|
HC INSERT/REPLACE SQ ICD W ELECTRODES
|
Facility
|
IP
|
$84,898.54
|
|
|
Service Code
|
CPT 33270
|
| Hospital Charge Code |
48100113
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$53,486.08 |
| Max. Negotiated Rate |
$76,408.69 |
| Rate for Payer: Aetna Commercial |
$72,163.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55,184.05
|
| Rate for Payer: Cash Price |
$67,918.83
|
| Rate for Payer: Cofinity Commercial |
$59,428.98
|
| Rate for Payer: Cofinity Commercial |
$73,012.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$59,428.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67,918.83
|
| Rate for Payer: Healthscope Commercial |
$76,408.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72,163.76
|
| Rate for Payer: PHP Commercial |
$72,163.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55,184.05
|
| Rate for Payer: Priority Health SBD |
$53,486.08
|
|
|
HC INSERT STRAIGHT CATH
|
Facility
|
OP
|
$185.30
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
45000003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$157.50
|
| Rate for Payer: Aetna Medicare |
$131.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$74.74
|
| Rate for Payer: BCN Commercial |
$74.74
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Cash Price |
$148.24
|
| Rate for Payer: Cash Price |
$148.24
|
| Rate for Payer: Cash Price |
$148.24
|
| Rate for Payer: Cofinity Commercial |
$129.71
|
| Rate for Payer: Cofinity Commercial |
$159.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Healthscope Commercial |
$166.77
|
| Rate for Payer: Mclaren Medicaid |
$67.69
|
| Rate for Payer: Mclaren Medicare |
$126.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.50
|
| Rate for Payer: Nomi Health Commercial |
$378.87
|
| Rate for Payer: PACE Medicare |
$119.98
|
| Rate for Payer: PACE SWMI |
$126.29
|
| Rate for Payer: PHP Commercial |
$157.50
|
| Rate for Payer: PHP Medicare Advantage |
$126.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$396.95
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$317.56
|
| Rate for Payer: Priority Health SBD |
$116.74
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.20
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$71.10
|
| Rate for Payer: VA VA |
$126.29
|
|
|
HC INSERT STRAIGHT CATH
|
Facility
|
IP
|
$185.30
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
45000003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$116.74 |
| Max. Negotiated Rate |
$166.77 |
| Rate for Payer: Aetna Commercial |
$157.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.44
|
| Rate for Payer: Cash Price |
$148.24
|
| Rate for Payer: Cofinity Commercial |
$129.71
|
| Rate for Payer: Cofinity Commercial |
$159.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.24
|
| Rate for Payer: Healthscope Commercial |
$166.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.50
|
| Rate for Payer: PHP Commercial |
$157.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.44
|
| Rate for Payer: Priority Health SBD |
$116.74
|
|
|
HC INSERT TUNNELED CENTRAL LINE WO PORT OR PUMP ABOVE 5 YRS AGE
|
Facility
|
OP
|
$4,076.99
|
|
|
Service Code
|
CPT 36558
|
| Hospital Charge Code |
36100123
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$271.12 |
| Max. Negotiated Rate |
$9,692.51 |
| Rate for Payer: Aetna Commercial |
$3,465.44
|
| Rate for Payer: Aetna Medicare |
$3,207.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,650.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,267.55
|
| Rate for Payer: BCN Commercial |
$1,267.55
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Cash Price |
$3,261.59
|
| Rate for Payer: Cash Price |
$3,261.59
|
| Rate for Payer: Cash Price |
$3,261.59
|
| Rate for Payer: Cofinity Commercial |
$2,853.89
|
| Rate for Payer: Cofinity Commercial |
$3,506.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,853.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,261.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Healthscope Commercial |
$3,669.29
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,465.44
|
| Rate for Payer: Nomi Health Commercial |
$6,476.11
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Commercial |
$3,465.44
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,650.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,692.51
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$7,754.01
|
| Rate for Payer: Priority Health SBD |
$2,568.50
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.12
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$5,811.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,736.21
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
HC INSERT TUNNELED CENTRAL LINE WO PORT OR PUMP ABOVE 5 YRS AGE
|
Facility
|
IP
|
$4,076.99
|
|
|
Service Code
|
CPT 36558
|
| Hospital Charge Code |
36100123
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,568.50 |
| Max. Negotiated Rate |
$3,669.29 |
| Rate for Payer: Aetna Commercial |
$3,465.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,650.04
|
| Rate for Payer: Cash Price |
$3,261.59
|
| Rate for Payer: Cofinity Commercial |
$2,853.89
|
| Rate for Payer: Cofinity Commercial |
$3,506.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,853.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,261.59
|
| Rate for Payer: Healthscope Commercial |
$3,669.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,465.44
|
| Rate for Payer: PHP Commercial |
$3,465.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,650.04
|
| Rate for Payer: Priority Health SBD |
$2,568.50
|
|
|
HC INSERT TUNNELED CENTRAL LINE WO PORT OR PUMP LESS THAN 5 YRS AGE
|
Facility
|
OP
|
$4,139.56
|
|
|
Service Code
|
CPT 36557
|
| Hospital Charge Code |
36100122
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$342.47 |
| Max. Negotiated Rate |
$16,646.50 |
| Rate for Payer: Aetna Commercial |
$3,518.63
|
| Rate for Payer: Aetna Medicare |
$5,508.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,690.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,620.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,620.50
|
| Rate for Payer: BCBS Complete |
$2,980.81
|
| Rate for Payer: BCBS MAPPO |
$5,296.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,895.57
|
| Rate for Payer: BCN Commercial |
$1,895.57
|
| Rate for Payer: BCN Medicare Advantage |
$5,296.40
|
| Rate for Payer: Cash Price |
$3,311.65
|
| Rate for Payer: Cash Price |
$3,311.65
|
| Rate for Payer: Cash Price |
$3,311.65
|
| Rate for Payer: Cofinity Commercial |
$2,897.69
|
| Rate for Payer: Cofinity Commercial |
$3,560.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,897.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,311.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,296.40
|
| Rate for Payer: Healthscope Commercial |
$3,725.60
|
| Rate for Payer: Mclaren Medicaid |
$2,838.87
|
| Rate for Payer: Mclaren Medicare |
$5,296.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,561.22
|
| Rate for Payer: Meridian Medicaid |
$2,980.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,090.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,518.63
|
| Rate for Payer: Nomi Health Commercial |
$11,122.44
|
| Rate for Payer: PACE Medicare |
$5,031.58
|
| Rate for Payer: PACE SWMI |
$5,296.40
|
| Rate for Payer: PHP Commercial |
$3,518.63
|
| Rate for Payer: PHP Medicare Advantage |
$5,296.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,838.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,690.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,646.50
|
| Rate for Payer: Priority Health Medicare |
$5,296.40
|
| Rate for Payer: Priority Health Narrow Network |
$13,317.20
|
| Rate for Payer: Priority Health SBD |
$2,607.92
|
| Rate for Payer: Railroad Medicare Medicare |
$5,296.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$342.47
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,296.40
|
| Rate for Payer: UHC Exchange |
$8,174.00
|
| Rate for Payer: UHC Medicare Advantage |
$5,296.40
|
| Rate for Payer: UHCCP Medicaid |
$2,981.87
|
| Rate for Payer: VA VA |
$5,296.40
|
|
|
HC INSERT TUNNELED CENTRAL LINE WO PORT OR PUMP LESS THAN 5 YRS AGE
|
Facility
|
IP
|
$4,139.56
|
|
|
Service Code
|
CPT 36557
|
| Hospital Charge Code |
36100122
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,607.92 |
| Max. Negotiated Rate |
$3,725.60 |
| Rate for Payer: Aetna Commercial |
$3,518.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,690.71
|
| Rate for Payer: Cash Price |
$3,311.65
|
| Rate for Payer: Cofinity Commercial |
$2,897.69
|
| Rate for Payer: Cofinity Commercial |
$3,560.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,897.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,311.65
|
| Rate for Payer: Healthscope Commercial |
$3,725.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,518.63
|
| Rate for Payer: PHP Commercial |
$3,518.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,690.71
|
| Rate for Payer: Priority Health SBD |
$2,607.92
|
|
|
HC IN SITU HYBRID EA ADDL PROBE STAIN PER SPECIMEN
|
Facility
|
OP
|
$265.10
|
|
|
Service Code
|
CPT 88364
|
| Hospital Charge Code |
31000120
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$106.04 |
| Max. Negotiated Rate |
$238.59 |
| Rate for Payer: Aetna Commercial |
$225.34
|
| Rate for Payer: Aetna Medicare |
$132.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.32
|
| Rate for Payer: BCBS Complete |
$106.04
|
| Rate for Payer: BCBS Trust/PPO |
$142.39
|
| Rate for Payer: BCCCP Commercial |
$119.98
|
| Rate for Payer: BCN Commercial |
$142.39
|
| Rate for Payer: Cash Price |
$212.08
|
| Rate for Payer: Cash Price |
$212.08
|
| Rate for Payer: Cofinity Commercial |
$185.57
|
| Rate for Payer: Cofinity Commercial |
$227.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.08
|
| Rate for Payer: Healthscope Commercial |
$238.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.34
|
| Rate for Payer: PHP Commercial |
$225.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.32
|
| Rate for Payer: Priority Health SBD |
$167.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.68
|
|
|
HC IN SITU HYBRID EA ADDL PROBE STAIN PER SPECIMEN
|
Facility
|
IP
|
$265.10
|
|
|
Service Code
|
CPT 88364
|
| Hospital Charge Code |
31000120
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$167.01 |
| Max. Negotiated Rate |
$238.59 |
| Rate for Payer: Aetna Commercial |
$225.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.32
|
| Rate for Payer: Cash Price |
$212.08
|
| Rate for Payer: Cofinity Commercial |
$185.57
|
| Rate for Payer: Cofinity Commercial |
$227.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.08
|
| Rate for Payer: Healthscope Commercial |
$238.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.34
|
| Rate for Payer: PHP Commercial |
$225.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.32
|
| Rate for Payer: Priority Health SBD |
$167.01
|
|
|
HC IN SITU HYBRID MULTIPLX MRPH QUANT OR SEMI-QUANT
|
Facility
|
IP
|
$655.45
|
|
|
Service Code
|
CPT 88377
|
| Hospital Charge Code |
31000119
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$412.93 |
| Max. Negotiated Rate |
$589.90 |
| Rate for Payer: Aetna Commercial |
$557.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$426.04
|
| Rate for Payer: Cash Price |
$524.36
|
| Rate for Payer: Cofinity Commercial |
$458.82
|
| Rate for Payer: Cofinity Commercial |
$563.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$458.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$524.36
|
| Rate for Payer: Healthscope Commercial |
$589.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$557.13
|
| Rate for Payer: PHP Commercial |
$557.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$426.04
|
| Rate for Payer: Priority Health SBD |
$412.93
|
|
|
HC IN SITU HYBRID MULTIPLX MRPH QUANT OR SEMI-QUANT
|
Facility
|
OP
|
$655.45
|
|
|
Service Code
|
CPT 88377
|
| Hospital Charge Code |
31000119
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$89.99 |
| Max. Negotiated Rate |
$589.90 |
| Rate for Payer: Aetna Commercial |
$557.13
|
| Rate for Payer: Aetna Medicare |
$174.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$426.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$209.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$209.88
|
| Rate for Payer: BCBS Complete |
$94.49
|
| Rate for Payer: BCBS MAPPO |
$167.90
|
| Rate for Payer: BCBS Trust/PPO |
$471.94
|
| Rate for Payer: BCCCP Commercial |
$359.30
|
| Rate for Payer: BCN Commercial |
$471.94
|
| Rate for Payer: BCN Medicare Advantage |
$167.90
|
| Rate for Payer: Cash Price |
$524.36
|
| Rate for Payer: Cash Price |
$524.36
|
| Rate for Payer: Cofinity Commercial |
$563.69
|
| Rate for Payer: Cofinity Commercial |
$458.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$458.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$524.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.90
|
| Rate for Payer: Healthscope Commercial |
$589.90
|
| Rate for Payer: Mclaren Medicaid |
$89.99
|
| Rate for Payer: Mclaren Medicare |
$167.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.30
|
| Rate for Payer: Meridian Medicaid |
$94.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$557.13
|
| Rate for Payer: Nomi Health Commercial |
$503.70
|
| Rate for Payer: PACE Medicare |
$159.50
|
| Rate for Payer: PACE SWMI |
$167.90
|
| Rate for Payer: PHP Commercial |
$557.13
|
| Rate for Payer: PHP Medicare Advantage |
$167.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$426.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$527.71
|
| Rate for Payer: Priority Health Medicare |
$167.90
|
| Rate for Payer: Priority Health Narrow Network |
$422.17
|
| Rate for Payer: Priority Health SBD |
$412.93
|
| Rate for Payer: Railroad Medicare Medicare |
$167.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$394.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.90
|
| Rate for Payer: UHC Medicare Advantage |
$167.90
|
| Rate for Payer: UHCCP Medicaid |
$94.53
|
| Rate for Payer: VA VA |
$167.90
|
|
|
HC INSTILL ANTICARCIN BLADDER
|
Facility
|
IP
|
$746.53
|
|
|
Service Code
|
CPT 51720
|
| Hospital Charge Code |
36100449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$470.31 |
| Max. Negotiated Rate |
$671.88 |
| Rate for Payer: Aetna Commercial |
$634.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$485.24
|
| Rate for Payer: Cash Price |
$597.22
|
| Rate for Payer: Cofinity Commercial |
$522.57
|
| Rate for Payer: Cofinity Commercial |
$642.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$522.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$597.22
|
| Rate for Payer: Healthscope Commercial |
$671.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$634.55
|
| Rate for Payer: PHP Commercial |
$634.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$485.24
|
| Rate for Payer: Priority Health SBD |
$470.31
|
|
|
HC INSTILL ANTICARCIN BLADDER
|
Facility
|
OP
|
$746.53
|
|
|
Service Code
|
CPT 51720
|
| Hospital Charge Code |
36100449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$46.16 |
| Max. Negotiated Rate |
$2,055.42 |
| Rate for Payer: Aetna Commercial |
$634.55
|
| Rate for Payer: Aetna Medicare |
$680.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$485.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$817.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$817.46
|
| Rate for Payer: BCBS Complete |
$368.05
|
| Rate for Payer: BCBS MAPPO |
$653.97
|
| Rate for Payer: BCBS Trust/PPO |
$402.53
|
| Rate for Payer: BCN Commercial |
$402.53
|
| Rate for Payer: BCN Medicare Advantage |
$653.97
|
| Rate for Payer: Cash Price |
$597.22
|
| Rate for Payer: Cash Price |
$597.22
|
| Rate for Payer: Cash Price |
$597.22
|
| Rate for Payer: Cofinity Commercial |
$642.02
|
| Rate for Payer: Cofinity Commercial |
$522.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$522.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$597.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$653.97
|
| Rate for Payer: Healthscope Commercial |
$671.88
|
| Rate for Payer: Mclaren Medicaid |
$350.53
|
| Rate for Payer: Mclaren Medicare |
$653.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$686.67
|
| Rate for Payer: Meridian Medicaid |
$368.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$752.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$634.55
|
| Rate for Payer: Nomi Health Commercial |
$1,373.34
|
| Rate for Payer: PACE Medicare |
$621.27
|
| Rate for Payer: PACE SWMI |
$653.97
|
| Rate for Payer: PHP Commercial |
$634.55
|
| Rate for Payer: PHP Medicare Advantage |
$653.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$350.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$485.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,055.42
|
| Rate for Payer: Priority Health Medicare |
$653.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,644.34
|
| Rate for Payer: Priority Health SBD |
$470.31
|
| Rate for Payer: Railroad Medicare Medicare |
$653.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.16
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$653.97
|
| Rate for Payer: UHC Medicare Advantage |
$653.97
|
| Rate for Payer: UHCCP Medicaid |
$368.19
|
| Rate for Payer: VA VA |
$653.97
|
|
|
HC INST THER AGENT RENAL PELVIS/URETER VIA TUB
|
Facility
|
OP
|
$666.90
|
|
|
Service Code
|
CPT 50391
|
| Hospital Charge Code |
36100571
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$36.51 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Commercial |
$566.86
|
| Rate for Payer: Aetna Medicare |
$247.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$433.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.86
|
| Rate for Payer: BCBS Complete |
$134.11
|
| Rate for Payer: BCBS MAPPO |
$238.29
|
| Rate for Payer: BCBS Trust/PPO |
$36.51
|
| Rate for Payer: BCN Commercial |
$36.51
|
| Rate for Payer: BCN Medicare Advantage |
$238.29
|
| Rate for Payer: Cash Price |
$533.52
|
| Rate for Payer: Cash Price |
$533.52
|
| Rate for Payer: Cash Price |
$533.52
|
| Rate for Payer: Cofinity Commercial |
$466.83
|
| Rate for Payer: Cofinity Commercial |
$573.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$466.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$533.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.29
|
| Rate for Payer: Healthscope Commercial |
$600.21
|
| Rate for Payer: Mclaren Medicaid |
$127.72
|
| Rate for Payer: Mclaren Medicare |
$238.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.20
|
| Rate for Payer: Meridian Medicaid |
$134.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$566.86
|
| Rate for Payer: Nomi Health Commercial |
$500.41
|
| Rate for Payer: PACE Medicare |
$226.38
|
| Rate for Payer: PACE SWMI |
$238.29
|
| Rate for Payer: PHP Commercial |
$566.86
|
| Rate for Payer: PHP Medicare Advantage |
$238.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$433.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$748.94
|
| Rate for Payer: Priority Health Medicare |
$238.29
|
| Rate for Payer: Priority Health Narrow Network |
$599.15
|
| Rate for Payer: Priority Health SBD |
$420.15
|
| Rate for Payer: Railroad Medicare Medicare |
$238.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.71
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.29
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$238.29
|
| Rate for Payer: UHCCP Medicaid |
$134.16
|
| Rate for Payer: VA VA |
$238.29
|
|
|
HC INST THER AGENT RENAL PELVIS/URETER VIA TUB
|
Facility
|
IP
|
$666.90
|
|
|
Service Code
|
CPT 50391
|
| Hospital Charge Code |
36100571
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$420.15 |
| Max. Negotiated Rate |
$600.21 |
| Rate for Payer: Aetna Commercial |
$566.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$433.48
|
| Rate for Payer: Cash Price |
$533.52
|
| Rate for Payer: Cofinity Commercial |
$466.83
|
| Rate for Payer: Cofinity Commercial |
$573.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$466.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$533.52
|
| Rate for Payer: Healthscope Commercial |
$600.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$566.86
|
| Rate for Payer: PHP Commercial |
$566.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$433.48
|
| Rate for Payer: Priority Health SBD |
$420.15
|
|
|
HC INSULIN
|
Facility
|
IP
|
$99.96
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
30100266
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.97 |
| Max. Negotiated Rate |
$89.96 |
| Rate for Payer: Aetna Commercial |
$84.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.97
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cofinity Commercial |
$69.97
|
| Rate for Payer: Cofinity Commercial |
$85.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.97
|
| Rate for Payer: Healthscope Commercial |
$89.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.97
|
| Rate for Payer: PHP Commercial |
$84.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.97
|
| Rate for Payer: Priority Health SBD |
$62.97
|
|
|
HC INSULIN
|
Facility
|
OP
|
$99.96
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
30100266
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.13 |
| Max. Negotiated Rate |
$89.96 |
| Rate for Payer: Aetna Commercial |
$84.97
|
| Rate for Payer: Aetna Medicare |
$11.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.29
|
| Rate for Payer: BCBS Complete |
$6.43
|
| Rate for Payer: BCBS MAPPO |
$11.43
|
| Rate for Payer: BCBS Trust/PPO |
$10.12
|
| Rate for Payer: BCN Commercial |
$10.12
|
| Rate for Payer: BCN Medicare Advantage |
$11.43
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cofinity Commercial |
$85.97
|
| Rate for Payer: Cofinity Commercial |
$69.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.43
|
| Rate for Payer: Healthscope Commercial |
$89.96
|
| Rate for Payer: Mclaren Medicaid |
$6.13
|
| Rate for Payer: Mclaren Medicare |
$11.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.00
|
| Rate for Payer: Meridian Medicaid |
$6.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.97
|
| Rate for Payer: Nomi Health Commercial |
$17.14
|
| Rate for Payer: PACE Medicare |
$10.86
|
| Rate for Payer: PACE SWMI |
$11.43
|
| Rate for Payer: PHP Commercial |
$84.97
|
| Rate for Payer: PHP Medicare Advantage |
$11.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.76
|
| Rate for Payer: Priority Health Medicare |
$11.43
|
| Rate for Payer: Priority Health Narrow Network |
$9.41
|
| Rate for Payer: Priority Health SBD |
$62.97
|
| Rate for Payer: Railroad Medicare Medicare |
$11.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.43
|
| Rate for Payer: UHC Medicare Advantage |
$11.43
|
| Rate for Payer: UHCCP Medicaid |
$6.44
|
| Rate for Payer: VA VA |
$11.43
|
|
|
HC INSULIN ANTIBODIES
|
Facility
|
OP
|
$69.36
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
30200199
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.48 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$58.96
|
| Rate for Payer: Aetna Medicare |
$22.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.76
|
| Rate for Payer: BCBS Complete |
$12.05
|
| Rate for Payer: BCBS MAPPO |
$21.41
|
| Rate for Payer: BCBS Trust/PPO |
$18.96
|
| Rate for Payer: BCN Commercial |
$18.96
|
| Rate for Payer: BCN Medicare Advantage |
$21.41
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Cofinity Commercial |
$48.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Mclaren Medicaid |
$11.48
|
| Rate for Payer: Mclaren Medicare |
$21.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.48
|
| Rate for Payer: Meridian Medicaid |
$12.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.96
|
| Rate for Payer: Nomi Health Commercial |
$32.12
|
| Rate for Payer: PACE Medicare |
$20.34
|
| Rate for Payer: PACE SWMI |
$21.41
|
| Rate for Payer: PHP Commercial |
$58.96
|
| Rate for Payer: PHP Medicare Advantage |
$21.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.03
|
| Rate for Payer: Priority Health Medicare |
$21.41
|
| Rate for Payer: Priority Health Narrow Network |
$17.62
|
| Rate for Payer: Priority Health SBD |
$43.70
|
| Rate for Payer: Railroad Medicare Medicare |
$21.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.41
|
| Rate for Payer: UHC Medicare Advantage |
$21.41
|
| Rate for Payer: UHCCP Medicaid |
$12.05
|
| Rate for Payer: VA VA |
$21.41
|
|
|
HC INSULIN ANTIBODIES
|
Facility
|
IP
|
$69.36
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
30200199
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$43.70 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$58.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.08
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$48.55
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.96
|
| Rate for Payer: PHP Commercial |
$58.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.08
|
| Rate for Payer: Priority Health SBD |
$43.70
|
|
|
HC INSULIN LIKE GROWTH FACTOR BP3
|
Facility
|
OP
|
$49.94
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$44.95 |
| Rate for Payer: Aetna Commercial |
$42.45
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: BCBS Complete |
$9.72
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$15.28
|
| Rate for Payer: BCN Commercial |
$15.28
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cofinity Commercial |
$42.95
|
| Rate for Payer: Cofinity Commercial |
$34.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$44.95
|
| Rate for Payer: Mclaren Medicaid |
$9.26
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: Meridian Medicaid |
$9.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.45
|
| Rate for Payer: Nomi Health Commercial |
$25.90
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$42.45
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.27
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health Narrow Network |
$13.82
|
| Rate for Payer: Priority Health SBD |
$31.46
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Medicare Advantage |
$17.27
|
| Rate for Payer: UHCCP Medicaid |
$9.72
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC INSULIN LIKE GROWTH FACTOR BP3
|
Facility
|
IP
|
$49.94
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.46 |
| Max. Negotiated Rate |
$44.95 |
| Rate for Payer: Aetna Commercial |
$42.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.46
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cofinity Commercial |
$34.96
|
| Rate for Payer: Cofinity Commercial |
$42.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.95
|
| Rate for Payer: Healthscope Commercial |
$44.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.45
|
| Rate for Payer: PHP Commercial |
$42.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.46
|
| Rate for Payer: Priority Health SBD |
$31.46
|
|
|
HC INTENSIVE CARE OBS OVERFLOW PER HR
|
Facility
|
OP
|
$189.78
|
|
| Hospital Charge Code |
76900004
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$75.91 |
| Max. Negotiated Rate |
$170.80 |
| Rate for Payer: Aetna Commercial |
$161.31
|
| Rate for Payer: Aetna Medicare |
$94.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.36
|
| Rate for Payer: BCBS Complete |
$75.91
|
| Rate for Payer: Cash Price |
$151.82
|
| Rate for Payer: Cofinity Commercial |
$132.85
|
| Rate for Payer: Cofinity Commercial |
$163.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.82
|
| Rate for Payer: Healthscope Commercial |
$170.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.31
|
| Rate for Payer: PHP Commercial |
$161.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.36
|
| Rate for Payer: Priority Health SBD |
$119.56
|
|
|
HC INTENSIVE CARE OBS OVERFLOW PER HR
|
Facility
|
IP
|
$189.78
|
|
| Hospital Charge Code |
76900004
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$119.56 |
| Max. Negotiated Rate |
$170.80 |
| Rate for Payer: Aetna Commercial |
$161.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.36
|
| Rate for Payer: Cash Price |
$151.82
|
| Rate for Payer: Cofinity Commercial |
$132.85
|
| Rate for Payer: Cofinity Commercial |
$163.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.82
|
| Rate for Payer: Healthscope Commercial |
$170.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.31
|
| Rate for Payer: PHP Commercial |
$161.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.36
|
| Rate for Payer: Priority Health SBD |
$119.56
|
|
|
HC INTERCEDE ANTIADHESIVE
|
Facility
|
IP
|
$1,185.64
|
|
| Hospital Charge Code |
27200134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$746.95 |
| Max. Negotiated Rate |
$1,067.08 |
| Rate for Payer: Aetna Commercial |
$1,007.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$770.67
|
| Rate for Payer: Cash Price |
$948.51
|
| Rate for Payer: Cofinity Commercial |
$1,019.65
|
| Rate for Payer: Cofinity Commercial |
$829.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$829.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$948.51
|
| Rate for Payer: Healthscope Commercial |
$1,067.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,007.79
|
| Rate for Payer: PHP Commercial |
$1,007.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.67
|
| Rate for Payer: Priority Health SBD |
$746.95
|
|
|
HC INTERCEDE ANTIADHESIVE
|
Facility
|
OP
|
$1,185.64
|
|
| Hospital Charge Code |
27200134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$474.26 |
| Max. Negotiated Rate |
$1,067.08 |
| Rate for Payer: Aetna Commercial |
$1,007.79
|
| Rate for Payer: Aetna Medicare |
$592.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$770.67
|
| Rate for Payer: BCBS Complete |
$474.26
|
| Rate for Payer: Cash Price |
$948.51
|
| Rate for Payer: Cofinity Commercial |
$1,019.65
|
| Rate for Payer: Cofinity Commercial |
$829.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$829.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$948.51
|
| Rate for Payer: Healthscope Commercial |
$1,067.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,007.79
|
| Rate for Payer: PHP Commercial |
$1,007.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.67
|
| Rate for Payer: Priority Health SBD |
$746.95
|
|
