|
HC REMOVE INT URETERAL STENT
|
Facility
|
IP
|
$2,722.84
|
|
|
Service Code
|
CPT 50384
|
| Hospital Charge Code |
36100237
|
|
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 INT URETRAL STENT TRANSURETHRAL
|
Facility
|
IP
|
$952.43
|
|
|
Service Code
|
CPT 50386
|
| Hospital Charge Code |
36100239
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$600.03 |
| Max. Negotiated Rate |
$857.19 |
| Rate for Payer: Aetna Commercial |
$809.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$619.08
|
| Rate for Payer: Cash Price |
$761.94
|
| Rate for Payer: Cofinity Commercial |
$819.09
|
| Rate for Payer: Cofinity Commercial |
$666.70
|
| Rate for Payer: Healthscope Commercial |
$857.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$809.57
|
| Rate for Payer: PHP Commercial |
$809.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$666.70
|
| Rate for Payer: Priority Health SBD |
$600.03
|
|
|
HC REMOVE INT URETRAL STENT TRANSURETHRAL
|
Facility
|
OP
|
$952.43
|
|
|
Service Code
|
CPT 50386
|
| Hospital Charge Code |
36100239
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$156.84 |
| Max. Negotiated Rate |
$5,575.00 |
| Rate for Payer: Aetna Commercial |
$809.57
|
| Rate for Payer: Aetna Medicare |
$1,884.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$619.08
|
| 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 |
$427.94
|
| Rate for Payer: BCN Medicare Advantage |
$1,812.34
|
| Rate for Payer: Cash Price |
$761.94
|
| Rate for Payer: Cash Price |
$761.94
|
| Rate for Payer: Cofinity Commercial |
$819.09
|
| Rate for Payer: Cofinity Commercial |
$666.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,812.34
|
| Rate for Payer: Healthscope Commercial |
$857.19
|
| 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 |
$809.57
|
| Rate for Payer: PACE Medicare |
$1,721.72
|
| Rate for Payer: PACE SWMI |
$1,812.34
|
| Rate for Payer: PHP Commercial |
$809.57
|
| 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 |
$666.70
|
| 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 |
$600.03
|
| Rate for Payer: Railroad Medicare Medicare |
$1,812.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.52
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,812.34
|
| Rate for Payer: UHC Exchange |
$156.84
|
| Rate for Payer: UHC Medicare Advantage |
$1,866.71
|
| Rate for Payer: VA VA |
$1,812.34
|
|
|
HC REMOVE NEPHROSTOMY TUBE
|
Facility
|
IP
|
$906.53
|
|
|
Service Code
|
CPT 50389
|
| Hospital Charge Code |
36100241
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$571.11 |
| Max. Negotiated Rate |
$815.88 |
| Rate for Payer: Aetna Commercial |
$770.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$589.24
|
| Rate for Payer: Cash Price |
$725.22
|
| Rate for Payer: Cofinity Commercial |
$634.57
|
| Rate for Payer: Cofinity Commercial |
$779.62
|
| Rate for Payer: Healthscope Commercial |
$815.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$770.55
|
| Rate for Payer: PHP Commercial |
$770.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.57
|
| Rate for Payer: Priority Health SBD |
$571.11
|
|
|
HC REMOVE NEPHROSTOMY TUBE
|
Facility
|
OP
|
$906.53
|
|
|
Service Code
|
CPT 50389
|
| Hospital Charge Code |
36100241
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$51.08 |
| Max. Negotiated Rate |
$1,791.30 |
| Rate for Payer: Aetna Commercial |
$770.55
|
| Rate for Payer: Aetna Medicare |
$632.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$589.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$759.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$759.79
|
| Rate for Payer: BCBS Complete |
$349.14
|
| Rate for Payer: BCBS MAPPO |
$607.83
|
| Rate for Payer: BCBS Trust/PPO |
$405.45
|
| Rate for Payer: BCN Medicare Advantage |
$607.83
|
| Rate for Payer: Cash Price |
$725.22
|
| Rate for Payer: Cash Price |
$725.22
|
| Rate for Payer: Cofinity Commercial |
$779.62
|
| Rate for Payer: Cofinity Commercial |
$634.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$607.83
|
| Rate for Payer: Healthscope Commercial |
$815.88
|
| Rate for Payer: Mclaren Medicaid |
$332.48
|
| Rate for Payer: Mclaren Medicare |
$607.83
|
| Rate for Payer: Meridian Medicaid |
$349.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$638.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$699.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$770.55
|
| Rate for Payer: PACE Medicare |
$577.44
|
| Rate for Payer: PACE SWMI |
$607.83
|
| Rate for Payer: PHP Commercial |
$770.55
|
| Rate for Payer: PHP Medicare Advantage |
$607.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$332.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,791.30
|
| Rate for Payer: Priority Health Medicare |
$607.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,433.04
|
| Rate for Payer: Priority Health SBD |
$571.11
|
| Rate for Payer: Railroad Medicare Medicare |
$607.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.19
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$607.83
|
| Rate for Payer: UHC Exchange |
$51.08
|
| Rate for Payer: UHC Medicare Advantage |
$626.06
|
| Rate for Payer: VA VA |
$607.83
|
|
|
HC REMOVE REPLACE INT URETRAL STENT TRANSURETHRAL
|
Facility
|
IP
|
$2,852.25
|
|
|
Service Code
|
CPT 50385
|
| Hospital Charge Code |
36100238
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,796.92 |
| Max. Negotiated Rate |
$2,567.02 |
| Rate for Payer: Aetna Commercial |
$2,424.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,853.96
|
| Rate for Payer: Cash Price |
$2,281.80
|
| Rate for Payer: Cofinity Commercial |
$1,996.58
|
| Rate for Payer: Cofinity Commercial |
$2,452.94
|
| Rate for Payer: Healthscope Commercial |
$2,567.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,424.41
|
| Rate for Payer: PHP Commercial |
$2,424.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,996.58
|
| Rate for Payer: Priority Health SBD |
$1,796.92
|
|
|
HC REMOVE REPLACE INT URETRAL STENT TRANSURETHRAL
|
Facility
|
OP
|
$2,852.25
|
|
|
Service Code
|
CPT 50385
|
| Hospital Charge Code |
36100238
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$206.62 |
| Max. Negotiated Rate |
$5,575.00 |
| Rate for Payer: Aetna Commercial |
$2,424.41
|
| Rate for Payer: Aetna Medicare |
$1,884.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,853.96
|
| 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 |
$986.60
|
| Rate for Payer: BCN Medicare Advantage |
$1,812.34
|
| Rate for Payer: Cash Price |
$2,281.80
|
| Rate for Payer: Cash Price |
$2,281.80
|
| Rate for Payer: Cofinity Commercial |
$2,452.94
|
| Rate for Payer: Cofinity Commercial |
$1,996.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,812.34
|
| Rate for Payer: Healthscope Commercial |
$2,567.02
|
| 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 |
$2,424.41
|
| Rate for Payer: PACE Medicare |
$1,721.72
|
| Rate for Payer: PACE SWMI |
$1,812.34
|
| Rate for Payer: PHP Commercial |
$2,424.41
|
| 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 |
$1,996.58
|
| 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 |
$1,796.92
|
| Rate for Payer: Railroad Medicare Medicare |
$1,812.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.28
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,812.34
|
| Rate for Payer: UHC Exchange |
$206.62
|
| Rate for Payer: UHC Medicare Advantage |
$1,866.71
|
| Rate for Payer: VA VA |
$1,812.34
|
|
|
HC REMOVE SESAMOID BONE 1ST TOE
|
Facility
|
OP
|
$8,200.00
|
|
|
Service Code
|
CPT 28315
|
| Hospital Charge Code |
76100368
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$323.19 |
| Max. Negotiated Rate |
$7,380.00 |
| Rate for Payer: Aetna Commercial |
$6,970.00
|
| Rate for Payer: Aetna Medicare |
$2,995.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,330.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,600.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,600.14
|
| Rate for Payer: BCBS Complete |
$1,654.34
|
| Rate for Payer: BCBS MAPPO |
$2,880.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,058.03
|
| Rate for Payer: BCN Medicare Advantage |
$2,880.11
|
| Rate for Payer: Cash Price |
$6,560.00
|
| Rate for Payer: Cash Price |
$6,560.00
|
| Rate for Payer: Cofinity Commercial |
$7,052.00
|
| Rate for Payer: Cofinity Commercial |
$5,740.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,880.11
|
| Rate for Payer: Healthscope Commercial |
$7,380.00
|
| Rate for Payer: Mclaren Medicaid |
$1,575.42
|
| Rate for Payer: Mclaren Medicare |
$2,880.11
|
| Rate for Payer: Meridian Medicaid |
$1,654.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,024.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,312.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,970.00
|
| Rate for Payer: PACE Medicare |
$2,736.10
|
| Rate for Payer: PACE SWMI |
$2,880.11
|
| Rate for Payer: PHP Commercial |
$6,970.00
|
| Rate for Payer: PHP Medicare Advantage |
$2,880.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,575.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,740.00
|
| Rate for Payer: Priority Health Medicare |
$2,880.11
|
| Rate for Payer: Priority Health SBD |
$5,166.00
|
| Rate for Payer: Railroad Medicare Medicare |
$2,880.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$355.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,880.11
|
| Rate for Payer: UHC Exchange |
$323.19
|
| Rate for Payer: UHC Medicare Advantage |
$2,966.51
|
| Rate for Payer: VA VA |
$2,880.11
|
|
|
HC REMOVE SESAMOID BONE 1ST TOE
|
Facility
|
IP
|
$8,200.00
|
|
|
Service Code
|
CPT 28315
|
| Hospital Charge Code |
76100368
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,166.00 |
| Max. Negotiated Rate |
$7,380.00 |
| Rate for Payer: Aetna Commercial |
$6,970.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,330.00
|
| Rate for Payer: Cash Price |
$6,560.00
|
| Rate for Payer: Cofinity Commercial |
$5,740.00
|
| Rate for Payer: Cofinity Commercial |
$7,052.00
|
| Rate for Payer: Healthscope Commercial |
$7,380.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,970.00
|
| Rate for Payer: PHP Commercial |
$6,970.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,740.00
|
| Rate for Payer: Priority Health SBD |
$5,166.00
|
|
|
HC REMOVE SPINAL NEUROSTIM ELECTRODE PERC
|
Facility
|
OP
|
$4,473.72
|
|
|
Service Code
|
CPT 63661
|
| Hospital Charge Code |
36100611
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$325.80 |
| Max. Negotiated Rate |
$4,155.00 |
| Rate for Payer: Aetna Commercial |
$3,802.66
|
| Rate for Payer: Aetna Medicare |
$1,786.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,907.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,147.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,147.49
|
| Rate for Payer: BCBS Complete |
$986.81
|
| Rate for Payer: BCBS MAPPO |
$1,717.99
|
| Rate for Payer: BCBS Trust/PPO |
$913.06
|
| Rate for Payer: BCN Medicare Advantage |
$1,717.99
|
| Rate for Payer: Cash Price |
$3,578.98
|
| Rate for Payer: Cash Price |
$3,578.98
|
| Rate for Payer: Cofinity Commercial |
$3,847.40
|
| Rate for Payer: Cofinity Commercial |
$3,131.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,717.99
|
| Rate for Payer: Healthscope Commercial |
$4,026.35
|
| Rate for Payer: Mclaren Medicaid |
$939.74
|
| Rate for Payer: Mclaren Medicare |
$1,717.99
|
| Rate for Payer: Meridian Medicaid |
$986.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,803.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,975.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,802.66
|
| Rate for Payer: PACE Medicare |
$1,632.09
|
| Rate for Payer: PACE SWMI |
$1,717.99
|
| Rate for Payer: PHP Commercial |
$3,802.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,717.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$939.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,131.60
|
| Rate for Payer: Priority Health Medicare |
$1,717.99
|
| Rate for Payer: Priority Health SBD |
$2,818.44
|
| Rate for Payer: Railroad Medicare Medicare |
$1,717.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$358.38
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,717.99
|
| Rate for Payer: UHC Exchange |
$325.80
|
| Rate for Payer: UHC Medicare Advantage |
$1,769.53
|
| Rate for Payer: VA VA |
$1,717.99
|
|
|
HC REMOVE SPINAL NEUROSTIM ELECTRODE PERC
|
Facility
|
IP
|
$4,473.72
|
|
|
Service Code
|
CPT 63661
|
| Hospital Charge Code |
36100611
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,818.44 |
| Max. Negotiated Rate |
$4,026.35 |
| Rate for Payer: Aetna Commercial |
$3,802.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,907.92
|
| Rate for Payer: Cash Price |
$3,578.98
|
| Rate for Payer: Cofinity Commercial |
$3,131.60
|
| Rate for Payer: Cofinity Commercial |
$3,847.40
|
| Rate for Payer: Healthscope Commercial |
$4,026.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,802.66
|
| Rate for Payer: PHP Commercial |
$3,802.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,131.60
|
| Rate for Payer: Priority Health SBD |
$2,818.44
|
|
|
HC REMOVE SUTURES AND STAPLES NO ANES
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 15854
|
| Hospital Charge Code |
76100371
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.72 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Aetna Commercial |
$37.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.60
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cofinity Commercial |
$30.80
|
| Rate for Payer: Cofinity Commercial |
$37.84
|
| Rate for Payer: Healthscope Commercial |
$39.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.40
|
| Rate for Payer: PHP Commercial |
$37.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.80
|
| Rate for Payer: Priority Health SBD |
$27.72
|
|
|
HC REMOVE SUTURES AND STAPLES NO ANES
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 15854
|
| Hospital Charge Code |
76100371
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.72 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Aetna Commercial |
$37.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.60
|
| Rate for Payer: BCBS Complete |
$17.60
|
| Rate for Payer: BCBS Trust/PPO |
$29.10
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cofinity Commercial |
$37.84
|
| Rate for Payer: Cofinity Commercial |
$30.80
|
| Rate for Payer: Healthscope Commercial |
$39.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.40
|
| Rate for Payer: PHP Commercial |
$37.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.80
|
| Rate for Payer: Priority Health SBD |
$27.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.29
|
| Rate for Payer: UHC Exchange |
$15.72
|
|
|
HC REMOVE SUTURES OR STAPLES NO ANES
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 15853
|
| Hospital Charge Code |
76100370
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$11.46 |
| Max. Negotiated Rate |
$27.90 |
| Rate for Payer: Aetna Commercial |
$26.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.15
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS Trust/PPO |
$20.62
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$21.70
|
| Rate for Payer: Cofinity Commercial |
$26.66
|
| Rate for Payer: Healthscope Commercial |
$27.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.35
|
| Rate for Payer: PHP Commercial |
$26.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
| Rate for Payer: Priority Health SBD |
$19.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.61
|
| Rate for Payer: UHC Exchange |
$11.46
|
|
|
HC REMOVE SUTURES OR STAPLES NO ANES
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT 15853
|
| Hospital Charge Code |
76100370
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.53 |
| Max. Negotiated Rate |
$27.90 |
| Rate for Payer: Aetna Commercial |
$26.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.15
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$21.70
|
| Rate for Payer: Cofinity Commercial |
$26.66
|
| Rate for Payer: Healthscope Commercial |
$27.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.35
|
| Rate for Payer: PHP Commercial |
$26.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
| Rate for Payer: Priority Health SBD |
$19.53
|
|
|
HC REMOVE SUTURES OR STAPLES REQ ANES
|
Facility
|
IP
|
$5,004.99
|
|
|
Service Code
|
CPT 15851
|
| Hospital Charge Code |
76100369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,153.14 |
| Max. Negotiated Rate |
$4,504.49 |
| Rate for Payer: Aetna Commercial |
$4,254.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,253.24
|
| Rate for Payer: Cash Price |
$4,003.99
|
| Rate for Payer: Cofinity Commercial |
$3,503.49
|
| Rate for Payer: Cofinity Commercial |
$4,304.29
|
| Rate for Payer: Healthscope Commercial |
$4,504.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,254.24
|
| Rate for Payer: PHP Commercial |
$4,254.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,503.49
|
| Rate for Payer: Priority Health SBD |
$3,153.14
|
|
|
HC REMOVE SUTURES OR STAPLES REQ ANES
|
Facility
|
OP
|
$5,004.99
|
|
|
Service Code
|
CPT 15851
|
| Hospital Charge Code |
76100369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.96 |
| Max. Negotiated Rate |
$5,175.07 |
| Rate for Payer: Aetna Commercial |
$4,254.24
|
| Rate for Payer: Aetna Medicare |
$1,687.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,253.24
|
| 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 |
$4,003.99
|
| Rate for Payer: Cash Price |
$4,003.99
|
| Rate for Payer: Cofinity Commercial |
$3,503.49
|
| Rate for Payer: Cofinity Commercial |
$4,304.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,622.64
|
| Rate for Payer: Healthscope Commercial |
$4,504.49
|
| 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 |
$4,254.24
|
| Rate for Payer: PACE Medicare |
$1,541.51
|
| Rate for Payer: PACE SWMI |
$1,622.64
|
| Rate for Payer: PHP Commercial |
$4,254.24
|
| 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 |
$3,503.49
|
| 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 |
$3,153.14
|
| 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 RENAL FUNCTION PANEL
|
Facility
|
IP
|
$34.68
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
30100016
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.85 |
| Max. Negotiated Rate |
$31.21 |
| Rate for Payer: Aetna Commercial |
$29.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.54
|
| Rate for Payer: Cash Price |
$27.74
|
| Rate for Payer: Cofinity Commercial |
$29.82
|
| Rate for Payer: Cofinity Commercial |
$24.28
|
| Rate for Payer: Healthscope Commercial |
$31.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.48
|
| Rate for Payer: PHP Commercial |
$29.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.28
|
| Rate for Payer: Priority Health SBD |
$21.85
|
|
|
HC RENAL FUNCTION PANEL
|
Facility
|
OP
|
$34.68
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
30100016
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$31.21 |
| Rate for Payer: Aetna Commercial |
$29.48
|
| Rate for Payer: Aetna Medicare |
$9.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.85
|
| Rate for Payer: BCBS Complete |
$4.99
|
| Rate for Payer: BCBS MAPPO |
$8.68
|
| Rate for Payer: BCBS Trust/PPO |
$11.32
|
| Rate for Payer: BCN Medicare Advantage |
$8.68
|
| Rate for Payer: Cash Price |
$27.74
|
| Rate for Payer: Cash Price |
$27.74
|
| Rate for Payer: Cofinity Commercial |
$24.28
|
| Rate for Payer: Cofinity Commercial |
$29.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.68
|
| Rate for Payer: Healthscope Commercial |
$31.21
|
| Rate for Payer: Mclaren Medicaid |
$4.75
|
| Rate for Payer: Mclaren Medicare |
$8.68
|
| Rate for Payer: Meridian Medicaid |
$4.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.48
|
| Rate for Payer: PACE Medicare |
$8.25
|
| Rate for Payer: PACE SWMI |
$8.68
|
| Rate for Payer: PHP Commercial |
$29.48
|
| Rate for Payer: PHP Medicare Advantage |
$8.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.28
|
| Rate for Payer: Priority Health Medicare |
$8.68
|
| Rate for Payer: Priority Health SBD |
$21.85
|
| Rate for Payer: Railroad Medicare Medicare |
$8.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.42
|
| Rate for Payer: UHC Core |
$14.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.68
|
| Rate for Payer: UHC Exchange |
$8.68
|
| Rate for Payer: UHC Medicare Advantage |
$8.94
|
| Rate for Payer: VA VA |
$8.68
|
|
|
HC RENIN
|
Facility
|
IP
|
$40.70
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
30100419
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.64 |
| Max. Negotiated Rate |
$36.63 |
| Rate for Payer: Aetna Commercial |
$34.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.46
|
| Rate for Payer: Cash Price |
$32.56
|
| Rate for Payer: Cofinity Commercial |
$28.49
|
| Rate for Payer: Cofinity Commercial |
$35.00
|
| Rate for Payer: Healthscope Commercial |
$36.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.60
|
| Rate for Payer: PHP Commercial |
$34.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.49
|
| Rate for Payer: Priority Health SBD |
$25.64
|
|
|
HC RENIN
|
Facility
|
OP
|
$40.70
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
30100419
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.03 |
| Max. Negotiated Rate |
$37.38 |
| Rate for Payer: Aetna Commercial |
$34.60
|
| Rate for Payer: Aetna Medicare |
$22.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.49
|
| Rate for Payer: BCBS Complete |
$12.63
|
| Rate for Payer: BCBS MAPPO |
$21.99
|
| Rate for Payer: BCBS Trust/PPO |
$17.22
|
| Rate for Payer: BCN Medicare Advantage |
$21.99
|
| Rate for Payer: Cash Price |
$32.56
|
| Rate for Payer: Cash Price |
$32.56
|
| Rate for Payer: Cofinity Commercial |
$28.49
|
| Rate for Payer: Cofinity Commercial |
$35.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.99
|
| Rate for Payer: Healthscope Commercial |
$36.63
|
| Rate for Payer: Mclaren Medicaid |
$12.03
|
| Rate for Payer: Mclaren Medicare |
$21.99
|
| Rate for Payer: Meridian Medicaid |
$12.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.60
|
| Rate for Payer: PACE Medicare |
$20.89
|
| Rate for Payer: PACE SWMI |
$21.99
|
| Rate for Payer: PHP Commercial |
$34.60
|
| Rate for Payer: PHP Medicare Advantage |
$21.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.49
|
| Rate for Payer: Priority Health Medicare |
$21.99
|
| Rate for Payer: Priority Health SBD |
$25.64
|
| Rate for Payer: Railroad Medicare Medicare |
$21.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.39
|
| Rate for Payer: UHC Core |
$37.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.99
|
| Rate for Payer: UHC Exchange |
$21.99
|
| Rate for Payer: UHC Medicare Advantage |
$22.65
|
| Rate for Payer: VA VA |
$21.99
|
|
|
HC RENO 60 PER ML
|
Facility
|
IP
|
$0.39
|
|
|
Service Code
|
HCPCS Q9961
|
| Hospital Charge Code |
63600018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Aetna Commercial |
$0.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.25
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Cofinity Commercial |
$0.27
|
| Rate for Payer: Cofinity Commercial |
$0.34
|
| Rate for Payer: Healthscope Commercial |
$0.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.33
|
| Rate for Payer: PHP Commercial |
$0.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.27
|
| Rate for Payer: Priority Health SBD |
$0.25
|
|
|
HC RENO 60 PER ML
|
Facility
|
OP
|
$0.39
|
|
|
Service Code
|
HCPCS Q9961
|
| Hospital Charge Code |
63600018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Aetna Commercial |
$0.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.25
|
| Rate for Payer: BCBS Complete |
$0.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.11
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Cofinity Commercial |
$0.27
|
| Rate for Payer: Cofinity Commercial |
$0.34
|
| Rate for Payer: Healthscope Commercial |
$0.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.33
|
| Rate for Payer: PHP Commercial |
$0.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.27
|
| Rate for Payer: Priority Health SBD |
$0.25
|
|
|
HC REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM
|
Facility
|
OP
|
$1,550.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
76100443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.12 |
| Max. Negotiated Rate |
$1,757.43 |
| Rate for Payer: Aetna Commercial |
$1,317.50
|
| Rate for Payer: Aetna Medicare |
$581.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,007.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$698.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$698.54
|
| Rate for Payer: BCBS Complete |
$320.99
|
| Rate for Payer: BCBS MAPPO |
$558.83
|
| Rate for Payer: BCBS Trust/PPO |
$363.15
|
| Rate for Payer: BCN Medicare Advantage |
$558.83
|
| Rate for Payer: Cash Price |
$1,240.00
|
| Rate for Payer: Cash Price |
$1,240.00
|
| Rate for Payer: Cofinity Commercial |
$1,085.00
|
| Rate for Payer: Cofinity Commercial |
$1,333.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.83
|
| Rate for Payer: Healthscope Commercial |
$1,395.00
|
| Rate for Payer: Mclaren Medicaid |
$305.68
|
| Rate for Payer: Mclaren Medicare |
$558.83
|
| Rate for Payer: Meridian Medicaid |
$320.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,317.50
|
| Rate for Payer: PACE Medicare |
$530.89
|
| Rate for Payer: PACE SWMI |
$558.83
|
| Rate for Payer: PHP Commercial |
$1,317.50
|
| Rate for Payer: PHP Medicare Advantage |
$558.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,085.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,757.43
|
| Rate for Payer: Priority Health Medicare |
$558.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,405.94
|
| Rate for Payer: Priority Health SBD |
$976.50
|
| Rate for Payer: Railroad Medicare Medicare |
$558.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$298.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.83
|
| Rate for Payer: UHC Exchange |
$271.12
|
| Rate for Payer: UHC Medicare Advantage |
$575.59
|
| Rate for Payer: VA VA |
$558.83
|
|
|
HC REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM
|
Facility
|
IP
|
$1,550.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
76100443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$976.50 |
| Max. Negotiated Rate |
$1,395.00 |
| Rate for Payer: Aetna Commercial |
$1,317.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,007.50
|
| Rate for Payer: Cash Price |
$1,240.00
|
| Rate for Payer: Cofinity Commercial |
$1,085.00
|
| Rate for Payer: Cofinity Commercial |
$1,333.00
|
| Rate for Payer: Healthscope Commercial |
$1,395.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,317.50
|
| Rate for Payer: PHP Commercial |
$1,317.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,085.00
|
| Rate for Payer: Priority Health SBD |
$976.50
|
|
