|
HC INTRO SHEATH NON GUIDE LVL 4
|
Facility
|
OP
|
$485.16
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$194.06 |
| Max. Negotiated Rate |
$436.64 |
| Rate for Payer: Aetna Commercial |
$412.39
|
| Rate for Payer: Aetna Medicare |
$242.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.35
|
| Rate for Payer: BCBS Complete |
$194.06
|
| Rate for Payer: Cash Price |
$388.13
|
| Rate for Payer: Cofinity Commercial |
$339.61
|
| Rate for Payer: Cofinity Commercial |
$417.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$339.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.13
|
| Rate for Payer: Healthscope Commercial |
$436.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.39
|
| Rate for Payer: PHP Commercial |
$412.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.35
|
| Rate for Payer: Priority Health SBD |
$305.65
|
|
|
HC INTRO SHEATH NON GUIDE LVL 4
|
Facility
|
IP
|
$485.16
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$305.65 |
| Max. Negotiated Rate |
$436.64 |
| Rate for Payer: Aetna Commercial |
$412.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.35
|
| Rate for Payer: Cash Price |
$388.13
|
| Rate for Payer: Cofinity Commercial |
$339.61
|
| Rate for Payer: Cofinity Commercial |
$417.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$339.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.13
|
| Rate for Payer: Healthscope Commercial |
$436.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.39
|
| Rate for Payer: PHP Commercial |
$412.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.35
|
| Rate for Payer: Priority Health SBD |
$305.65
|
|
|
HC IODINE, S
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
30100687
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.32 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$43.69
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health SBD |
$39.32
|
|
|
HC IODINE, S
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
30100687
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$67.87 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna Medicare |
$25.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.14
|
| Rate for Payer: BCBS Complete |
$13.57
|
| Rate for Payer: BCBS MAPPO |
$24.11
|
| Rate for Payer: BCN Medicare Advantage |
$24.11
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Cofinity Commercial |
$43.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.11
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Mclaren Medicaid |
$12.92
|
| Rate for Payer: Mclaren Medicare |
$24.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.32
|
| Rate for Payer: Meridian Medicaid |
$13.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: PACE Medicare |
$22.90
|
| Rate for Payer: PACE SWMI |
$24.11
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: PHP Medicare Advantage |
$24.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health Medicare |
$24.11
|
| Rate for Payer: Priority Health SBD |
$39.32
|
| Rate for Payer: Railroad Medicare Medicare |
$24.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.11
|
| Rate for Payer: UHC Medicare Advantage |
$24.11
|
| Rate for Payer: UHCCP Medicaid |
$13.57
|
| Rate for Payer: VA VA |
$24.11
|
|
|
HC IOFLUPANE I-123 PER STUDY
|
Facility
|
OP
|
$5,436.63
|
|
|
Service Code
|
HCPCS A9584
|
| Hospital Charge Code |
34300035
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$743.98 |
| Max. Negotiated Rate |
$4,892.97 |
| Rate for Payer: Aetna Commercial |
$4,621.14
|
| Rate for Payer: Aetna Medicare |
$1,443.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,533.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,735.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,735.03
|
| Rate for Payer: BCBS Complete |
$781.18
|
| Rate for Payer: BCBS MAPPO |
$1,388.02
|
| Rate for Payer: BCN Medicare Advantage |
$1,388.02
|
| Rate for Payer: Cash Price |
$4,349.30
|
| Rate for Payer: Cash Price |
$4,349.30
|
| Rate for Payer: Cofinity Commercial |
$4,675.50
|
| Rate for Payer: Cofinity Commercial |
$3,805.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,805.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,349.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,388.02
|
| Rate for Payer: Healthscope Commercial |
$4,892.97
|
| Rate for Payer: Mclaren Medicaid |
$743.98
|
| Rate for Payer: Mclaren Medicare |
$1,388.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,457.42
|
| Rate for Payer: Meridian Medicaid |
$781.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,596.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,621.14
|
| Rate for Payer: PACE Medicare |
$1,318.62
|
| Rate for Payer: PACE SWMI |
$1,388.02
|
| Rate for Payer: PHP Commercial |
$4,621.14
|
| Rate for Payer: PHP Medicare Advantage |
$1,388.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$743.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,533.81
|
| Rate for Payer: Priority Health Medicare |
$1,388.02
|
| Rate for Payer: Priority Health SBD |
$3,425.08
|
| Rate for Payer: Railroad Medicare Medicare |
$1,388.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,907.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,388.02
|
| Rate for Payer: UHC Medicare Advantage |
$1,388.02
|
| Rate for Payer: UHCCP Medicaid |
$781.46
|
| Rate for Payer: VA VA |
$1,388.02
|
|
|
HC IOFLUPANE I-123 PER STUDY
|
Facility
|
IP
|
$5,436.63
|
|
|
Service Code
|
HCPCS A9584
|
| Hospital Charge Code |
34300035
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$3,425.08 |
| Max. Negotiated Rate |
$4,892.97 |
| Rate for Payer: Aetna Commercial |
$4,621.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,533.81
|
| Rate for Payer: Cash Price |
$4,349.30
|
| Rate for Payer: Cofinity Commercial |
$3,805.64
|
| Rate for Payer: Cofinity Commercial |
$4,675.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,805.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,349.30
|
| Rate for Payer: Healthscope Commercial |
$4,892.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,621.14
|
| Rate for Payer: PHP Commercial |
$4,621.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,533.81
|
| Rate for Payer: Priority Health SBD |
$3,425.08
|
|
|
HC IOM EEG CAROTID ENDARTERECTOMY
|
Facility
|
IP
|
$1,297.89
|
|
|
Service Code
|
CPT 95955
|
| Hospital Charge Code |
74000014
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$817.67 |
| Max. Negotiated Rate |
$1,168.10 |
| Rate for Payer: Aetna Commercial |
$1,103.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$843.63
|
| Rate for Payer: Cash Price |
$1,038.31
|
| Rate for Payer: Cofinity Commercial |
$1,116.19
|
| Rate for Payer: Cofinity Commercial |
$908.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$908.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,038.31
|
| Rate for Payer: Healthscope Commercial |
$1,168.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,103.21
|
| Rate for Payer: PHP Commercial |
$1,103.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$843.63
|
| Rate for Payer: Priority Health SBD |
$817.67
|
|
|
HC IOM EEG CAROTID ENDARTERECTOMY
|
Facility
|
OP
|
$1,297.89
|
|
|
Service Code
|
CPT 95955
|
| Hospital Charge Code |
74000014
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$519.16 |
| Max. Negotiated Rate |
$1,168.10 |
| Rate for Payer: Aetna Commercial |
$1,103.21
|
| Rate for Payer: Aetna Medicare |
$648.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$843.63
|
| Rate for Payer: BCBS Complete |
$519.16
|
| Rate for Payer: Cash Price |
$1,038.31
|
| Rate for Payer: Cofinity Commercial |
$1,116.19
|
| Rate for Payer: Cofinity Commercial |
$908.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$908.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,038.31
|
| Rate for Payer: Healthscope Commercial |
$1,168.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,103.21
|
| Rate for Payer: PHP Commercial |
$1,103.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$843.63
|
| Rate for Payer: Priority Health SBD |
$817.67
|
| Rate for Payer: UHC Exchange |
$960.44
|
|
|
HC IOM INTRAOPERATIVE MONITOR/15 MINUTES
|
Facility
|
OP
|
$187.07
|
|
|
Service Code
|
CPT 95940
|
| Hospital Charge Code |
74000017
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$74.83 |
| Max. Negotiated Rate |
$168.36 |
| Rate for Payer: Aetna Commercial |
$159.01
|
| Rate for Payer: Aetna Medicare |
$93.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.60
|
| Rate for Payer: BCBS Complete |
$74.83
|
| Rate for Payer: Cash Price |
$149.66
|
| Rate for Payer: Cofinity Commercial |
$130.95
|
| Rate for Payer: Cofinity Commercial |
$160.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$130.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.66
|
| Rate for Payer: Healthscope Commercial |
$168.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.01
|
| Rate for Payer: PHP Commercial |
$159.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.60
|
| Rate for Payer: Priority Health SBD |
$117.85
|
| Rate for Payer: UHC Exchange |
$138.43
|
|
|
HC IOM INTRAOPERATIVE MONITOR/15 MINUTES
|
Facility
|
IP
|
$187.07
|
|
|
Service Code
|
CPT 95940
|
| Hospital Charge Code |
74000017
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$117.85 |
| Max. Negotiated Rate |
$168.36 |
| Rate for Payer: Aetna Commercial |
$159.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.60
|
| Rate for Payer: Cash Price |
$149.66
|
| Rate for Payer: Cofinity Commercial |
$130.95
|
| Rate for Payer: Cofinity Commercial |
$160.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$130.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.66
|
| Rate for Payer: Healthscope Commercial |
$168.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.01
|
| Rate for Payer: PHP Commercial |
$159.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.60
|
| Rate for Payer: Priority Health SBD |
$117.85
|
|
|
HC IOM STD PRASS PROBE
|
Facility
|
OP
|
$357.38
|
|
| Hospital Charge Code |
62200008
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$142.95 |
| Max. Negotiated Rate |
$321.64 |
| Rate for Payer: Aetna Commercial |
$303.77
|
| Rate for Payer: Aetna Medicare |
$178.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.30
|
| Rate for Payer: BCBS Complete |
$142.95
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cofinity Commercial |
$250.17
|
| Rate for Payer: Cofinity Commercial |
$307.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$250.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.90
|
| Rate for Payer: Healthscope Commercial |
$321.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.77
|
| Rate for Payer: PHP Commercial |
$303.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.30
|
| Rate for Payer: Priority Health SBD |
$225.15
|
|
|
HC IOM STD PRASS PROBE
|
Facility
|
IP
|
$357.38
|
|
| Hospital Charge Code |
62200008
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$225.15 |
| Max. Negotiated Rate |
$321.64 |
| Rate for Payer: Aetna Commercial |
$303.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.30
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cofinity Commercial |
$250.17
|
| Rate for Payer: Cofinity Commercial |
$307.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$250.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.90
|
| Rate for Payer: Healthscope Commercial |
$321.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.77
|
| Rate for Payer: PHP Commercial |
$303.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.30
|
| Rate for Payer: Priority Health SBD |
$225.15
|
|
|
HC IOM SUBDERMAL RECORDING ELECTR
|
Facility
|
IP
|
$15.36
|
|
| Hospital Charge Code |
62200009
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.68 |
| Max. Negotiated Rate |
$13.82 |
| Rate for Payer: Aetna Commercial |
$13.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.98
|
| Rate for Payer: Cash Price |
$12.29
|
| Rate for Payer: Cofinity Commercial |
$10.75
|
| Rate for Payer: Cofinity Commercial |
$13.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.29
|
| Rate for Payer: Healthscope Commercial |
$13.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.06
|
| Rate for Payer: PHP Commercial |
$13.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.98
|
| Rate for Payer: Priority Health SBD |
$9.68
|
|
|
HC IOM SUBDERMAL RECORDING ELECTR
|
Facility
|
OP
|
$15.36
|
|
| Hospital Charge Code |
62200009
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.14 |
| Max. Negotiated Rate |
$13.82 |
| Rate for Payer: Aetna Commercial |
$13.06
|
| Rate for Payer: Aetna Medicare |
$7.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.98
|
| Rate for Payer: BCBS Complete |
$6.14
|
| Rate for Payer: Cash Price |
$12.29
|
| Rate for Payer: Cofinity Commercial |
$10.75
|
| Rate for Payer: Cofinity Commercial |
$13.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.29
|
| Rate for Payer: Healthscope Commercial |
$13.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.06
|
| Rate for Payer: PHP Commercial |
$13.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.98
|
| Rate for Payer: Priority Health SBD |
$9.68
|
|
|
HC IONIZED CALCIUM
|
Facility
|
OP
|
$107.51
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
30100130
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.33 |
| Max. Negotiated Rate |
$96.76 |
| Rate for Payer: Aetna Commercial |
$91.38
|
| Rate for Payer: Aetna Medicare |
$14.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.10
|
| Rate for Payer: BCBS Complete |
$7.70
|
| Rate for Payer: BCBS MAPPO |
$13.68
|
| Rate for Payer: BCN Medicare Advantage |
$13.68
|
| Rate for Payer: Cash Price |
$86.01
|
| Rate for Payer: Cash Price |
$86.01
|
| Rate for Payer: Cofinity Commercial |
$92.46
|
| Rate for Payer: Cofinity Commercial |
$75.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.68
|
| Rate for Payer: Healthscope Commercial |
$96.76
|
| Rate for Payer: Mclaren Medicaid |
$7.33
|
| Rate for Payer: Mclaren Medicare |
$13.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.36
|
| Rate for Payer: Meridian Medicaid |
$7.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.38
|
| Rate for Payer: PACE Medicare |
$13.00
|
| Rate for Payer: PACE SWMI |
$13.68
|
| Rate for Payer: PHP Commercial |
$91.38
|
| Rate for Payer: PHP Medicare Advantage |
$13.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.88
|
| Rate for Payer: Priority Health Medicare |
$13.68
|
| Rate for Payer: Priority Health SBD |
$67.73
|
| Rate for Payer: Railroad Medicare Medicare |
$13.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.68
|
| Rate for Payer: UHC Medicare Advantage |
$13.68
|
| Rate for Payer: UHCCP Medicaid |
$7.70
|
| Rate for Payer: VA VA |
$13.68
|
|
|
HC IONIZED CALCIUM
|
Facility
|
IP
|
$107.51
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
30100130
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.73 |
| Max. Negotiated Rate |
$96.76 |
| Rate for Payer: Aetna Commercial |
$91.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.88
|
| Rate for Payer: Cash Price |
$86.01
|
| Rate for Payer: Cofinity Commercial |
$75.26
|
| Rate for Payer: Cofinity Commercial |
$92.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.01
|
| Rate for Payer: Healthscope Commercial |
$96.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.38
|
| Rate for Payer: PHP Commercial |
$91.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.88
|
| Rate for Payer: Priority Health SBD |
$67.73
|
|
|
HC IONTOPHORESIS EACH 15 MIN
|
Facility
|
OP
|
$106.12
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
42000016
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.45 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$90.20
|
| Rate for Payer: Aetna Medicare |
$53.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.98
|
| Rate for Payer: BCBS Complete |
$42.45
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cofinity Commercial |
$91.26
|
| Rate for Payer: Cofinity Commercial |
$74.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.90
|
| Rate for Payer: Healthscope Commercial |
$95.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.20
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$90.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.98
|
| Rate for Payer: Priority Health SBD |
$66.86
|
| Rate for Payer: UHC Core |
$78.53
|
| Rate for Payer: UHC Exchange |
$78.53
|
|
|
HC IONTOPHORESIS EACH 15 MIN
|
Facility
|
IP
|
$106.12
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
42000016
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$66.86 |
| Max. Negotiated Rate |
$95.51 |
| Rate for Payer: Aetna Commercial |
$90.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.98
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cofinity Commercial |
$74.28
|
| Rate for Payer: Cofinity Commercial |
$91.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.90
|
| Rate for Payer: Healthscope Commercial |
$95.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.20
|
| Rate for Payer: PHP Commercial |
$90.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.98
|
| Rate for Payer: Priority Health SBD |
$66.86
|
|
|
HC IP 1:1 HEMODIALYSIS
|
Facility
|
OP
|
$969.00
|
|
| Hospital Charge Code |
80100002
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$387.60 |
| Max. Negotiated Rate |
$872.10 |
| Rate for Payer: Aetna Commercial |
$823.65
|
| Rate for Payer: Aetna Medicare |
$484.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$629.85
|
| Rate for Payer: BCBS Complete |
$387.60
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$678.30
|
| Rate for Payer: Cofinity Commercial |
$833.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$678.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.20
|
| Rate for Payer: Healthscope Commercial |
$872.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$823.65
|
| Rate for Payer: PHP Commercial |
$823.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: Priority Health SBD |
$610.47
|
|
|
HC IP 1:1 HEMODIALYSIS
|
Facility
|
IP
|
$969.00
|
|
| Hospital Charge Code |
80100002
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$610.47 |
| Max. Negotiated Rate |
$872.10 |
| Rate for Payer: Aetna Commercial |
$823.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$629.85
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$678.30
|
| Rate for Payer: Cofinity Commercial |
$833.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$678.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.20
|
| Rate for Payer: Healthscope Commercial |
$872.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$823.65
|
| Rate for Payer: PHP Commercial |
$823.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: Priority Health SBD |
$610.47
|
|
|
HC IP 2:1 HEMODIALYSIS
|
Facility
|
IP
|
$969.00
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
80100001
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$610.47 |
| Max. Negotiated Rate |
$872.10 |
| Rate for Payer: Aetna Commercial |
$823.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$629.85
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$678.30
|
| Rate for Payer: Cofinity Commercial |
$833.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$678.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.20
|
| Rate for Payer: Healthscope Commercial |
$872.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$823.65
|
| Rate for Payer: PHP Commercial |
$823.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: Priority Health SBD |
$610.47
|
|
|
HC IP 2:1 HEMODIALYSIS
|
Facility
|
OP
|
$969.00
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
80100001
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$365.78 |
| Max. Negotiated Rate |
$1,920.94 |
| Rate for Payer: Aetna Commercial |
$823.65
|
| Rate for Payer: Aetna Medicare |
$709.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$629.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$853.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$853.02
|
| Rate for Payer: BCBS Complete |
$384.07
|
| Rate for Payer: BCBS MAPPO |
$682.42
|
| Rate for Payer: BCN Medicare Advantage |
$682.42
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$833.34
|
| Rate for Payer: Cofinity Commercial |
$678.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$678.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$682.42
|
| Rate for Payer: Healthscope Commercial |
$872.10
|
| Rate for Payer: Mclaren Medicaid |
$365.78
|
| Rate for Payer: Mclaren Medicare |
$682.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$716.54
|
| Rate for Payer: Meridian Medicaid |
$384.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$784.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$823.65
|
| Rate for Payer: PACE Medicare |
$648.30
|
| Rate for Payer: PACE SWMI |
$682.42
|
| Rate for Payer: PHP Commercial |
$823.65
|
| Rate for Payer: PHP Medicare Advantage |
$682.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$365.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: Priority Health Medicare |
$682.42
|
| Rate for Payer: Priority Health SBD |
$610.47
|
| Rate for Payer: Railroad Medicare Medicare |
$682.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,920.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$682.42
|
| Rate for Payer: UHC Medicare Advantage |
$682.42
|
| Rate for Payer: UHCCP Medicaid |
$384.20
|
| Rate for Payer: VA VA |
$682.42
|
|
|
HC IPPB/IPV TREATMENT
|
Facility
|
IP
|
$138.64
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
41000015
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$87.34 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna Commercial |
$117.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.12
|
| Rate for Payer: Cash Price |
$110.91
|
| Rate for Payer: Cofinity Commercial |
$119.23
|
| Rate for Payer: Cofinity Commercial |
$97.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.91
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.84
|
| Rate for Payer: PHP Commercial |
$117.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.12
|
| Rate for Payer: Priority Health SBD |
$87.34
|
|
|
HC IPPB/IPV TREATMENT
|
Facility
|
OP
|
$138.64
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
41000015
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$87.34 |
| Max. Negotiated Rate |
$558.36 |
| Rate for Payer: Aetna Commercial |
$117.84
|
| Rate for Payer: Aetna Medicare |
$206.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$247.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$247.95
|
| Rate for Payer: BCBS Complete |
$111.64
|
| Rate for Payer: BCBS MAPPO |
$198.36
|
| Rate for Payer: BCN Medicare Advantage |
$198.36
|
| Rate for Payer: Cash Price |
$110.91
|
| Rate for Payer: Cash Price |
$110.91
|
| Rate for Payer: Cofinity Commercial |
$97.05
|
| Rate for Payer: Cofinity Commercial |
$119.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.36
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Mclaren Medicaid |
$106.32
|
| Rate for Payer: Mclaren Medicare |
$198.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$208.28
|
| Rate for Payer: Meridian Medicaid |
$111.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.84
|
| Rate for Payer: PACE Medicare |
$188.44
|
| Rate for Payer: PACE SWMI |
$198.36
|
| Rate for Payer: PHP Commercial |
$117.84
|
| Rate for Payer: PHP Medicare Advantage |
$198.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.12
|
| Rate for Payer: Priority Health Medicare |
$198.36
|
| Rate for Payer: Priority Health SBD |
$87.34
|
| Rate for Payer: Railroad Medicare Medicare |
$198.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$558.36
|
| Rate for Payer: UHC Core |
$102.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$198.36
|
| Rate for Payer: UHC Exchange |
$102.59
|
| Rate for Payer: UHC Medicare Advantage |
$198.36
|
| Rate for Payer: UHCCP Medicaid |
$111.68
|
| Rate for Payer: VA VA |
$198.36
|
|
|
HC IPRATROPIUM BROMIDE, INHALATION SOLUTION, UNIT DOSE/MILLIGRAM
|
Facility
|
IP
|
$4.16
|
|
|
Service Code
|
CPT J7644
|
| Hospital Charge Code |
63600112
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.70
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$2.91
|
| Rate for Payer: Cofinity Commercial |
$3.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.33
|
| Rate for Payer: Healthscope Commercial |
$3.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.54
|
| Rate for Payer: PHP Commercial |
$3.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.70
|
| Rate for Payer: Priority Health SBD |
$2.62
|
|
