|
HC IMPELLA LVAD
|
Facility
|
OP
|
$46,227.59
|
|
| Hospital Charge Code |
27200132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18,491.04 |
| Max. Negotiated Rate |
$41,604.83 |
| Rate for Payer: Aetna Commercial |
$39,293.45
|
| Rate for Payer: Aetna Medicare |
$23,113.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30,047.93
|
| Rate for Payer: BCBS Complete |
$18,491.04
|
| Rate for Payer: Cash Price |
$36,982.07
|
| Rate for Payer: Cofinity Commercial |
$32,359.31
|
| Rate for Payer: Cofinity Commercial |
$39,755.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$32,359.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36,982.07
|
| Rate for Payer: Healthscope Commercial |
$41,604.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39,293.45
|
| Rate for Payer: PHP Commercial |
$39,293.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30,047.93
|
| Rate for Payer: Priority Health SBD |
$29,123.38
|
|
|
HC IMPELLA LVAD
|
Facility
|
IP
|
$46,227.59
|
|
| Hospital Charge Code |
27200132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29,123.38 |
| Max. Negotiated Rate |
$41,604.83 |
| Rate for Payer: Aetna Commercial |
$39,293.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30,047.93
|
| Rate for Payer: Cash Price |
$36,982.07
|
| Rate for Payer: Cofinity Commercial |
$32,359.31
|
| Rate for Payer: Cofinity Commercial |
$39,755.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$32,359.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36,982.07
|
| Rate for Payer: Healthscope Commercial |
$41,604.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39,293.45
|
| Rate for Payer: PHP Commercial |
$39,293.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30,047.93
|
| Rate for Payer: Priority Health SBD |
$29,123.38
|
|
|
HC IMPELLA MONITORING KIT
|
Facility
|
IP
|
$339.45
|
|
| Hospital Charge Code |
27200133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$213.85 |
| Max. Negotiated Rate |
$305.50 |
| Rate for Payer: Aetna Commercial |
$288.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.64
|
| Rate for Payer: Cash Price |
$271.56
|
| Rate for Payer: Cofinity Commercial |
$237.62
|
| Rate for Payer: Cofinity Commercial |
$291.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$237.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.56
|
| Rate for Payer: Healthscope Commercial |
$305.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.53
|
| Rate for Payer: PHP Commercial |
$288.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.64
|
| Rate for Payer: Priority Health SBD |
$213.85
|
|
|
HC IMPELLA MONITORING KIT
|
Facility
|
OP
|
$339.45
|
|
| Hospital Charge Code |
27200133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.78 |
| Max. Negotiated Rate |
$305.50 |
| Rate for Payer: Aetna Commercial |
$288.53
|
| Rate for Payer: Aetna Medicare |
$169.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.64
|
| Rate for Payer: BCBS Complete |
$135.78
|
| Rate for Payer: Cash Price |
$271.56
|
| Rate for Payer: Cofinity Commercial |
$237.62
|
| Rate for Payer: Cofinity Commercial |
$291.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$237.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.56
|
| Rate for Payer: Healthscope Commercial |
$305.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.53
|
| Rate for Payer: PHP Commercial |
$288.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.64
|
| Rate for Payer: Priority Health SBD |
$213.85
|
|
|
HC IMPELLA REMOVAL
|
Facility
|
IP
|
$2,930.58
|
|
|
Service Code
|
CPT 33992
|
| Hospital Charge Code |
48100114
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,846.27 |
| Max. Negotiated Rate |
$2,637.52 |
| Rate for Payer: Aetna Commercial |
$2,490.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,904.88
|
| Rate for Payer: Cash Price |
$2,344.46
|
| Rate for Payer: Cofinity Commercial |
$2,051.41
|
| Rate for Payer: Cofinity Commercial |
$2,520.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,051.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,344.46
|
| Rate for Payer: Healthscope Commercial |
$2,637.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,490.99
|
| Rate for Payer: PHP Commercial |
$2,490.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,904.88
|
| Rate for Payer: Priority Health SBD |
$1,846.27
|
|
|
HC IMPELLA REMOVAL
|
Facility
|
OP
|
$2,930.58
|
|
|
Service Code
|
CPT 33992
|
| Hospital Charge Code |
48100114
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$199.50 |
| Max. Negotiated Rate |
$3,362.00 |
| Rate for Payer: Aetna Commercial |
$2,490.99
|
| Rate for Payer: Aetna Medicare |
$1,465.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,904.88
|
| Rate for Payer: BCBS Complete |
$1,172.23
|
| Rate for Payer: BCBS Trust/PPO |
$423.48
|
| Rate for Payer: BCN Commercial |
$423.48
|
| Rate for Payer: Cash Price |
$2,344.46
|
| Rate for Payer: Cash Price |
$2,344.46
|
| Rate for Payer: Cash Price |
$2,344.46
|
| Rate for Payer: Cofinity Commercial |
$2,051.41
|
| Rate for Payer: Cofinity Commercial |
$2,520.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,051.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,344.46
|
| Rate for Payer: Healthscope Commercial |
$2,637.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,490.99
|
| Rate for Payer: PHP Commercial |
$2,490.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,904.88
|
| Rate for Payer: Priority Health SBD |
$1,846.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.50
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
|
|
HC IMPLANTABLE PRESSURE SENSOR W ANGIO
|
Facility
|
IP
|
$6,202.63
|
|
|
Service Code
|
CPT 33289
|
| Hospital Charge Code |
48100105
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,907.66 |
| Max. Negotiated Rate |
$5,582.37 |
| Rate for Payer: Aetna Commercial |
$5,272.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,031.71
|
| Rate for Payer: Cash Price |
$4,962.10
|
| Rate for Payer: Cofinity Commercial |
$4,341.84
|
| Rate for Payer: Cofinity Commercial |
$5,334.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,341.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,962.10
|
| Rate for Payer: Healthscope Commercial |
$5,582.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,272.24
|
| Rate for Payer: PHP Commercial |
$5,272.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,031.71
|
| Rate for Payer: Priority Health SBD |
$3,907.66
|
|
|
HC IMPLANTABLE PRESSURE SENSOR W ANGIO
|
Facility
|
OP
|
$6,202.63
|
|
|
Service Code
|
CPT 33289
|
| Hospital Charge Code |
48100105
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$353.21 |
| Max. Negotiated Rate |
$87,543.14 |
| Rate for Payer: Aetna Commercial |
$5,272.24
|
| Rate for Payer: Aetna Medicare |
$28,967.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,031.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34,816.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34,816.89
|
| Rate for Payer: BCBS Complete |
$15,675.96
|
| Rate for Payer: BCBS MAPPO |
$27,853.51
|
| Rate for Payer: BCN Medicare Advantage |
$27,853.51
|
| Rate for Payer: Cash Price |
$4,962.10
|
| Rate for Payer: Cash Price |
$4,962.10
|
| Rate for Payer: Cash Price |
$4,962.10
|
| Rate for Payer: Cofinity Commercial |
$5,334.26
|
| Rate for Payer: Cofinity Commercial |
$4,341.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,341.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,962.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,853.51
|
| Rate for Payer: Healthscope Commercial |
$5,582.37
|
| Rate for Payer: Mclaren Medicaid |
$14,929.48
|
| Rate for Payer: Mclaren Medicare |
$27,853.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29,246.19
|
| Rate for Payer: Meridian Medicaid |
$15,675.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32,031.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,272.24
|
| Rate for Payer: Nomi Health Commercial |
$58,492.37
|
| Rate for Payer: PACE Medicare |
$26,460.83
|
| Rate for Payer: PACE SWMI |
$27,853.51
|
| Rate for Payer: PHP Commercial |
$5,272.24
|
| Rate for Payer: PHP Medicare Advantage |
$27,853.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,929.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,031.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87,543.14
|
| Rate for Payer: Priority Health Medicare |
$27,853.51
|
| Rate for Payer: Priority Health Narrow Network |
$70,034.51
|
| Rate for Payer: Priority Health SBD |
$3,907.66
|
| Rate for Payer: Railroad Medicare Medicare |
$27,853.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.21
|
| Rate for Payer: UHC Core |
$15,010.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$27,853.51
|
| Rate for Payer: UHC Exchange |
$16,076.00
|
| Rate for Payer: UHC Medicare Advantage |
$27,853.51
|
| Rate for Payer: UHCCP Medicaid |
$15,681.53
|
| Rate for Payer: VA VA |
$27,853.51
|
|
|
HC IMPLANTABLE PRESSURE SENSOR WO LEAD
|
Facility
|
OP
|
$72,139.89
|
|
|
Service Code
|
HCPCS C2624
|
| Hospital Charge Code |
27800103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$64,925.90 |
| Rate for Payer: Aetna Commercial |
$61,318.91
|
| Rate for Payer: Aetna Medicare |
$36,069.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46,890.93
|
| Rate for Payer: BCBS Complete |
$28,855.96
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$57,711.91
|
| Rate for Payer: Cash Price |
$57,711.91
|
| Rate for Payer: Cofinity Commercial |
$50,497.92
|
| Rate for Payer: Cofinity Commercial |
$62,040.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$50,497.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57,711.91
|
| Rate for Payer: Healthscope Commercial |
$64,925.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61,318.91
|
| Rate for Payer: PHP Commercial |
$61,318.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46,890.93
|
| Rate for Payer: Priority Health SBD |
$45,448.13
|
|
|
HC IMPLANTABLE PRESSURE SENSOR WO LEAD
|
Facility
|
IP
|
$72,139.89
|
|
|
Service Code
|
HCPCS C2624
|
| Hospital Charge Code |
27800103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45,448.13 |
| Max. Negotiated Rate |
$64,925.90 |
| Rate for Payer: Aetna Commercial |
$61,318.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46,890.93
|
| Rate for Payer: Cash Price |
$57,711.91
|
| Rate for Payer: Cofinity Commercial |
$50,497.92
|
| Rate for Payer: Cofinity Commercial |
$62,040.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$50,497.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57,711.91
|
| Rate for Payer: Healthscope Commercial |
$64,925.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61,318.91
|
| Rate for Payer: PHP Commercial |
$61,318.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46,890.93
|
| Rate for Payer: Priority Health SBD |
$45,448.13
|
|
|
HC IMPLANT HORMONE SUBCUTANEOUS
|
Facility
|
OP
|
$543.33
|
|
|
Service Code
|
CPT 11980
|
| Hospital Charge Code |
76100178
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.08 |
| Max. Negotiated Rate |
$1,228.82 |
| Rate for Payer: Aetna Commercial |
$461.83
|
| Rate for Payer: Aetna Medicare |
$406.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$353.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$488.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$488.71
|
| Rate for Payer: BCBS Complete |
$220.04
|
| Rate for Payer: BCBS MAPPO |
$390.97
|
| Rate for Payer: BCBS Trust/PPO |
$243.04
|
| Rate for Payer: BCN Commercial |
$243.04
|
| Rate for Payer: BCN Medicare Advantage |
$390.97
|
| Rate for Payer: Cash Price |
$434.66
|
| Rate for Payer: Cash Price |
$434.66
|
| Rate for Payer: Cash Price |
$434.66
|
| Rate for Payer: Cofinity Commercial |
$380.33
|
| Rate for Payer: Cofinity Commercial |
$467.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$380.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$434.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$390.97
|
| Rate for Payer: Healthscope Commercial |
$489.00
|
| Rate for Payer: Mclaren Medicaid |
$209.56
|
| Rate for Payer: Mclaren Medicare |
$390.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$410.52
|
| Rate for Payer: Meridian Medicaid |
$220.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$449.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$461.83
|
| Rate for Payer: Nomi Health Commercial |
$1,172.91
|
| Rate for Payer: PACE Medicare |
$371.42
|
| Rate for Payer: PACE SWMI |
$390.97
|
| Rate for Payer: PHP Commercial |
$461.83
|
| Rate for Payer: PHP Medicare Advantage |
$390.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,228.82
|
| Rate for Payer: Priority Health Medicare |
$390.97
|
| Rate for Payer: Priority Health Narrow Network |
$983.06
|
| Rate for Payer: Priority Health SBD |
$342.30
|
| Rate for Payer: Railroad Medicare Medicare |
$390.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.08
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$390.97
|
| Rate for Payer: UHC Medicare Advantage |
$390.97
|
| Rate for Payer: UHCCP Medicaid |
$220.12
|
| Rate for Payer: VA VA |
$390.97
|
|
|
HC IMPLANT HORMONE SUBCUTANEOUS
|
Facility
|
IP
|
$543.33
|
|
|
Service Code
|
CPT 11980
|
| Hospital Charge Code |
76100178
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$342.30 |
| Max. Negotiated Rate |
$489.00 |
| Rate for Payer: Aetna Commercial |
$461.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$353.16
|
| Rate for Payer: Cash Price |
$434.66
|
| Rate for Payer: Cofinity Commercial |
$380.33
|
| Rate for Payer: Cofinity Commercial |
$467.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$380.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$434.66
|
| Rate for Payer: Healthscope Commercial |
$489.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$461.83
|
| Rate for Payer: PHP Commercial |
$461.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.16
|
| Rate for Payer: Priority Health SBD |
$342.30
|
|
|
HC IMRT PLAN
|
Facility
|
IP
|
$7,125.70
|
|
|
Service Code
|
CPT 77301
|
| Hospital Charge Code |
33300006
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$4,489.19 |
| Max. Negotiated Rate |
$6,413.13 |
| Rate for Payer: Aetna Commercial |
$6,056.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,631.70
|
| Rate for Payer: Cash Price |
$5,700.56
|
| Rate for Payer: Cofinity Commercial |
$4,987.99
|
| Rate for Payer: Cofinity Commercial |
$6,128.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,987.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,700.56
|
| Rate for Payer: Healthscope Commercial |
$6,413.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,056.84
|
| Rate for Payer: PHP Commercial |
$6,056.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,631.70
|
| Rate for Payer: Priority Health SBD |
$4,489.19
|
|
|
HC IMRT PLAN
|
Facility
|
OP
|
$7,125.70
|
|
|
Service Code
|
CPT 77301
|
| Hospital Charge Code |
33300006
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$718.56 |
| Max. Negotiated Rate |
$6,413.13 |
| Rate for Payer: Aetna Commercial |
$6,056.84
|
| Rate for Payer: Aetna Medicare |
$1,394.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,631.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,675.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,675.74
|
| Rate for Payer: BCBS Complete |
$754.48
|
| Rate for Payer: BCBS MAPPO |
$1,340.59
|
| Rate for Payer: BCBS Trust/PPO |
$2,804.64
|
| Rate for Payer: BCN Commercial |
$2,804.64
|
| Rate for Payer: BCN Medicare Advantage |
$1,340.59
|
| Rate for Payer: Cash Price |
$5,700.56
|
| Rate for Payer: Cash Price |
$5,700.56
|
| Rate for Payer: Cofinity Commercial |
$6,128.10
|
| Rate for Payer: Cofinity Commercial |
$4,987.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,987.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,700.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,340.59
|
| Rate for Payer: Healthscope Commercial |
$6,413.13
|
| Rate for Payer: Mclaren Medicaid |
$718.56
|
| Rate for Payer: Mclaren Medicare |
$1,340.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,407.62
|
| Rate for Payer: Meridian Medicaid |
$754.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,541.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,056.84
|
| Rate for Payer: Nomi Health Commercial |
$4,021.77
|
| Rate for Payer: PACE Medicare |
$1,273.56
|
| Rate for Payer: PACE SWMI |
$1,340.59
|
| Rate for Payer: PHP Commercial |
$6,056.84
|
| Rate for Payer: PHP Medicare Advantage |
$1,340.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$718.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,631.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,213.47
|
| Rate for Payer: Priority Health Medicare |
$1,340.59
|
| Rate for Payer: Priority Health Narrow Network |
$3,370.78
|
| Rate for Payer: Priority Health SBD |
$4,489.19
|
| Rate for Payer: Railroad Medicare Medicare |
$1,340.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,848.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,340.59
|
| Rate for Payer: UHC Exchange |
$5,273.02
|
| Rate for Payer: UHC Medicare Advantage |
$1,340.59
|
| Rate for Payer: UHCCP Medicaid |
$754.75
|
| Rate for Payer: VA VA |
$1,340.59
|
|
|
HC IN 111 AUTOLOG WBC PER STUDY
|
Facility
|
OP
|
$784.03
|
|
|
Service Code
|
HCPCS A9570
|
| Hospital Charge Code |
34300013
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$375.09 |
| Max. Negotiated Rate |
$3,094.17 |
| Rate for Payer: Aetna Commercial |
$666.43
|
| Rate for Payer: Aetna Medicare |
$1,072.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$509.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,289.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,289.24
|
| Rate for Payer: BCBS Complete |
$580.47
|
| Rate for Payer: BCBS MAPPO |
$1,031.39
|
| Rate for Payer: BCBS Trust/PPO |
$375.09
|
| Rate for Payer: BCN Commercial |
$375.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,031.39
|
| Rate for Payer: Cash Price |
$627.22
|
| Rate for Payer: Cash Price |
$627.22
|
| Rate for Payer: Cofinity Commercial |
$674.27
|
| Rate for Payer: Cofinity Commercial |
$548.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$548.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$627.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,031.39
|
| Rate for Payer: Healthscope Commercial |
$705.63
|
| Rate for Payer: Mclaren Medicaid |
$552.83
|
| Rate for Payer: Mclaren Medicare |
$1,031.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,082.96
|
| Rate for Payer: Meridian Medicaid |
$580.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,186.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$666.43
|
| Rate for Payer: Nomi Health Commercial |
$3,094.17
|
| Rate for Payer: PACE Medicare |
$979.82
|
| Rate for Payer: PACE SWMI |
$1,031.39
|
| Rate for Payer: PHP Commercial |
$666.43
|
| Rate for Payer: PHP Medicare Advantage |
$1,031.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$552.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$509.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,968.36
|
| Rate for Payer: Priority Health Medicare |
$1,031.39
|
| Rate for Payer: Priority Health Narrow Network |
$2,374.69
|
| Rate for Payer: Priority Health SBD |
$493.94
|
| Rate for Payer: Railroad Medicare Medicare |
$1,031.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,903.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,031.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,031.39
|
| Rate for Payer: UHCCP Medicaid |
$580.67
|
| Rate for Payer: VA VA |
$1,031.39
|
|
|
HC IN 111 AUTOLOG WBC PER STUDY
|
Facility
|
IP
|
$784.03
|
|
|
Service Code
|
HCPCS A9570
|
| Hospital Charge Code |
34300013
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$493.94 |
| Max. Negotiated Rate |
$705.63 |
| Rate for Payer: Aetna Commercial |
$666.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$509.62
|
| Rate for Payer: Cash Price |
$627.22
|
| Rate for Payer: Cofinity Commercial |
$548.82
|
| Rate for Payer: Cofinity Commercial |
$674.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$548.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$627.22
|
| Rate for Payer: Healthscope Commercial |
$705.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$666.43
|
| Rate for Payer: PHP Commercial |
$666.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$509.62
|
| Rate for Payer: Priority Health SBD |
$493.94
|
|
|
HC IN 111 OCTEO PER STUDY UP TO 6 MCI
|
Facility
|
IP
|
$5,411.53
|
|
|
Service Code
|
HCPCS A9572
|
| Hospital Charge Code |
34300014
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$3,409.26 |
| Max. Negotiated Rate |
$4,870.38 |
| Rate for Payer: Aetna Commercial |
$4,599.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,517.49
|
| Rate for Payer: Cash Price |
$4,329.22
|
| Rate for Payer: Cofinity Commercial |
$3,788.07
|
| Rate for Payer: Cofinity Commercial |
$4,653.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,788.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,329.22
|
| Rate for Payer: Healthscope Commercial |
$4,870.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,599.80
|
| Rate for Payer: PHP Commercial |
$4,599.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,517.49
|
| Rate for Payer: Priority Health SBD |
$3,409.26
|
|
|
HC IN 111 OCTEO PER STUDY UP TO 6 MCI
|
Facility
|
OP
|
$5,411.53
|
|
|
Service Code
|
HCPCS A9572
|
| Hospital Charge Code |
34300014
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,026.23 |
| Max. Negotiated Rate |
$5,743.83 |
| Rate for Payer: Aetna Commercial |
$4,599.80
|
| Rate for Payer: Aetna Medicare |
$1,991.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,517.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,393.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,393.26
|
| Rate for Payer: BCBS Complete |
$1,077.54
|
| Rate for Payer: BCBS MAPPO |
$1,914.61
|
| Rate for Payer: BCBS Trust/PPO |
$3,483.43
|
| Rate for Payer: BCN Commercial |
$3,483.43
|
| Rate for Payer: BCN Medicare Advantage |
$1,914.61
|
| Rate for Payer: Cash Price |
$4,329.22
|
| Rate for Payer: Cash Price |
$4,329.22
|
| Rate for Payer: Cofinity Commercial |
$4,653.92
|
| Rate for Payer: Cofinity Commercial |
$3,788.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,788.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,329.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,914.61
|
| Rate for Payer: Healthscope Commercial |
$4,870.38
|
| Rate for Payer: Mclaren Medicaid |
$1,026.23
|
| Rate for Payer: Mclaren Medicare |
$1,914.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,010.34
|
| Rate for Payer: Meridian Medicaid |
$1,077.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,201.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,599.80
|
| Rate for Payer: Nomi Health Commercial |
$5,743.83
|
| Rate for Payer: PACE Medicare |
$1,818.88
|
| Rate for Payer: PACE SWMI |
$1,914.61
|
| Rate for Payer: PHP Commercial |
$4,599.80
|
| Rate for Payer: PHP Medicare Advantage |
$1,914.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,026.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,517.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,510.28
|
| Rate for Payer: Priority Health Medicare |
$1,914.61
|
| Rate for Payer: Priority Health Narrow Network |
$4,408.22
|
| Rate for Payer: Priority Health SBD |
$3,409.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1,914.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,389.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,914.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,914.61
|
| Rate for Payer: UHCCP Medicaid |
$1,077.93
|
| Rate for Payer: VA VA |
$1,914.61
|
|
|
HC INCIS & DRAIN EPIDIDYMIS TESTIS &/OR SCROTUM
|
Facility
|
IP
|
$5,517.33
|
|
|
Service Code
|
CPT 54700
|
| Hospital Charge Code |
76100349
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,475.92 |
| Max. Negotiated Rate |
$4,965.60 |
| Rate for Payer: Aetna Commercial |
$4,689.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,586.26
|
| Rate for Payer: Cash Price |
$4,413.86
|
| Rate for Payer: Cofinity Commercial |
$3,862.13
|
| Rate for Payer: Cofinity Commercial |
$4,744.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,862.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,413.86
|
| Rate for Payer: Healthscope Commercial |
$4,965.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,689.73
|
| Rate for Payer: PHP Commercial |
$4,689.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,586.26
|
| Rate for Payer: Priority Health SBD |
$3,475.92
|
|
|
HC INCIS & DRAIN EPIDIDYMIS TESTIS &/OR SCROTUM
|
Facility
|
OP
|
$5,517.33
|
|
|
Service Code
|
CPT 54700
|
| Hospital Charge Code |
76100349
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.88 |
| Max. Negotiated Rate |
$6,308.24 |
| Rate for Payer: Aetna Commercial |
$4,689.73
|
| Rate for Payer: Aetna Medicare |
$2,087.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,586.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,508.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,508.86
|
| Rate for Payer: BCBS Complete |
$1,129.59
|
| Rate for Payer: BCBS MAPPO |
$2,007.09
|
| Rate for Payer: BCBS Trust/PPO |
$855.81
|
| Rate for Payer: BCN Commercial |
$855.81
|
| Rate for Payer: BCN Medicare Advantage |
$2,007.09
|
| Rate for Payer: Cash Price |
$4,413.86
|
| Rate for Payer: Cash Price |
$4,413.86
|
| Rate for Payer: Cash Price |
$4,413.86
|
| Rate for Payer: Cofinity Commercial |
$4,744.90
|
| Rate for Payer: Cofinity Commercial |
$3,862.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,862.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,413.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,007.09
|
| Rate for Payer: Healthscope Commercial |
$4,965.60
|
| Rate for Payer: Mclaren Medicaid |
$1,075.80
|
| Rate for Payer: Mclaren Medicare |
$2,007.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,107.44
|
| Rate for Payer: Meridian Medicaid |
$1,129.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,308.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,689.73
|
| Rate for Payer: Nomi Health Commercial |
$4,214.89
|
| Rate for Payer: PACE Medicare |
$1,906.74
|
| Rate for Payer: PACE SWMI |
$2,007.09
|
| Rate for Payer: PHP Commercial |
$4,689.73
|
| Rate for Payer: PHP Medicare Advantage |
$2,007.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,586.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,308.24
|
| Rate for Payer: Priority Health Medicare |
$2,007.09
|
| Rate for Payer: Priority Health Narrow Network |
$5,046.59
|
| Rate for Payer: Priority Health SBD |
$3,475.92
|
| Rate for Payer: Railroad Medicare Medicare |
$2,007.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.88
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,007.09
|
| Rate for Payer: UHC Medicare Advantage |
$2,007.09
|
| Rate for Payer: UHCCP Medicaid |
$1,129.99
|
| Rate for Payer: VA VA |
$2,007.09
|
|
|
HC INCISIONAL BIOPSY SKIN ADDL LESION
|
Facility
|
IP
|
$111.32
|
|
|
Service Code
|
CPT 11107
|
| Hospital Charge Code |
76100153
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.13 |
| Max. Negotiated Rate |
$100.19 |
| Rate for Payer: Aetna Commercial |
$94.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.36
|
| Rate for Payer: Cash Price |
$89.06
|
| Rate for Payer: Cofinity Commercial |
$77.92
|
| Rate for Payer: Cofinity Commercial |
$95.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.06
|
| Rate for Payer: Healthscope Commercial |
$100.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.62
|
| Rate for Payer: PHP Commercial |
$94.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.36
|
| Rate for Payer: Priority Health SBD |
$70.13
|
|
|
HC INCISIONAL BIOPSY SKIN ADDL LESION
|
Facility
|
OP
|
$111.32
|
|
|
Service Code
|
CPT 11107
|
| Hospital Charge Code |
76100153
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.25 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$94.62
|
| Rate for Payer: Aetna Medicare |
$55.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.36
|
| Rate for Payer: BCBS Complete |
$44.53
|
| Rate for Payer: BCBS Trust/PPO |
$271.00
|
| Rate for Payer: BCN Commercial |
$271.00
|
| Rate for Payer: Cash Price |
$89.06
|
| Rate for Payer: Cash Price |
$89.06
|
| Rate for Payer: Cash Price |
$89.06
|
| Rate for Payer: Cofinity Commercial |
$77.92
|
| Rate for Payer: Cofinity Commercial |
$95.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.06
|
| Rate for Payer: Healthscope Commercial |
$100.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.62
|
| Rate for Payer: PHP Commercial |
$94.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.36
|
| Rate for Payer: Priority Health SBD |
$70.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.25
|
| Rate for Payer: UHC Core |
$878.00
|
|
|
HC INCISIONAL BIOPSY SKIN SINGLE LESION
|
Facility
|
OP
|
$490.03
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
76100152
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.59 |
| Max. Negotiated Rate |
$1,885.01 |
| Rate for Payer: Aetna Commercial |
$416.53
|
| Rate for Payer: Aetna Medicare |
$623.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$749.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$749.69
|
| Rate for Payer: BCBS Complete |
$337.54
|
| Rate for Payer: BCBS MAPPO |
$599.75
|
| Rate for Payer: BCBS Trust/PPO |
$152.84
|
| Rate for Payer: BCN Commercial |
$152.84
|
| Rate for Payer: BCN Medicare Advantage |
$599.75
|
| Rate for Payer: Cash Price |
$392.02
|
| Rate for Payer: Cash Price |
$392.02
|
| Rate for Payer: Cash Price |
$392.02
|
| Rate for Payer: Cofinity Commercial |
$421.43
|
| Rate for Payer: Cofinity Commercial |
$343.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$343.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$599.75
|
| Rate for Payer: Healthscope Commercial |
$441.03
|
| Rate for Payer: Mclaren Medicaid |
$321.47
|
| Rate for Payer: Mclaren Medicare |
$599.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$629.74
|
| Rate for Payer: Meridian Medicaid |
$337.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$689.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.53
|
| Rate for Payer: Nomi Health Commercial |
$1,259.48
|
| Rate for Payer: PACE Medicare |
$569.76
|
| Rate for Payer: PACE SWMI |
$599.75
|
| Rate for Payer: PHP Commercial |
$416.53
|
| Rate for Payer: PHP Medicare Advantage |
$599.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,885.01
|
| Rate for Payer: Priority Health Medicare |
$599.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,508.01
|
| Rate for Payer: Priority Health SBD |
$308.72
|
| Rate for Payer: Railroad Medicare Medicare |
$599.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.59
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$599.75
|
| Rate for Payer: UHC Medicare Advantage |
$599.75
|
| Rate for Payer: UHCCP Medicaid |
$337.66
|
| Rate for Payer: VA VA |
$599.75
|
|
|
HC INCISIONAL BIOPSY SKIN SINGLE LESION
|
Facility
|
IP
|
$490.03
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
76100152
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$308.72 |
| Max. Negotiated Rate |
$441.03 |
| Rate for Payer: Aetna Commercial |
$416.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.52
|
| Rate for Payer: Cash Price |
$392.02
|
| Rate for Payer: Cofinity Commercial |
$343.02
|
| Rate for Payer: Cofinity Commercial |
$421.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$343.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.02
|
| Rate for Payer: Healthscope Commercial |
$441.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.53
|
| Rate for Payer: PHP Commercial |
$416.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.52
|
| Rate for Payer: Priority Health SBD |
$308.72
|
|
|
HC INCISION AND DRAINAGE TISSUE ABSCESS SUBFACIAL
|
Facility
|
IP
|
$2,004.12
|
|
| Hospital Charge Code |
36100439
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,262.60 |
| Max. Negotiated Rate |
$1,803.71 |
| Rate for Payer: Aetna Commercial |
$1,703.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,302.68
|
| Rate for Payer: Cash Price |
$1,603.30
|
| Rate for Payer: Cofinity Commercial |
$1,402.88
|
| Rate for Payer: Cofinity Commercial |
$1,723.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,402.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,603.30
|
| Rate for Payer: Healthscope Commercial |
$1,803.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,703.50
|
| Rate for Payer: PHP Commercial |
$1,703.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,302.68
|
| Rate for Payer: Priority Health SBD |
$1,262.60
|
|
