$380.03
|
|
|
HC INTRAOSSEOUS NEEDLE PLACEMENT
|
Facility
|
IP
|
$494.59
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
45000080
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$311.59 |
| Max. Negotiated Rate |
$445.13 |
| Rate for Payer: Aetna Commercial |
$420.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.48
|
| Rate for Payer: Cash Price |
$395.67
|
| Rate for Payer: Cofinity Advantage |
$346.21
|
| Rate for Payer: Cofinity Commercial |
$425.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.67
|
| Rate for Payer: Healthscope Commercial |
$445.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$370.94
|
| Rate for Payer: PHP Commercial |
$420.40
|
| Rate for Payer: Priority Health SBD |
$311.59
|
|
|
HC INTRAOSSEOUS NEEDLE PLACEMENT
|
Facility
|
OP
|
$494.59
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
45000080
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$1,439.47 |
| Rate for Payer: Aetna Commercial |
$420.40
|
| Rate for Payer: Aetna Medicare |
$462.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$556.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$556.40
|
| Rate for Payer: BCBS Complete |
$244.46
|
| Rate for Payer: BCBS MAPPO |
$445.12
|
| Rate for Payer: BCBS Trust/PPO |
$181.00
|
| Rate for Payer: BCN Commercial |
$181.00
|
| Rate for Payer: BCN Medicare Advantage |
$445.12
|
| Rate for Payer: Cash Price |
$395.67
|
| Rate for Payer: Cash Price |
$395.67
|
| Rate for Payer: Cash Price |
$395.67
|
| Rate for Payer: Cofinity Advantage |
$346.21
|
| Rate for Payer: Cofinity Commercial |
$425.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$445.12
|
| Rate for Payer: Healthscope Commercial |
$445.13
|
| Rate for Payer: Mclaren Medicaid |
$232.80
|
| Rate for Payer: Mclaren Medicare |
$445.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$467.38
|
| Rate for Payer: Meridian Medicaid |
$467.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$511.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$489.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.40
|
| Rate for Payer: Nomi Health Commercial |
$1,335.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$370.94
|
| Rate for Payer: PACE Medicare |
$422.86
|
| Rate for Payer: PACE SWMI |
$445.12
|
| Rate for Payer: PHP Commercial |
$420.40
|
| Rate for Payer: PHP Medicare Advantage |
$445.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$232.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,439.47
|
| Rate for Payer: Priority Health Medicare |
$445.12
|
| Rate for Payer: Priority Health SBD |
$311.59
|
| Rate for Payer: Priority Health Tiered Network |
$1,151.58
|
| Rate for Payer: Railroad Medicare Medicare |
$445.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$445.12
|
| Rate for Payer: UHC Medicaid |
$232.80
|
| Rate for Payer: UHCCP Medicaid |
$144.00
|
| Rate for Payer: VA VA |
$445.12
|
|
|
HC INTRASPINAL CATHETER
|
Facility
|
OP
|
$298.59
|
|
|
Service Code
|
HCPCS C1755
|
| Hospital Charge Code |
27200248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.35 |
| Max. Negotiated Rate |
$268.73 |
| Rate for Payer: Aetna Commercial |
$253.80
|
| Rate for Payer: Aetna Medicare |
$149.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.08
|
| Rate for Payer: BCBS Complete |
$119.44
|
| Rate for Payer: Cash Price |
$238.87
|
| Rate for Payer: Cofinity Advantage |
$209.01
|
| Rate for Payer: Cofinity Commercial |
$256.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.87
|
| Rate for Payer: Healthscope Commercial |
$268.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$238.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.94
|
| Rate for Payer: PHP Commercial |
$253.80
|
| Rate for Payer: Priority Health SBD |
$188.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.08
|
| Rate for Payer: UHC Core |
$155.57
|
| Rate for Payer: UHC Exchange |
$117.35
|
|
|
HC INTRASPINAL CATHETER
|
Facility
|
IP
|
$298.59
|
|
|
Service Code
|
HCPCS C1755
|
| Hospital Charge Code |
27200248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.11 |
| Max. Negotiated Rate |
$268.73 |
| Rate for Payer: Aetna Commercial |
$253.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.08
|
| Rate for Payer: Cash Price |
$238.87
|
| Rate for Payer: Cofinity Advantage |
$209.01
|
| Rate for Payer: Cofinity Commercial |
$256.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.87
|
| Rate for Payer: Healthscope Commercial |
$268.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.94
|
| Rate for Payer: PHP Commercial |
$253.80
|
| Rate for Payer: Priority Health SBD |
$188.11
|
|
|
HC INTRAUTERINE COPPER CONTRACEPTIVE
|
Facility
|
IP
|
$1,800.75
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
63600119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,134.47 |
| Max. Negotiated Rate |
$1,620.67 |
| Rate for Payer: Aetna Commercial |
$1,530.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,170.49
|
| Rate for Payer: Cash Price |
$1,440.60
|
| Rate for Payer: Cofinity Advantage |
$1,260.53
|
| Rate for Payer: Cofinity Commercial |
$1,548.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,440.60
|
| Rate for Payer: Healthscope Commercial |
$1,620.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,530.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,350.56
|
| Rate for Payer: PHP Commercial |
$1,530.64
|
| Rate for Payer: Priority Health SBD |
$1,134.47
|
|
|
HC INTRAUTERINE COPPER CONTRACEPTIVE
|
Facility
|
OP
|
$1,800.75
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
63600119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$720.30 |
| Max. Negotiated Rate |
$2,945.40 |
| Rate for Payer: Aetna Commercial |
$1,530.64
|
| Rate for Payer: Aetna Medicare |
$900.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,170.49
|
| Rate for Payer: BCBS Complete |
$720.30
|
| Rate for Payer: BCBS Trust/PPO |
$2,945.40
|
| Rate for Payer: BCN Commercial |
$2,945.40
|
| Rate for Payer: Cash Price |
$1,440.60
|
| Rate for Payer: Cash Price |
$1,440.60
|
| Rate for Payer: Cofinity Advantage |
$1,260.53
|
| Rate for Payer: Cofinity Commercial |
$1,548.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,440.60
|
| Rate for Payer: Healthscope Commercial |
$1,620.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,440.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,530.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,350.56
|
| Rate for Payer: PHP Commercial |
$1,530.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,207.34
|
| Rate for Payer: Priority Health SBD |
$1,134.47
|
| Rate for Payer: Priority Health Tiered Network |
$965.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,349.60
|
| Rate for Payer: UHC Core |
$2,349.60
|
| Rate for Payer: UHC Exchange |
$2,349.60
|
|
|
HC INTRAVENTRICULAR PACING
|
Facility
|
IP
|
$3,842.58
|
|
|
Service Code
|
CPT 93612
|
| Hospital Charge Code |
48100034
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,420.83 |
| Max. Negotiated Rate |
$3,458.32 |
| Rate for Payer: Aetna Commercial |
$3,266.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,497.68
|
| Rate for Payer: Cash Price |
$3,074.06
|
| Rate for Payer: Cofinity Advantage |
$2,689.81
|
| Rate for Payer: Cofinity Commercial |
$3,304.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,074.06
|
| Rate for Payer: Healthscope Commercial |
$3,458.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,266.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,881.93
|
| Rate for Payer: PHP Commercial |
$3,266.19
|
| Rate for Payer: Priority Health SBD |
$2,420.83
|
|
|
HC INTRAVENTRICULAR PACING
|
Facility
|
OP
|
$3,842.58
|
|
|
Service Code
|
CPT 93612
|
| Hospital Charge Code |
48100034
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,420.83 |
| Max. Negotiated Rate |
$25,132.71 |
| Rate for Payer: Aetna Commercial |
$3,266.19
|
| Rate for Payer: Aetna Medicare |
$8,082.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,497.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,714.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,714.52
|
| Rate for Payer: BCBS Complete |
$4,268.17
|
| Rate for Payer: BCBS MAPPO |
$7,771.62
|
| Rate for Payer: BCBS Trust/PPO |
$21,092.64
|
| Rate for Payer: BCN Commercial |
$21,092.64
|
| Rate for Payer: BCN Medicare Advantage |
$7,771.62
|
| Rate for Payer: Cash Price |
$3,074.06
|
| Rate for Payer: Cash Price |
$3,074.06
|
| Rate for Payer: Cofinity Advantage |
$2,689.81
|
| Rate for Payer: Cofinity Commercial |
$3,304.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,074.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,771.62
|
| Rate for Payer: Healthscope Commercial |
$3,458.32
|
| Rate for Payer: Mclaren Medicaid |
$4,064.56
|
| Rate for Payer: Mclaren Medicare |
$7,771.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,160.20
|
| Rate for Payer: Meridian Medicaid |
$8,160.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,937.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,548.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,266.19
|
| Rate for Payer: Nomi Health Commercial |
$23,314.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,881.93
|
| Rate for Payer: PACE Medicare |
$7,383.04
|
| Rate for Payer: PACE SWMI |
$7,771.62
|
| Rate for Payer: PHP Commercial |
$3,266.19
|
| Rate for Payer: PHP Medicare Advantage |
$7,771.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,064.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$25,132.71
|
| Rate for Payer: Priority Health Medicare |
$7,771.62
|
| Rate for Payer: Priority Health SBD |
$2,420.83
|
| Rate for Payer: Priority Health Tiered Network |
$20,106.17
|
| Rate for Payer: Railroad Medicare Medicare |
$7,771.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,771.62
|
| Rate for Payer: UHC Medicaid |
$4,064.56
|
| Rate for Payer: UHCCP Medicaid |
$4,064.56
|
| Rate for Payer: VA VA |
$7,771.62
|
|
|
HC INTRINSIC FACTOR ANTIBODIES
|
Facility
|
OP
|
$49.94
|
|
|
Service Code
|
CPT 86340
|
| Hospital Charge Code |
30200200
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.89 |
| Max. Negotiated Rate |
$44.95 |
| Rate for Payer: Aetna Commercial |
$42.45
|
| Rate for Payer: Aetna Medicare |
$15.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.85
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: BCBS MAPPO |
$15.08
|
| Rate for Payer: BCBS Trust/PPO |
$16.08
|
| Rate for Payer: BCN Commercial |
$16.08
|
| Rate for Payer: BCN Medicare Advantage |
$15.08
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cofinity Advantage |
$34.96
|
| Rate for Payer: Cofinity Commercial |
$42.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.08
|
| Rate for Payer: Healthscope Commercial |
$44.95
|
| Rate for Payer: Mclaren Medicaid |
$7.89
|
| Rate for Payer: Mclaren Medicare |
$15.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.83
|
| Rate for Payer: Meridian Medicaid |
$15.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.45
|
| Rate for Payer: Nomi Health Commercial |
$22.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.45
|
| Rate for Payer: PACE Medicare |
$14.33
|
| Rate for Payer: PACE SWMI |
$15.08
|
| Rate for Payer: PHP Commercial |
$42.45
|
| Rate for Payer: PHP Medicare Advantage |
$15.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15.08
|
| Rate for Payer: Priority Health Medicare |
$15.08
|
| Rate for Payer: Priority Health SBD |
$31.46
|
| Rate for Payer: Priority Health Tiered Network |
$12.06
|
| Rate for Payer: Railroad Medicare Medicare |
$15.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.62
|
| Rate for Payer: UHC Core |
$22.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.08
|
| Rate for Payer: UHC Exchange |
$22.62
|
| Rate for Payer: UHC Medicaid |
$7.89
|
| Rate for Payer: UHCCP Medicaid |
$7.89
|
| Rate for Payer: VA VA |
$15.08
|
|
|
HC INTRINSIC FACTOR ANTIBODIES
|
Facility
|
IP
|
$49.94
|
|
|
Service Code
|
CPT 86340
|
| Hospital Charge Code |
30200200
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.46 |
| Max. Negotiated Rate |
$44.95 |
| Rate for Payer: Aetna Commercial |
$42.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.46
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cofinity Advantage |
$34.96
|
| Rate for Payer: Cofinity Commercial |
$42.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.95
|
| Rate for Payer: Healthscope Commercial |
$44.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.45
|
| Rate for Payer: PHP Commercial |
$42.45
|
| Rate for Payer: Priority Health SBD |
$31.46
|
|
|
HC INTRO AORTA TRANSLUMBAR
|
Facility
|
IP
|
$3,820.35
|
|
|
Service Code
|
CPT 36160
|
| Hospital Charge Code |
36100621
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,406.82 |
| Max. Negotiated Rate |
$3,438.32 |
| Rate for Payer: Aetna Commercial |
$3,247.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,483.23
|
| Rate for Payer: Cash Price |
$3,056.28
|
| Rate for Payer: Cofinity Advantage |
$2,674.24
|
| Rate for Payer: Cofinity Commercial |
$3,285.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,056.28
|
| Rate for Payer: Healthscope Commercial |
$3,438.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,247.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,865.26
|
| Rate for Payer: PHP Commercial |
$3,247.30
|
| Rate for Payer: Priority Health SBD |
$2,406.82
|
|
|
HC INTRO AORTA TRANSLUMBAR
|
Facility
|
OP
|
$3,820.35
|
|
|
Service Code
|
CPT 36160
|
| Hospital Charge Code |
36100621
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,293.81 |
| Max. Negotiated Rate |
$3,438.32 |
| Rate for Payer: Aetna Commercial |
$3,247.30
|
| Rate for Payer: Aetna Medicare |
$1,910.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,483.23
|
| Rate for Payer: BCBS Complete |
$1,528.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,293.81
|
| Rate for Payer: BCN Commercial |
$1,293.81
|
| Rate for Payer: Cash Price |
$3,056.28
|
| Rate for Payer: Cash Price |
$3,056.28
|
| Rate for Payer: Cofinity Advantage |
$2,674.24
|
| Rate for Payer: Cofinity Commercial |
$3,285.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,056.28
|
| Rate for Payer: Healthscope Commercial |
$3,438.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,056.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,247.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,865.26
|
| Rate for Payer: PHP Commercial |
$3,247.30
|
| Rate for Payer: Priority Health SBD |
$2,406.82
|
|
|
HC INTRODUCER
|
Facility
|
OP
|
$305.57
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.09 |
| Max. Negotiated Rate |
$275.01 |
| Rate for Payer: Aetna Commercial |
$259.73
|
| Rate for Payer: Aetna Medicare |
$152.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.62
|
| Rate for Payer: BCBS Complete |
$122.23
|
| Rate for Payer: Cash Price |
$244.46
|
| Rate for Payer: Cofinity Advantage |
$213.90
|
| Rate for Payer: Cofinity Commercial |
$262.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.46
|
| Rate for Payer: Healthscope Commercial |
$275.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$244.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.18
|
| Rate for Payer: PHP Commercial |
$259.73
|
| Rate for Payer: Priority Health SBD |
$192.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.62
|
| Rate for Payer: UHC Core |
$159.20
|
| Rate for Payer: UHC Exchange |
$120.09
|
|
|
HC INTRODUCER
|
Facility
|
IP
|
$305.57
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$192.51 |
| Max. Negotiated Rate |
$275.01 |
| Rate for Payer: Aetna Commercial |
$259.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.62
|
| Rate for Payer: Cash Price |
$244.46
|
| Rate for Payer: Cofinity Advantage |
$213.90
|
| Rate for Payer: Cofinity Commercial |
$262.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.46
|
| Rate for Payer: Healthscope Commercial |
$275.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.18
|
| Rate for Payer: PHP Commercial |
$259.73
|
| Rate for Payer: Priority Health SBD |
$192.51
|
|
|
HC INTRODUCER LONG
|
Facility
|
OP
|
$260.03
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.19 |
| Max. Negotiated Rate |
$234.03 |
| Rate for Payer: Aetna Commercial |
$221.03
|
| Rate for Payer: Aetna Medicare |
$130.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.02
|
| Rate for Payer: BCBS Complete |
$104.01
|
| Rate for Payer: Cash Price |
$208.02
|
| Rate for Payer: Cofinity Advantage |
$182.02
|
| Rate for Payer: Cofinity Commercial |
$223.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.02
|
| Rate for Payer: Healthscope Commercial |
$234.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$208.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.02
|
| Rate for Payer: PHP Commercial |
$221.03
|
| Rate for Payer: Priority Health SBD |
$163.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.02
|
| Rate for Payer: UHC Core |
$135.48
|
| Rate for Payer: UHC Exchange |
$102.19
|
|
|
HC INTRODUCER LONG
|
Facility
|
IP
|
$260.03
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$163.82 |
| Max. Negotiated Rate |
$234.03 |
| Rate for Payer: Aetna Commercial |
$221.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.02
|
| Rate for Payer: Cash Price |
$208.02
|
| Rate for Payer: Cofinity Advantage |
$182.02
|
| Rate for Payer: Cofinity Commercial |
$223.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.02
|
| Rate for Payer: Healthscope Commercial |
$234.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.02
|
| Rate for Payer: PHP Commercial |
$221.03
|
| Rate for Payer: Priority Health SBD |
$163.82
|
|
|
HC INTRODUCER REGULAR
|
Facility
|
OP
|
$96.57
|
|
|
Service Code
|
HCPCS C1893
|
| Hospital Charge Code |
27200051
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$86.91 |
| Rate for Payer: Aetna Commercial |
$82.08
|
| Rate for Payer: Aetna Medicare |
$48.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.77
|
| Rate for Payer: BCBS Complete |
$38.63
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$77.26
|
| Rate for Payer: Cash Price |
$77.26
|
| Rate for Payer: Cofinity Advantage |
$67.60
|
| Rate for Payer: Cofinity Commercial |
$83.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.26
|
| Rate for Payer: Healthscope Commercial |
$86.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.43
|
| Rate for Payer: PHP Commercial |
$82.08
|
| Rate for Payer: Priority Health SBD |
$60.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.77
|
| Rate for Payer: UHC Core |
$50.31
|
| Rate for Payer: UHC Exchange |
$37.95
|
|
|
HC INTRODUCER REGULAR
|
Facility
|
IP
|
$96.57
|
|
|
Service Code
|
HCPCS C1893
|
| Hospital Charge Code |
27200051
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.84 |
| Max. Negotiated Rate |
$86.91 |
| Rate for Payer: Aetna Commercial |
$82.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.77
|
| Rate for Payer: Cash Price |
$77.26
|
| Rate for Payer: Cofinity Advantage |
$67.60
|
| Rate for Payer: Cofinity Commercial |
$83.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.26
|
| Rate for Payer: Healthscope Commercial |
$86.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.43
|
| Rate for Payer: PHP Commercial |
$82.08
|
| Rate for Payer: Priority Health SBD |
$60.84
|
|
|
HC INTRODUCTION OF URETRAL CATH VIA NEPHROSTOMY
|
Facility
|
OP
|
$3,526.75
|
|
|
Service Code
|
CPT 50553
|
| Hospital Charge Code |
36100246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,992.53 |
| Max. Negotiated Rate |
$17,277.20 |
| Rate for Payer: Aetna Commercial |
$2,997.74
|
| Rate for Payer: Aetna Medicare |
$5,556.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,292.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,678.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,678.15
|
| Rate for Payer: BCBS Complete |
$2,934.11
|
| Rate for Payer: BCBS MAPPO |
$5,342.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,992.53
|
| Rate for Payer: BCN Commercial |
$1,992.53
|
| Rate for Payer: BCN Medicare Advantage |
$5,342.52
|
| Rate for Payer: Cash Price |
$2,821.40
|
| Rate for Payer: Cash Price |
$2,821.40
|
| Rate for Payer: Cash Price |
$2,821.40
|
| Rate for Payer: Cofinity Advantage |
$2,468.72
|
| Rate for Payer: Cofinity Commercial |
$3,033.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,821.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,342.52
|
| Rate for Payer: Healthscope Commercial |
$3,174.07
|
| Rate for Payer: Mclaren Medicaid |
$2,794.14
|
| Rate for Payer: Mclaren Medicare |
$5,342.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,609.65
|
| Rate for Payer: Meridian Medicaid |
$5,609.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,143.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,876.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,997.74
|
| Rate for Payer: Nomi Health Commercial |
$16,027.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,645.06
|
| Rate for Payer: PACE Medicare |
$5,075.39
|
| Rate for Payer: PACE SWMI |
$5,342.52
|
| Rate for Payer: PHP Commercial |
$2,997.74
|
| Rate for Payer: PHP Medicare Advantage |
$5,342.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,794.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,277.20
|
| Rate for Payer: Priority Health Medicare |
$5,342.52
|
| Rate for Payer: Priority Health SBD |
$2,221.85
|
| Rate for Payer: Priority Health Tiered Network |
$13,821.76
|
| Rate for Payer: Railroad Medicare Medicare |
$5,342.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,342.52
|
| Rate for Payer: UHC Medicaid |
$2,794.14
|
| Rate for Payer: UHCCP Medicaid |
$2,794.14
|
| Rate for Payer: VA VA |
$5,342.52
|
|
|
HC INTRODUCTION OF URETRAL CATH VIA NEPHROSTOMY
|
Facility
|
IP
|
$3,526.75
|
|
|
Service Code
|
CPT 50553
|
| Hospital Charge Code |
36100246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,221.85 |
| Max. Negotiated Rate |
$3,174.07 |
| Rate for Payer: Aetna Commercial |
$2,997.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,292.39
|
| Rate for Payer: Cash Price |
$2,821.40
|
| Rate for Payer: Cofinity Advantage |
$2,468.72
|
| Rate for Payer: Cofinity Commercial |
$3,033.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,821.40
|
| Rate for Payer: Healthscope Commercial |
$3,174.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,997.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,645.06
|
| Rate for Payer: PHP Commercial |
$2,997.74
|
| Rate for Payer: Priority Health SBD |
$2,221.85
|
|
|
HC INTRO SHEATH NON GUIDE LVL 1
|
Facility
|
IP
|
$41.77
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.32 |
| Max. Negotiated Rate |
$37.59 |
| Rate for Payer: Aetna Commercial |
$35.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.15
|
| Rate for Payer: Cash Price |
$33.42
|
| Rate for Payer: Cofinity Advantage |
$29.24
|
| Rate for Payer: Cofinity Commercial |
$35.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.42
|
| Rate for Payer: Healthscope Commercial |
$37.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.33
|
| Rate for Payer: PHP Commercial |
$35.50
|
| Rate for Payer: Priority Health SBD |
$26.32
|
|
|
HC INTRO SHEATH NON GUIDE LVL 1
|
Facility
|
OP
|
$41.77
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.42 |
| Max. Negotiated Rate |
$37.59 |
| Rate for Payer: Aetna Commercial |
$35.50
|
| Rate for Payer: Aetna Medicare |
$20.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.15
|
| Rate for Payer: BCBS Complete |
$16.71
|
| Rate for Payer: Cash Price |
$33.42
|
| Rate for Payer: Cofinity Advantage |
$29.24
|
| Rate for Payer: Cofinity Commercial |
$35.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.42
|
| Rate for Payer: Healthscope Commercial |
$37.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.33
|
| Rate for Payer: PHP Commercial |
$35.50
|
| Rate for Payer: Priority Health SBD |
$26.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.15
|
| Rate for Payer: UHC Core |
$21.76
|
| Rate for Payer: UHC Exchange |
$16.42
|
|
|
HC INTRO SHEATH NON GUIDE LVL 11
|
Facility
|
IP
|
$1,195.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$752.85 |
| Max. Negotiated Rate |
$1,075.50 |
| Rate for Payer: Aetna Commercial |
$1,015.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$776.75
|
| Rate for Payer: Cash Price |
$956.00
|
| Rate for Payer: Cofinity Advantage |
$836.50
|
| Rate for Payer: Cofinity Commercial |
$1,027.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$956.00
|
| Rate for Payer: Healthscope Commercial |
$1,075.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,015.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$896.25
|
| Rate for Payer: PHP Commercial |
$1,015.75
|
| Rate for Payer: Priority Health SBD |
$752.85
|
|
|
HC INTRO SHEATH NON GUIDE LVL 11
|
Facility
|
OP
|
$1,195.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$469.63 |
| Max. Negotiated Rate |
$1,075.50 |
| Rate for Payer: Aetna Commercial |
$1,015.75
|
| Rate for Payer: Aetna Medicare |
$597.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$776.75
|
| Rate for Payer: BCBS Complete |
$478.00
|
| Rate for Payer: Cash Price |
$956.00
|
| Rate for Payer: Cofinity Advantage |
$836.50
|
| Rate for Payer: Cofinity Commercial |
$1,027.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$956.00
|
| Rate for Payer: Healthscope Commercial |
$1,075.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$956.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,015.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$896.25
|
| Rate for Payer: PHP Commercial |
$1,015.75
|
| Rate for Payer: Priority Health SBD |
$752.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$776.75
|
| Rate for Payer: UHC Core |
$622.60
|
| Rate for Payer: UHC Exchange |
$469.63
|
|
