|
HC REMOVAL SALIVARY STONE COMPLICATED
|
Facility
|
IP
|
$7,900.00
|
|
|
Service Code
|
CPT 42335
|
| Hospital Charge Code |
76100470
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,977.00 |
| Max. Negotiated Rate |
$7,110.00 |
| Rate for Payer: Aetna Commercial |
$6,715.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,135.00
|
| Rate for Payer: Cash Price |
$6,320.00
|
| Rate for Payer: Cofinity Commercial |
$5,530.00
|
| Rate for Payer: Cofinity Commercial |
$6,794.00
|
| Rate for Payer: Healthscope Commercial |
$7,110.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,715.00
|
| Rate for Payer: PHP Commercial |
$6,715.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,530.00
|
| Rate for Payer: Priority Health SBD |
$4,977.00
|
|
|
HC REMOVAL SUTURES UNDER ANESTHESIA OTHER SURGEON
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
CPT 15851
|
| Hospital Charge Code |
76100446
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.96 |
| Max. Negotiated Rate |
$5,175.07 |
| Rate for Payer: Aetna Commercial |
$4,250.00
|
| Rate for Payer: Aetna Medicare |
$1,687.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,250.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,028.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,028.30
|
| Rate for Payer: BCBS Complete |
$932.04
|
| Rate for Payer: BCBS MAPPO |
$1,622.64
|
| Rate for Payer: BCBS Trust/PPO |
$48.96
|
| Rate for Payer: BCN Medicare Advantage |
$1,622.64
|
| Rate for Payer: Cash Price |
$4,000.00
|
| Rate for Payer: Cash Price |
$4,000.00
|
| Rate for Payer: Cofinity Commercial |
$4,300.00
|
| Rate for Payer: Cofinity Commercial |
$3,500.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,622.64
|
| Rate for Payer: Healthscope Commercial |
$4,500.00
|
| Rate for Payer: Mclaren Medicaid |
$887.58
|
| Rate for Payer: Mclaren Medicare |
$1,622.64
|
| Rate for Payer: Meridian Medicaid |
$932.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,703.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,866.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,250.00
|
| Rate for Payer: PACE Medicare |
$1,541.51
|
| Rate for Payer: PACE SWMI |
$1,622.64
|
| Rate for Payer: PHP Commercial |
$4,250.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,622.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$887.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,500.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,175.07
|
| Rate for Payer: Priority Health Medicare |
$1,622.64
|
| Rate for Payer: Priority Health Narrow Network |
$4,140.06
|
| Rate for Payer: Priority Health SBD |
$3,150.00
|
| Rate for Payer: Railroad Medicare Medicare |
$1,622.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,622.64
|
| Rate for Payer: UHC Exchange |
$63.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,671.32
|
| Rate for Payer: VA VA |
$1,622.64
|
|
|
HC REMOVAL SUTURES UNDER ANESTHESIA OTHER SURGEON
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
CPT 15851
|
| Hospital Charge Code |
76100446
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,150.00 |
| Max. Negotiated Rate |
$4,500.00 |
| Rate for Payer: Aetna Commercial |
$4,250.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,250.00
|
| Rate for Payer: Cash Price |
$4,000.00
|
| Rate for Payer: Cofinity Commercial |
$3,500.00
|
| Rate for Payer: Cofinity Commercial |
$4,300.00
|
| Rate for Payer: Healthscope Commercial |
$4,500.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,250.00
|
| Rate for Payer: PHP Commercial |
$4,250.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,500.00
|
| Rate for Payer: Priority Health SBD |
$3,150.00
|
|
|
HC REMOVAL TUNNELED CVC WO PORT OR PUMP
|
Facility
|
IP
|
$1,102.95
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
36100140
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$694.86 |
| Max. Negotiated Rate |
$992.66 |
| Rate for Payer: Aetna Commercial |
$937.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$716.92
|
| Rate for Payer: Cash Price |
$882.36
|
| Rate for Payer: Cofinity Commercial |
$772.06
|
| Rate for Payer: Cofinity Commercial |
$948.54
|
| Rate for Payer: Healthscope Commercial |
$992.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$937.51
|
| Rate for Payer: PHP Commercial |
$937.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$772.06
|
| Rate for Payer: Priority Health SBD |
$694.86
|
|
|
HC REMOVAL TUNNELED CVC WO PORT OR PUMP
|
Facility
|
OP
|
$1,102.95
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
36100140
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$131.96 |
| Max. Negotiated Rate |
$1,683.01 |
| Rate for Payer: Aetna Commercial |
$937.51
|
| Rate for Payer: Aetna Medicare |
$581.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$716.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$698.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$698.71
|
| Rate for Payer: BCBS Complete |
$321.07
|
| Rate for Payer: BCBS MAPPO |
$558.97
|
| Rate for Payer: BCBS Trust/PPO |
$474.99
|
| Rate for Payer: BCN Medicare Advantage |
$558.97
|
| Rate for Payer: Cash Price |
$882.36
|
| Rate for Payer: Cash Price |
$882.36
|
| Rate for Payer: Cofinity Commercial |
$948.54
|
| Rate for Payer: Cofinity Commercial |
$772.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.97
|
| Rate for Payer: Healthscope Commercial |
$992.66
|
| Rate for Payer: Mclaren Medicaid |
$305.76
|
| Rate for Payer: Mclaren Medicare |
$558.97
|
| Rate for Payer: Meridian Medicaid |
$321.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$937.51
|
| Rate for Payer: PACE Medicare |
$531.02
|
| Rate for Payer: PACE SWMI |
$558.97
|
| Rate for Payer: PHP Commercial |
$937.51
|
| Rate for Payer: PHP Medicare Advantage |
$558.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$772.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,683.01
|
| Rate for Payer: Priority Health Medicare |
$558.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,346.40
|
| Rate for Payer: Priority Health SBD |
$694.86
|
| Rate for Payer: Railroad Medicare Medicare |
$558.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.97
|
| Rate for Payer: UHC Exchange |
$131.96
|
| Rate for Payer: UHC Medicare Advantage |
$575.74
|
| Rate for Payer: VA VA |
$558.97
|
|
|
HC REMOVAL TUNNELED INTRAPERI CATHETER
|
Facility
|
IP
|
$3,228.27
|
|
|
Service Code
|
CPT 49422
|
| Hospital Charge Code |
36100221
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,033.81 |
| Max. Negotiated Rate |
$2,905.44 |
| Rate for Payer: Aetna Commercial |
$2,744.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,098.38
|
| Rate for Payer: Cash Price |
$2,582.62
|
| Rate for Payer: Cofinity Commercial |
$2,259.79
|
| Rate for Payer: Cofinity Commercial |
$2,776.31
|
| Rate for Payer: Healthscope Commercial |
$2,905.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,744.03
|
| Rate for Payer: PHP Commercial |
$2,744.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,259.79
|
| Rate for Payer: Priority Health SBD |
$2,033.81
|
|
|
HC REMOVAL TUNNELED INTRAPERI CATHETER
|
Facility
|
OP
|
$3,228.27
|
|
|
Service Code
|
CPT 49422
|
| Hospital Charge Code |
36100221
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$215.46 |
| Max. Negotiated Rate |
$8,913.25 |
| Rate for Payer: Aetna Commercial |
$2,744.03
|
| Rate for Payer: Aetna Medicare |
$2,949.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,098.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,545.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,545.25
|
| Rate for Payer: BCBS Complete |
$1,629.11
|
| Rate for Payer: BCBS MAPPO |
$2,836.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,370.59
|
| Rate for Payer: BCN Medicare Advantage |
$2,836.20
|
| Rate for Payer: Cash Price |
$2,582.62
|
| Rate for Payer: Cash Price |
$2,582.62
|
| Rate for Payer: Cofinity Commercial |
$2,776.31
|
| Rate for Payer: Cofinity Commercial |
$2,259.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,836.20
|
| Rate for Payer: Healthscope Commercial |
$2,905.44
|
| Rate for Payer: Mclaren Medicaid |
$1,551.40
|
| Rate for Payer: Mclaren Medicare |
$2,836.20
|
| Rate for Payer: Meridian Medicaid |
$1,629.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,978.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,261.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,744.03
|
| Rate for Payer: PACE Medicare |
$2,694.39
|
| Rate for Payer: PACE SWMI |
$2,836.20
|
| Rate for Payer: PHP Commercial |
$2,744.03
|
| Rate for Payer: PHP Medicare Advantage |
$2,836.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,551.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,259.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,913.25
|
| Rate for Payer: Priority Health Medicare |
$2,836.20
|
| Rate for Payer: Priority Health Narrow Network |
$7,130.60
|
| Rate for Payer: Priority Health SBD |
$2,033.81
|
| Rate for Payer: Railroad Medicare Medicare |
$2,836.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.01
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,836.20
|
| Rate for Payer: UHC Exchange |
$215.46
|
| Rate for Payer: UHC Medicare Advantage |
$2,921.29
|
| Rate for Payer: VA VA |
$2,836.20
|
|
|
HC REMOVAL TUNNELED PLEURAL CATHETER
|
Facility
|
IP
|
$964.69
|
|
|
Service Code
|
CPT 32552
|
| Hospital Charge Code |
36100054
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$607.75 |
| Max. Negotiated Rate |
$868.22 |
| Rate for Payer: Aetna Commercial |
$819.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$627.05
|
| Rate for Payer: Cash Price |
$771.75
|
| Rate for Payer: Cofinity Commercial |
$829.63
|
| Rate for Payer: Cofinity Commercial |
$675.28
|
| Rate for Payer: Healthscope Commercial |
$868.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$819.99
|
| Rate for Payer: PHP Commercial |
$819.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$675.28
|
| Rate for Payer: Priority Health SBD |
$607.75
|
|
|
HC REMOVAL TUNNELED PLEURAL CATHETER
|
Facility
|
OP
|
$964.69
|
|
|
Service Code
|
CPT 32552
|
| Hospital Charge Code |
36100054
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$152.59 |
| Max. Negotiated Rate |
$1,683.01 |
| Rate for Payer: Aetna Commercial |
$819.99
|
| Rate for Payer: Aetna Medicare |
$581.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$627.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$698.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$698.71
|
| Rate for Payer: BCBS Complete |
$321.07
|
| Rate for Payer: BCBS MAPPO |
$558.97
|
| Rate for Payer: BCBS Trust/PPO |
$465.60
|
| Rate for Payer: BCN Medicare Advantage |
$558.97
|
| Rate for Payer: Cash Price |
$771.75
|
| Rate for Payer: Cash Price |
$771.75
|
| Rate for Payer: Cofinity Commercial |
$829.63
|
| Rate for Payer: Cofinity Commercial |
$675.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.97
|
| Rate for Payer: Healthscope Commercial |
$868.22
|
| Rate for Payer: Mclaren Medicaid |
$305.76
|
| Rate for Payer: Mclaren Medicare |
$558.97
|
| Rate for Payer: Meridian Medicaid |
$321.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$819.99
|
| Rate for Payer: PACE Medicare |
$531.02
|
| Rate for Payer: PACE SWMI |
$558.97
|
| Rate for Payer: PHP Commercial |
$819.99
|
| Rate for Payer: PHP Medicare Advantage |
$558.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$675.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,683.01
|
| Rate for Payer: Priority Health Medicare |
$558.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,346.41
|
| Rate for Payer: Priority Health SBD |
$607.75
|
| Rate for Payer: Railroad Medicare Medicare |
$558.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.85
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.97
|
| Rate for Payer: UHC Exchange |
$152.59
|
| Rate for Payer: UHC Medicare Advantage |
$575.74
|
| Rate for Payer: VA VA |
$558.97
|
|
|
HC REMOVAL W/ REINSERT DRUG IMPLANT DEVICE
|
Facility
|
IP
|
$532.68
|
|
|
Service Code
|
CPT 11983
|
| Hospital Charge Code |
76100180
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$335.59 |
| Max. Negotiated Rate |
$479.41 |
| Rate for Payer: Aetna Commercial |
$452.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$346.24
|
| Rate for Payer: Cash Price |
$426.14
|
| Rate for Payer: Cofinity Commercial |
$372.88
|
| Rate for Payer: Cofinity Commercial |
$458.10
|
| Rate for Payer: Healthscope Commercial |
$479.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$452.78
|
| Rate for Payer: PHP Commercial |
$452.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$372.88
|
| Rate for Payer: Priority Health SBD |
$335.59
|
|
|
HC REMOVAL W/ REINSERT DRUG IMPLANT DEVICE
|
Facility
|
OP
|
$532.68
|
|
|
Service Code
|
CPT 11983
|
| Hospital Charge Code |
76100180
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.85 |
| Max. Negotiated Rate |
$845.03 |
| Rate for Payer: Aetna Commercial |
$452.78
|
| Rate for Payer: Aetna Medicare |
$368.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$346.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.16
|
| Rate for Payer: BCBS Complete |
$203.64
|
| Rate for Payer: BCBS MAPPO |
$354.53
|
| Rate for Payer: BCBS Trust/PPO |
$236.02
|
| Rate for Payer: BCN Medicare Advantage |
$354.53
|
| Rate for Payer: Cash Price |
$426.14
|
| Rate for Payer: Cash Price |
$426.14
|
| Rate for Payer: Cofinity Commercial |
$458.10
|
| Rate for Payer: Cofinity Commercial |
$372.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.53
|
| Rate for Payer: Healthscope Commercial |
$479.41
|
| Rate for Payer: Mclaren Medicaid |
$193.93
|
| Rate for Payer: Mclaren Medicare |
$354.53
|
| Rate for Payer: Meridian Medicaid |
$203.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$452.78
|
| Rate for Payer: PACE Medicare |
$336.80
|
| Rate for Payer: PACE SWMI |
$354.53
|
| Rate for Payer: PHP Commercial |
$452.78
|
| Rate for Payer: PHP Medicare Advantage |
$354.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$372.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$845.03
|
| Rate for Payer: Priority Health Medicare |
$354.53
|
| Rate for Payer: Priority Health Narrow Network |
$676.02
|
| Rate for Payer: Priority Health SBD |
$335.59
|
| Rate for Payer: Railroad Medicare Medicare |
$354.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.53
|
| Rate for Payer: UHC Exchange |
$100.85
|
| Rate for Payer: UHC Medicare Advantage |
$365.17
|
| Rate for Payer: VA VA |
$354.53
|
|
|
HC REMOVE ADDITIONAL NAIL PLATE
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 11732
|
| Hospital Charge Code |
76100329
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$16.37 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Aetna Commercial |
$216.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.75
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: BCBS Trust/PPO |
$63.37
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cofinity Commercial |
$178.50
|
| Rate for Payer: Cofinity Commercial |
$219.30
|
| Rate for Payer: Healthscope Commercial |
$229.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.75
|
| Rate for Payer: PHP Commercial |
$216.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.50
|
| Rate for Payer: Priority Health SBD |
$160.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.01
|
| Rate for Payer: UHC Exchange |
$16.37
|
|
|
HC REMOVE ADDITIONAL NAIL PLATE
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 11732
|
| Hospital Charge Code |
76100329
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$160.65 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Aetna Commercial |
$216.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.75
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cofinity Commercial |
$219.30
|
| Rate for Payer: Cofinity Commercial |
$178.50
|
| Rate for Payer: Healthscope Commercial |
$229.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.75
|
| Rate for Payer: PHP Commercial |
$216.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.50
|
| Rate for Payer: Priority Health SBD |
$160.65
|
|
|
HC REMOVE AND REPLACE INT URETERAL STENT
|
Facility
|
OP
|
$2,722.84
|
|
|
Service Code
|
CPT 50382
|
| Hospital Charge Code |
36100236
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$239.69 |
| Max. Negotiated Rate |
$5,575.00 |
| Rate for Payer: Aetna Commercial |
$2,314.41
|
| Rate for Payer: Aetna Medicare |
$1,884.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,769.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,265.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,265.42
|
| Rate for Payer: BCBS Complete |
$1,041.01
|
| Rate for Payer: BCBS MAPPO |
$1,812.34
|
| Rate for Payer: BCBS Trust/PPO |
$831.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,812.34
|
| Rate for Payer: Cash Price |
$2,178.27
|
| Rate for Payer: Cash Price |
$2,178.27
|
| Rate for Payer: Cofinity Commercial |
$1,905.99
|
| Rate for Payer: Cofinity Commercial |
$2,341.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,812.34
|
| Rate for Payer: Healthscope Commercial |
$2,450.56
|
| Rate for Payer: Mclaren Medicaid |
$991.35
|
| Rate for Payer: Mclaren Medicare |
$1,812.34
|
| Rate for Payer: Meridian Medicaid |
$1,041.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,902.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,084.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,314.41
|
| Rate for Payer: PACE Medicare |
$1,721.72
|
| Rate for Payer: PACE SWMI |
$1,812.34
|
| Rate for Payer: PHP Commercial |
$2,314.41
|
| Rate for Payer: PHP Medicare Advantage |
$1,812.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$991.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,905.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,575.00
|
| Rate for Payer: Priority Health Medicare |
$1,812.34
|
| Rate for Payer: Priority Health Narrow Network |
$4,460.00
|
| Rate for Payer: Priority Health SBD |
$1,715.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,812.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$263.66
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,812.34
|
| Rate for Payer: UHC Exchange |
$239.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,866.71
|
| Rate for Payer: VA VA |
$1,812.34
|
|
|
HC REMOVE AND REPLACE INT URETERAL STENT
|
Facility
|
IP
|
$2,722.84
|
|
|
Service Code
|
CPT 50382
|
| Hospital Charge Code |
36100236
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,715.39 |
| Max. Negotiated Rate |
$2,450.56 |
| Rate for Payer: Aetna Commercial |
$2,314.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,769.85
|
| Rate for Payer: Cash Price |
$2,178.27
|
| Rate for Payer: Cofinity Commercial |
$1,905.99
|
| Rate for Payer: Cofinity Commercial |
$2,341.64
|
| Rate for Payer: Healthscope Commercial |
$2,450.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,314.41
|
| Rate for Payer: PHP Commercial |
$2,314.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,905.99
|
| Rate for Payer: Priority Health SBD |
$1,715.39
|
|
|
HC REMOVE BILIARY DRAIN CATH
|
Facility
|
IP
|
$844.26
|
|
|
Service Code
|
CPT 47537
|
| Hospital Charge Code |
36100494
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$531.88 |
| Max. Negotiated Rate |
$759.83 |
| Rate for Payer: Aetna Commercial |
$717.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$548.77
|
| Rate for Payer: Cash Price |
$675.41
|
| Rate for Payer: Cofinity Commercial |
$590.98
|
| Rate for Payer: Cofinity Commercial |
$726.06
|
| Rate for Payer: Healthscope Commercial |
$759.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$717.62
|
| Rate for Payer: PHP Commercial |
$717.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$590.98
|
| Rate for Payer: Priority Health SBD |
$531.88
|
|
|
HC REMOVE BILIARY DRAIN CATH
|
Facility
|
OP
|
$844.26
|
|
|
Service Code
|
CPT 47537
|
| Hospital Charge Code |
36100494
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$92.01 |
| Max. Negotiated Rate |
$3,138.00 |
| Rate for Payer: Aetna Commercial |
$717.62
|
| Rate for Payer: Aetna Medicare |
$838.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$548.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,008.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,008.22
|
| Rate for Payer: BCBS Complete |
$463.30
|
| Rate for Payer: BCBS MAPPO |
$806.58
|
| Rate for Payer: BCBS Trust/PPO |
$548.28
|
| Rate for Payer: BCN Medicare Advantage |
$806.58
|
| Rate for Payer: Cash Price |
$675.41
|
| Rate for Payer: Cash Price |
$675.41
|
| Rate for Payer: Cofinity Commercial |
$590.98
|
| Rate for Payer: Cofinity Commercial |
$726.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$806.58
|
| Rate for Payer: Healthscope Commercial |
$759.83
|
| Rate for Payer: Mclaren Medicaid |
$441.20
|
| Rate for Payer: Mclaren Medicare |
$806.58
|
| Rate for Payer: Meridian Medicaid |
$463.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$927.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$717.62
|
| Rate for Payer: PACE Medicare |
$766.25
|
| Rate for Payer: PACE SWMI |
$806.58
|
| Rate for Payer: PHP Commercial |
$717.62
|
| Rate for Payer: PHP Medicare Advantage |
$806.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$441.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$590.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,519.41
|
| Rate for Payer: Priority Health Medicare |
$806.58
|
| Rate for Payer: Priority Health Narrow Network |
$2,015.53
|
| Rate for Payer: Priority Health SBD |
$531.88
|
| Rate for Payer: Railroad Medicare Medicare |
$806.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.21
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$806.58
|
| Rate for Payer: UHC Exchange |
$92.01
|
| Rate for Payer: UHC Medicare Advantage |
$830.78
|
| Rate for Payer: VA VA |
$806.58
|
|
|
HC REMOVE/BIVALVE ARM/LEG
|
Facility
|
OP
|
$170.37
|
|
|
Service Code
|
CPT 29705
|
| Hospital Charge Code |
70000015
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$298.70 |
| Rate for Payer: Aetna Commercial |
$144.81
|
| Rate for Payer: Aetna Medicare |
$248.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$298.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$298.70
|
| Rate for Payer: BCBS Complete |
$137.26
|
| Rate for Payer: BCBS MAPPO |
$238.96
|
| Rate for Payer: BCBS Trust/PPO |
$149.97
|
| Rate for Payer: BCN Medicare Advantage |
$238.96
|
| Rate for Payer: Cash Price |
$136.30
|
| Rate for Payer: Cash Price |
$136.30
|
| Rate for Payer: Cofinity Commercial |
$146.52
|
| Rate for Payer: Cofinity Commercial |
$119.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.96
|
| Rate for Payer: Healthscope Commercial |
$153.33
|
| Rate for Payer: Mclaren Medicaid |
$130.71
|
| Rate for Payer: Mclaren Medicare |
$238.96
|
| Rate for Payer: Meridian Medicaid |
$137.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$250.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$144.81
|
| Rate for Payer: PACE Medicare |
$227.01
|
| Rate for Payer: PACE SWMI |
$238.96
|
| Rate for Payer: PHP Commercial |
$144.81
|
| Rate for Payer: PHP Medicare Advantage |
$238.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.26
|
| Rate for Payer: Priority Health Medicare |
$238.96
|
| Rate for Payer: Priority Health SBD |
$107.33
|
| Rate for Payer: Railroad Medicare Medicare |
$238.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.96
|
| Rate for Payer: UHC Exchange |
$43.55
|
| Rate for Payer: UHC Medicare Advantage |
$246.13
|
| Rate for Payer: VA VA |
$238.96
|
|
|
HC REMOVE/BIVALVE ARM/LEG
|
Facility
|
IP
|
$170.37
|
|
|
Service Code
|
CPT 29705
|
| Hospital Charge Code |
70000015
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$107.33 |
| Max. Negotiated Rate |
$153.33 |
| Rate for Payer: Aetna Commercial |
$144.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.74
|
| Rate for Payer: Cash Price |
$136.30
|
| Rate for Payer: Cofinity Commercial |
$119.26
|
| Rate for Payer: Cofinity Commercial |
$146.52
|
| Rate for Payer: Healthscope Commercial |
$153.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$144.81
|
| Rate for Payer: PHP Commercial |
$144.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.26
|
| Rate for Payer: Priority Health SBD |
$107.33
|
|
|
HC REMOVE/BIVALVE BODY CAST
|
Facility
|
IP
|
$190.11
|
|
|
Service Code
|
CPT 29700
|
| Hospital Charge Code |
70000014
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$119.77 |
| Max. Negotiated Rate |
$171.10 |
| Rate for Payer: Aetna Commercial |
$161.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.57
|
| Rate for Payer: Cash Price |
$152.09
|
| Rate for Payer: Cofinity Commercial |
$133.08
|
| Rate for Payer: Cofinity Commercial |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$171.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.59
|
| Rate for Payer: PHP Commercial |
$161.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.08
|
| Rate for Payer: Priority Health SBD |
$119.77
|
|
|
HC REMOVE/BIVALVE BODY CAST
|
Facility
|
OP
|
$190.11
|
|
|
Service Code
|
CPT 29700
|
| Hospital Charge Code |
70000014
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$30.17 |
| Max. Negotiated Rate |
$298.70 |
| Rate for Payer: Aetna Commercial |
$161.59
|
| Rate for Payer: Aetna Medicare |
$248.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$298.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$298.70
|
| Rate for Payer: BCBS Complete |
$137.26
|
| Rate for Payer: BCBS MAPPO |
$238.96
|
| Rate for Payer: BCBS Trust/PPO |
$30.17
|
| Rate for Payer: BCN Medicare Advantage |
$238.96
|
| Rate for Payer: Cash Price |
$152.09
|
| Rate for Payer: Cash Price |
$152.09
|
| Rate for Payer: Cofinity Commercial |
$133.08
|
| Rate for Payer: Cofinity Commercial |
$163.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.96
|
| Rate for Payer: Healthscope Commercial |
$171.10
|
| Rate for Payer: Mclaren Medicaid |
$130.71
|
| Rate for Payer: Mclaren Medicare |
$238.96
|
| Rate for Payer: Meridian Medicaid |
$137.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$250.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.59
|
| Rate for Payer: PACE Medicare |
$227.01
|
| Rate for Payer: PACE SWMI |
$238.96
|
| Rate for Payer: PHP Commercial |
$161.59
|
| Rate for Payer: PHP Medicare Advantage |
$238.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.08
|
| Rate for Payer: Priority Health Medicare |
$238.96
|
| Rate for Payer: Priority Health SBD |
$119.77
|
| Rate for Payer: Railroad Medicare Medicare |
$238.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.96
|
| Rate for Payer: UHC Exchange |
$32.42
|
| Rate for Payer: UHC Medicare Advantage |
$246.13
|
| Rate for Payer: VA VA |
$238.96
|
|
|
HC REMOVE/BIVALVE SPICA
|
Facility
|
IP
|
$345.19
|
|
|
Service Code
|
CPT 29710
|
| Hospital Charge Code |
70000016
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$217.47 |
| Max. Negotiated Rate |
$310.67 |
| Rate for Payer: Aetna Commercial |
$293.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.37
|
| Rate for Payer: Cash Price |
$276.15
|
| Rate for Payer: Cofinity Commercial |
$241.63
|
| Rate for Payer: Cofinity Commercial |
$296.86
|
| Rate for Payer: Healthscope Commercial |
$310.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$293.41
|
| Rate for Payer: PHP Commercial |
$293.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.63
|
| Rate for Payer: Priority Health SBD |
$217.47
|
|
|
HC REMOVE/BIVALVE SPICA
|
Facility
|
OP
|
$345.19
|
|
|
Service Code
|
CPT 29710
|
| Hospital Charge Code |
70000016
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$310.67 |
| Rate for Payer: Aetna Commercial |
$293.41
|
| Rate for Payer: Aetna Medicare |
$248.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$298.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$298.70
|
| Rate for Payer: BCBS Complete |
$137.26
|
| Rate for Payer: BCBS MAPPO |
$238.96
|
| Rate for Payer: BCBS Trust/PPO |
$49.50
|
| Rate for Payer: BCN Medicare Advantage |
$238.96
|
| Rate for Payer: Cash Price |
$276.15
|
| Rate for Payer: Cash Price |
$276.15
|
| Rate for Payer: Cofinity Commercial |
$241.63
|
| Rate for Payer: Cofinity Commercial |
$296.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.96
|
| Rate for Payer: Healthscope Commercial |
$310.67
|
| Rate for Payer: Mclaren Medicaid |
$130.71
|
| Rate for Payer: Mclaren Medicare |
$238.96
|
| Rate for Payer: Meridian Medicaid |
$137.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$250.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$293.41
|
| Rate for Payer: PACE Medicare |
$227.01
|
| Rate for Payer: PACE SWMI |
$238.96
|
| Rate for Payer: PHP Commercial |
$293.41
|
| Rate for Payer: PHP Medicare Advantage |
$238.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.63
|
| Rate for Payer: Priority Health Medicare |
$238.96
|
| Rate for Payer: Priority Health SBD |
$217.47
|
| Rate for Payer: Railroad Medicare Medicare |
$238.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.96
|
| Rate for Payer: UHC Exchange |
$80.55
|
| Rate for Payer: UHC Medicare Advantage |
$246.13
|
| Rate for Payer: VA VA |
$238.96
|
|
|
HC REMOVE CERUMEN INSTR BILAT
|
Facility
|
IP
|
$209.17
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
45000099
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$131.78 |
| Max. Negotiated Rate |
$188.25 |
| Rate for Payer: Aetna Commercial |
$177.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.96
|
| Rate for Payer: Cash Price |
$167.34
|
| Rate for Payer: Cofinity Commercial |
$146.42
|
| Rate for Payer: Cofinity Commercial |
$179.89
|
| Rate for Payer: Healthscope Commercial |
$188.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.79
|
| Rate for Payer: PHP Commercial |
$177.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.42
|
| Rate for Payer: Priority Health SBD |
$131.78
|
|
|
HC REMOVE CERUMEN INSTR BILAT
|
Facility
|
OP
|
$209.17
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
45000099
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$29.77 |
| Max. Negotiated Rate |
$188.25 |
| Rate for Payer: Aetna Commercial |
$177.79
|
| Rate for Payer: Aetna Medicare |
$56.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.04
|
| Rate for Payer: BCBS Complete |
$31.26
|
| Rate for Payer: BCBS MAPPO |
$54.43
|
| Rate for Payer: BCBS Trust/PPO |
$60.08
|
| Rate for Payer: BCN Medicare Advantage |
$54.43
|
| Rate for Payer: Cash Price |
$167.34
|
| Rate for Payer: Cash Price |
$167.34
|
| Rate for Payer: Cofinity Commercial |
$179.89
|
| Rate for Payer: Cofinity Commercial |
$146.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.43
|
| Rate for Payer: Healthscope Commercial |
$188.25
|
| Rate for Payer: Mclaren Medicaid |
$29.77
|
| Rate for Payer: Mclaren Medicare |
$54.43
|
| Rate for Payer: Meridian Medicaid |
$31.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.79
|
| Rate for Payer: PACE Medicare |
$51.71
|
| Rate for Payer: PACE SWMI |
$54.43
|
| Rate for Payer: PHP Commercial |
$177.79
|
| Rate for Payer: PHP Medicare Advantage |
$54.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.33
|
| Rate for Payer: Priority Health Medicare |
$54.43
|
| Rate for Payer: Priority Health Narrow Network |
$138.66
|
| Rate for Payer: Priority Health SBD |
$131.78
|
| Rate for Payer: Railroad Medicare Medicare |
$54.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.43
|
| Rate for Payer: UHC Exchange |
$31.76
|
| Rate for Payer: UHC Medicare Advantage |
$56.06
|
| Rate for Payer: VA VA |
$54.43
|
|
