|
HC INTRO SHEATH NON GUIDE LVL 2
|
Facility
|
IP
|
$162.30
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.25 |
| Max. Negotiated Rate |
$146.07 |
| Rate for Payer: Aetna Commercial |
$137.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.50
|
| Rate for Payer: Cash Price |
$129.84
|
| Rate for Payer: Cofinity Advantage |
$113.61
|
| Rate for Payer: Cofinity Commercial |
$139.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.84
|
| Rate for Payer: Healthscope Commercial |
$146.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.72
|
| Rate for Payer: PHP Commercial |
$137.96
|
| Rate for Payer: Priority Health SBD |
$102.25
|
|
|
HC INTRO SHEATH NON GUIDE LVL 2
|
Facility
|
OP
|
$162.30
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.78 |
| Max. Negotiated Rate |
$146.07 |
| Rate for Payer: Aetna Commercial |
$137.96
|
| Rate for Payer: Aetna Medicare |
$81.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.50
|
| Rate for Payer: BCBS Complete |
$64.92
|
| Rate for Payer: Cash Price |
$129.84
|
| Rate for Payer: Cofinity Advantage |
$113.61
|
| Rate for Payer: Cofinity Commercial |
$139.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.84
|
| Rate for Payer: Healthscope Commercial |
$146.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.72
|
| Rate for Payer: PHP Commercial |
$137.96
|
| Rate for Payer: Priority Health SBD |
$102.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.50
|
| Rate for Payer: UHC Core |
$84.56
|
| Rate for Payer: UHC Exchange |
$63.78
|
|
|
HC INTRO SHEATH NON GUIDE LVL 3
|
Facility
|
OP
|
$337.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200042
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.64 |
| Max. Negotiated Rate |
$303.75 |
| Rate for Payer: Aetna Commercial |
$286.88
|
| Rate for Payer: Aetna Medicare |
$168.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.38
|
| Rate for Payer: BCBS Complete |
$135.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cofinity Advantage |
$236.25
|
| Rate for Payer: Cofinity Commercial |
$290.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.00
|
| Rate for Payer: Healthscope Commercial |
$303.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.12
|
| Rate for Payer: PHP Commercial |
$286.88
|
| Rate for Payer: Priority Health SBD |
$212.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.38
|
| Rate for Payer: UHC Core |
$175.84
|
| Rate for Payer: UHC Exchange |
$132.64
|
|
|
HC INTRO SHEATH NON GUIDE LVL 3
|
Facility
|
IP
|
$337.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200042
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$212.62 |
| Max. Negotiated Rate |
$303.75 |
| Rate for Payer: Aetna Commercial |
$286.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.38
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cofinity Advantage |
$236.25
|
| Rate for Payer: Cofinity Commercial |
$290.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.00
|
| Rate for Payer: Healthscope Commercial |
$303.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.12
|
| Rate for Payer: PHP Commercial |
$286.88
|
| Rate for Payer: Priority Health SBD |
$212.62
|
|
|
HC INTRO SHEATH NON GUIDE LVL 4
|
Facility
|
IP
|
$485.16
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$305.65 |
| Max. Negotiated Rate |
$436.64 |
| Rate for Payer: Aetna Commercial |
$412.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.35
|
| Rate for Payer: Cash Price |
$388.13
|
| Rate for Payer: Cofinity Advantage |
$339.61
|
| Rate for Payer: Cofinity Commercial |
$417.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.13
|
| Rate for Payer: Healthscope Commercial |
$436.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$363.87
|
| Rate for Payer: PHP Commercial |
$412.39
|
| Rate for Payer: Priority Health SBD |
$305.65
|
|
|
HC INTRO SHEATH NON GUIDE LVL 4
|
Facility
|
OP
|
$485.16
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$190.67 |
| Max. Negotiated Rate |
$436.64 |
| Rate for Payer: Aetna Commercial |
$412.39
|
| Rate for Payer: Aetna Medicare |
$242.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.35
|
| Rate for Payer: BCBS Complete |
$194.06
|
| Rate for Payer: Cash Price |
$388.13
|
| Rate for Payer: Cofinity Advantage |
$339.61
|
| Rate for Payer: Cofinity Commercial |
$417.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.13
|
| Rate for Payer: Healthscope Commercial |
$436.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$388.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$363.87
|
| Rate for Payer: PHP Commercial |
$412.39
|
| Rate for Payer: Priority Health SBD |
$305.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.35
|
| Rate for Payer: UHC Core |
$252.77
|
| Rate for Payer: UHC Exchange |
$190.67
|
|
|
HC IODINE, S
|
Facility
|
OP
|
$63.67
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
30100687
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.61 |
| Max. Negotiated Rate |
$57.30 |
| Rate for Payer: Aetna Commercial |
$54.12
|
| Rate for Payer: Aetna Medicare |
$25.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.14
|
| Rate for Payer: BCBS Complete |
$13.24
|
| Rate for Payer: BCBS MAPPO |
$24.11
|
| Rate for Payer: BCBS Trust/PPO |
$25.70
|
| Rate for Payer: BCN Commercial |
$25.70
|
| Rate for Payer: BCN Medicare Advantage |
$24.11
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Advantage |
$44.57
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.11
|
| Rate for Payer: Healthscope Commercial |
$57.30
|
| Rate for Payer: Mclaren Medicaid |
$12.61
|
| Rate for Payer: Mclaren Medicare |
$24.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.32
|
| Rate for Payer: Meridian Medicaid |
$25.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.12
|
| Rate for Payer: Nomi Health Commercial |
$36.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.75
|
| Rate for Payer: PACE Medicare |
$22.90
|
| Rate for Payer: PACE SWMI |
$24.11
|
| Rate for Payer: PHP Commercial |
$54.12
|
| Rate for Payer: PHP Medicare Advantage |
$24.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24.11
|
| Rate for Payer: Priority Health Medicare |
$24.11
|
| Rate for Payer: Priority Health SBD |
$40.11
|
| Rate for Payer: Priority Health Tiered Network |
$19.29
|
| Rate for Payer: Railroad Medicare Medicare |
$24.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.17
|
| Rate for Payer: UHC Core |
$36.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.11
|
| Rate for Payer: UHC Exchange |
$36.17
|
| Rate for Payer: UHC Medicaid |
$12.61
|
| Rate for Payer: UHCCP Medicaid |
$12.61
|
| Rate for Payer: VA VA |
$24.11
|
|
|
HC IODINE, S
|
Facility
|
IP
|
$63.67
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
30100687
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.11 |
| Max. Negotiated Rate |
$57.30 |
| Rate for Payer: Aetna Commercial |
$54.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.39
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Advantage |
$44.57
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Healthscope Commercial |
$57.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.75
|
| Rate for Payer: PHP Commercial |
$54.12
|
| Rate for Payer: Priority Health SBD |
$40.11
|
|
|
HC IOFLUPANE I-123 PER STUDY
|
Facility
|
OP
|
$5,545.36
|
|
|
Service Code
|
HCPCS A9584
|
| Hospital Charge Code |
34300035
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$725.79 |
| Max. Negotiated Rate |
$4,990.82 |
| Rate for Payer: Aetna Commercial |
$4,713.56
|
| Rate for Payer: Aetna Medicare |
$1,443.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,604.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,734.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,734.67
|
| Rate for Payer: BCBS Complete |
$762.15
|
| Rate for Payer: BCBS MAPPO |
$1,387.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,973.21
|
| Rate for Payer: BCN Commercial |
$1,973.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,387.74
|
| Rate for Payer: Cash Price |
$4,436.29
|
| Rate for Payer: Cash Price |
$4,436.29
|
| Rate for Payer: Cofinity Advantage |
$3,881.75
|
| Rate for Payer: Cofinity Commercial |
$4,769.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,436.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,387.74
|
| Rate for Payer: Healthscope Commercial |
$4,990.82
|
| Rate for Payer: Mclaren Medicaid |
$725.79
|
| Rate for Payer: Mclaren Medicare |
$1,387.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,457.13
|
| Rate for Payer: Meridian Medicaid |
$1,457.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,595.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,526.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,713.56
|
| Rate for Payer: Nomi Health Commercial |
$4,163.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,159.02
|
| Rate for Payer: PACE Medicare |
$1,318.35
|
| Rate for Payer: PACE SWMI |
$1,387.74
|
| Rate for Payer: PHP Commercial |
$4,713.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,387.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$725.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,376.90
|
| Rate for Payer: Priority Health Medicare |
$1,387.74
|
| Rate for Payer: Priority Health SBD |
$3,493.58
|
| Rate for Payer: Priority Health Tiered Network |
$3,501.52
|
| Rate for Payer: Railroad Medicare Medicare |
$1,387.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,289.77
|
| Rate for Payer: UHC Core |
$2,289.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,387.74
|
| Rate for Payer: UHC Exchange |
$2,289.77
|
| Rate for Payer: UHC Medicaid |
$725.79
|
| Rate for Payer: UHCCP Medicaid |
$725.79
|
| Rate for Payer: VA VA |
$1,387.74
|
|
|
HC IOFLUPANE I-123 PER STUDY
|
Facility
|
IP
|
$5,545.36
|
|
|
Service Code
|
HCPCS A9584
|
| Hospital Charge Code |
34300035
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$3,493.58 |
| Max. Negotiated Rate |
$4,990.82 |
| Rate for Payer: Aetna Commercial |
$4,713.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,604.48
|
| Rate for Payer: Cash Price |
$4,436.29
|
| Rate for Payer: Cofinity Advantage |
$3,881.75
|
| Rate for Payer: Cofinity Commercial |
$4,769.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,436.29
|
| Rate for Payer: Healthscope Commercial |
$4,990.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,713.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,159.02
|
| Rate for Payer: PHP Commercial |
$4,713.56
|
| Rate for Payer: Priority Health SBD |
$3,493.58
|
|
|
HC IOM EEG CAROTID ENDARTERECTOMY
|
Facility
|
OP
|
$1,323.85
|
|
|
Service Code
|
CPT 95955
|
| Hospital Charge Code |
74000014
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$520.27 |
| Max. Negotiated Rate |
$1,191.46 |
| Rate for Payer: Aetna Commercial |
$1,125.27
|
| Rate for Payer: Aetna Medicare |
$661.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$860.50
|
| Rate for Payer: BCBS Complete |
$529.54
|
| Rate for Payer: BCBS Trust/PPO |
$574.43
|
| Rate for Payer: BCN Commercial |
$574.43
|
| Rate for Payer: Cash Price |
$1,059.08
|
| Rate for Payer: Cash Price |
$1,059.08
|
| Rate for Payer: Cofinity Advantage |
$926.70
|
| Rate for Payer: Cofinity Commercial |
$1,138.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,059.08
|
| Rate for Payer: Healthscope Commercial |
$1,191.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,059.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,125.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$992.89
|
| Rate for Payer: PHP Commercial |
$1,125.27
|
| Rate for Payer: Priority Health SBD |
$834.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$860.50
|
| Rate for Payer: UHC Core |
$689.73
|
| Rate for Payer: UHC Exchange |
$520.27
|
|
|
HC IOM EEG CAROTID ENDARTERECTOMY
|
Facility
|
IP
|
$1,323.85
|
|
|
Service Code
|
CPT 95955
|
| Hospital Charge Code |
74000014
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$834.03 |
| Max. Negotiated Rate |
$1,191.46 |
| Rate for Payer: Aetna Commercial |
$1,125.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$860.50
|
| Rate for Payer: Cash Price |
$1,059.08
|
| Rate for Payer: Cofinity Advantage |
$926.70
|
| Rate for Payer: Cofinity Commercial |
$1,138.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,059.08
|
| Rate for Payer: Healthscope Commercial |
$1,191.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,125.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$992.89
|
| Rate for Payer: PHP Commercial |
$1,125.27
|
| Rate for Payer: Priority Health SBD |
$834.03
|
|
|
HC IOM INTRAOPERATIVE MONITOR/15 MINUTES
|
Facility
|
IP
|
$190.81
|
|
|
Service Code
|
CPT 95940
|
| Hospital Charge Code |
74000017
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$120.21 |
| Max. Negotiated Rate |
$171.73 |
| Rate for Payer: Aetna Commercial |
$162.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.03
|
| Rate for Payer: Cash Price |
$152.65
|
| Rate for Payer: Cofinity Advantage |
$133.57
|
| Rate for Payer: Cofinity Commercial |
$164.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.65
|
| Rate for Payer: Healthscope Commercial |
$171.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.11
|
| Rate for Payer: PHP Commercial |
$162.19
|
| Rate for Payer: Priority Health SBD |
$120.21
|
|
|
HC IOM INTRAOPERATIVE MONITOR/15 MINUTES
|
Facility
|
OP
|
$190.81
|
|
|
Service Code
|
CPT 95940
|
| Hospital Charge Code |
74000017
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$74.99 |
| Max. Negotiated Rate |
$171.73 |
| Rate for Payer: Aetna Commercial |
$162.19
|
| Rate for Payer: Aetna Medicare |
$95.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.03
|
| Rate for Payer: BCBS Complete |
$76.32
|
| Rate for Payer: Cash Price |
$152.65
|
| Rate for Payer: Cofinity Advantage |
$133.57
|
| Rate for Payer: Cofinity Commercial |
$164.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.65
|
| Rate for Payer: Healthscope Commercial |
$171.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.11
|
| Rate for Payer: PHP Commercial |
$162.19
|
| Rate for Payer: Priority Health SBD |
$120.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.03
|
| Rate for Payer: UHC Core |
$99.41
|
| Rate for Payer: UHC Exchange |
$74.99
|
|
|
HC IOM STD PRASS PROBE
|
Facility
|
IP
|
$364.53
|
|
| Hospital Charge Code |
62200008
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$229.65 |
| Max. Negotiated Rate |
$328.08 |
| Rate for Payer: Aetna Commercial |
$309.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.94
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Advantage |
$255.17
|
| Rate for Payer: Cofinity Commercial |
$313.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Healthscope Commercial |
$328.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.40
|
| Rate for Payer: PHP Commercial |
$309.85
|
| Rate for Payer: Priority Health SBD |
$229.65
|
|
|
HC IOM STD PRASS PROBE
|
Facility
|
OP
|
$364.53
|
|
| Hospital Charge Code |
62200008
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$143.26 |
| Max. Negotiated Rate |
$328.08 |
| Rate for Payer: Aetna Commercial |
$309.85
|
| Rate for Payer: Aetna Medicare |
$182.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.94
|
| Rate for Payer: BCBS Complete |
$145.81
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Advantage |
$255.17
|
| Rate for Payer: Cofinity Commercial |
$313.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Healthscope Commercial |
$328.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$291.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.40
|
| Rate for Payer: PHP Commercial |
$309.85
|
| Rate for Payer: Priority Health SBD |
$229.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.94
|
| Rate for Payer: UHC Core |
$189.92
|
| Rate for Payer: UHC Exchange |
$143.26
|
|
|
HC IOM SUBDERMAL RECORDING ELECTR
|
Facility
|
IP
|
$15.67
|
|
| Hospital Charge Code |
62200009
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.87 |
| Max. Negotiated Rate |
$14.10 |
| Rate for Payer: Aetna Commercial |
$13.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.19
|
| Rate for Payer: Cash Price |
$12.54
|
| Rate for Payer: Cofinity Advantage |
$10.97
|
| Rate for Payer: Cofinity Commercial |
$13.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.54
|
| Rate for Payer: Healthscope Commercial |
$14.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.75
|
| Rate for Payer: PHP Commercial |
$13.32
|
| Rate for Payer: Priority Health SBD |
$9.87
|
|
|
HC IOM SUBDERMAL RECORDING ELECTR
|
Facility
|
OP
|
$15.67
|
|
| Hospital Charge Code |
62200009
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$14.10 |
| Rate for Payer: Aetna Commercial |
$13.32
|
| Rate for Payer: Aetna Medicare |
$7.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.19
|
| Rate for Payer: BCBS Complete |
$6.27
|
| Rate for Payer: Cash Price |
$12.54
|
| Rate for Payer: Cofinity Advantage |
$10.97
|
| Rate for Payer: Cofinity Commercial |
$13.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.54
|
| Rate for Payer: Healthscope Commercial |
$14.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.75
|
| Rate for Payer: PHP Commercial |
$13.32
|
| Rate for Payer: Priority Health SBD |
$9.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.19
|
| Rate for Payer: UHC Core |
$8.16
|
| Rate for Payer: UHC Exchange |
$6.16
|
|
|
HC IONIZED CALCIUM
|
Facility
|
OP
|
$109.66
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
30100130
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$98.69 |
| Rate for Payer: Aetna Commercial |
$93.21
|
| Rate for Payer: Aetna Medicare |
$14.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.10
|
| Rate for Payer: BCBS Complete |
$7.51
|
| Rate for Payer: BCBS MAPPO |
$13.68
|
| Rate for Payer: BCBS Trust/PPO |
$14.59
|
| Rate for Payer: BCN Commercial |
$14.59
|
| Rate for Payer: BCN Medicare Advantage |
$13.68
|
| Rate for Payer: Cash Price |
$87.73
|
| Rate for Payer: Cash Price |
$87.73
|
| Rate for Payer: Cofinity Advantage |
$76.76
|
| Rate for Payer: Cofinity Commercial |
$94.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.68
|
| Rate for Payer: Healthscope Commercial |
$98.69
|
| Rate for Payer: Mclaren Medicaid |
$7.15
|
| Rate for Payer: Mclaren Medicare |
$13.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.36
|
| Rate for Payer: Meridian Medicaid |
$14.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.21
|
| Rate for Payer: Nomi Health Commercial |
$20.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.25
|
| Rate for Payer: PACE Medicare |
$13.00
|
| Rate for Payer: PACE SWMI |
$13.68
|
| Rate for Payer: PHP Commercial |
$93.21
|
| Rate for Payer: PHP Medicare Advantage |
$13.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.68
|
| Rate for Payer: Priority Health Medicare |
$13.68
|
| Rate for Payer: Priority Health SBD |
$69.09
|
| Rate for Payer: Priority Health Tiered Network |
$10.94
|
| Rate for Payer: Railroad Medicare Medicare |
$13.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.52
|
| Rate for Payer: UHC Core |
$20.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.68
|
| Rate for Payer: UHC Exchange |
$20.52
|
| Rate for Payer: UHC Medicaid |
$7.15
|
| Rate for Payer: UHCCP Medicaid |
$7.15
|
| Rate for Payer: VA VA |
$13.68
|
|
|
HC IONIZED CALCIUM
|
Facility
|
IP
|
$109.66
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
30100130
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.09 |
| Max. Negotiated Rate |
$98.69 |
| Rate for Payer: Aetna Commercial |
$93.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.28
|
| Rate for Payer: Cash Price |
$87.73
|
| Rate for Payer: Cofinity Advantage |
$76.76
|
| Rate for Payer: Cofinity Commercial |
$94.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.73
|
| Rate for Payer: Healthscope Commercial |
$98.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.25
|
| Rate for Payer: PHP Commercial |
$93.21
|
| Rate for Payer: Priority Health SBD |
$69.09
|
|
|
HC IONTOPHORESIS EACH 15 MIN
|
Facility
|
IP
|
$108.24
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
42000016
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$68.19 |
| Max. Negotiated Rate |
$97.42 |
| Rate for Payer: Aetna Commercial |
$92.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.36
|
| Rate for Payer: Cash Price |
$86.59
|
| Rate for Payer: Cofinity Advantage |
$75.77
|
| Rate for Payer: Cofinity Commercial |
$93.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.59
|
| Rate for Payer: Healthscope Commercial |
$97.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.18
|
| Rate for Payer: PHP Commercial |
$92.00
|
| Rate for Payer: Priority Health SBD |
$68.19
|
|
|
HC IONTOPHORESIS EACH 15 MIN
|
Facility
|
OP
|
$108.24
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
42000016
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.67 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$92.00
|
| Rate for Payer: Aetna Medicare |
$54.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.36
|
| Rate for Payer: BCBS Complete |
$43.30
|
| Rate for Payer: BCBS Trust/PPO |
$17.67
|
| Rate for Payer: BCN Commercial |
$17.67
|
| Rate for Payer: Cash Price |
$86.59
|
| Rate for Payer: Cash Price |
$86.59
|
| Rate for Payer: Cash Price |
$86.59
|
| Rate for Payer: Cofinity Advantage |
$75.77
|
| Rate for Payer: Cofinity Commercial |
$93.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.59
|
| Rate for Payer: Healthscope Commercial |
$97.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.00
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.18
|
| Rate for Payer: PHP Commercial |
$92.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23.00
|
| Rate for Payer: Priority Health SBD |
$68.19
|
| Rate for Payer: Priority Health Tiered Network |
$18.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.36
|
| Rate for Payer: UHC Core |
$56.39
|
| Rate for Payer: UHC Exchange |
$42.54
|
|
|
HC IP 1:1 HEMODIALYSIS
|
Facility
|
OP
|
$1,430.00
|
|
| Hospital Charge Code |
80100002
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$561.99 |
| Max. Negotiated Rate |
$1,287.00 |
| Rate for Payer: Aetna Commercial |
$1,215.50
|
| Rate for Payer: Aetna Medicare |
$715.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$929.50
|
| Rate for Payer: BCBS Complete |
$572.00
|
| Rate for Payer: Cash Price |
$1,144.00
|
| Rate for Payer: Cofinity Advantage |
$1,001.00
|
| Rate for Payer: Cofinity Commercial |
$1,229.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,144.00
|
| Rate for Payer: Healthscope Commercial |
$1,287.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,144.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,215.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,072.50
|
| Rate for Payer: PHP Commercial |
$1,215.50
|
| Rate for Payer: Priority Health SBD |
$900.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$929.50
|
| Rate for Payer: UHC Core |
$745.03
|
| Rate for Payer: UHC Exchange |
$561.99
|
|
|
HC IP 1:1 HEMODIALYSIS
|
Facility
|
IP
|
$1,430.00
|
|
| Hospital Charge Code |
80100002
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$900.90 |
| Max. Negotiated Rate |
$1,287.00 |
| Rate for Payer: Aetna Commercial |
$1,215.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$929.50
|
| Rate for Payer: Cash Price |
$1,144.00
|
| Rate for Payer: Cofinity Advantage |
$1,001.00
|
| Rate for Payer: Cofinity Commercial |
$1,229.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,144.00
|
| Rate for Payer: Healthscope Commercial |
$1,287.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,215.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,072.50
|
| Rate for Payer: PHP Commercial |
$1,215.50
|
| Rate for Payer: Priority Health SBD |
$900.90
|
|
|
HC IP 2:1 HEMODIALYSIS
|
Facility
|
IP
|
$1,205.00
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
80100001
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$759.15 |
| Max. Negotiated Rate |
$1,084.50 |
| Rate for Payer: Aetna Commercial |
$1,024.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$783.25
|
| Rate for Payer: Cash Price |
$964.00
|
| Rate for Payer: Cofinity Advantage |
$843.50
|
| Rate for Payer: Cofinity Commercial |
$1,036.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$964.00
|
| Rate for Payer: Healthscope Commercial |
$1,084.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,024.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$903.75
|
| Rate for Payer: PHP Commercial |
$1,024.25
|
| Rate for Payer: Priority Health SBD |
$759.15
|
|
