|
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 |
$33.47 |
| Max. Negotiated Rate |
$168.36 |
| Rate for Payer: Aetna Commercial |
$159.01
|
| Rate for Payer: Aetna Medicare |
$93.54
|
| 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: 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 All Payor (Choice/PPO) |
$33.47
|
| Rate for Payer: UHC Exchange |
$138.43
|
|
|
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 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 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
|
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 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 |
$3,718.82 |
| 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: BCBS Trust/PPO |
$12.11
|
| Rate for Payer: BCN Commercial |
$12.11
|
| 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 |
$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: 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: Nomi Health Commercial |
$20.52
|
| 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 HMO/PPO/Tiered Network |
$14.07
|
| Rate for Payer: Priority Health Medicare |
$13.68
|
| Rate for Payer: Priority Health Narrow Network |
$11.26
|
| Rate for Payer: Priority Health SBD |
$67.73
|
| Rate for Payer: Railroad Medicare Medicare |
$13.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.42
|
| Rate for Payer: UHC Core |
$3,718.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.68
|
| Rate for Payer: UHC Exchange |
$3,718.82
|
| Rate for Payer: UHC Medicare Advantage |
$13.68
|
| Rate for Payer: UHCCP Medicaid |
$7.70
|
| Rate for Payer: VA VA |
$13.68
|
|
|
HC IONTOPHORESIS EACH 15 MIN
|
Facility
|
OP
|
$106.12
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
42000016
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.93 |
| 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: BCBS Trust/PPO |
$15.93
|
| Rate for Payer: BCN Commercial |
$15.93
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cash Price |
$84.90
|
| 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: 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 HMO/PPO/Tiered Network |
$23.00
|
| Rate for Payer: Priority Health Narrow Network |
$18.40
|
| Rate for Payer: Priority Health SBD |
$66.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.95
|
| 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 |
$367.47 |
| Max. Negotiated Rate |
$2,154.74 |
| Rate for Payer: Aetna Commercial |
$823.65
|
| Rate for Payer: Aetna Medicare |
$712.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$629.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$856.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$856.96
|
| Rate for Payer: BCBS Complete |
$385.84
|
| Rate for Payer: BCBS MAPPO |
$685.57
|
| Rate for Payer: BCN Medicare Advantage |
$685.57
|
| Rate for Payer: Cash Price |
$775.20
|
| 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: Health Alliance Plan Medicare Advantage |
$685.57
|
| Rate for Payer: Healthscope Commercial |
$872.10
|
| Rate for Payer: Mclaren Medicaid |
$367.47
|
| Rate for Payer: Mclaren Medicare |
$685.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$719.85
|
| Rate for Payer: Meridian Medicaid |
$385.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$788.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$823.65
|
| Rate for Payer: Nomi Health Commercial |
$2,056.71
|
| Rate for Payer: PACE Medicare |
$651.29
|
| Rate for Payer: PACE SWMI |
$685.57
|
| Rate for Payer: PHP Commercial |
$823.65
|
| Rate for Payer: PHP Medicare Advantage |
$685.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,154.74
|
| Rate for Payer: Priority Health Medicare |
$685.57
|
| Rate for Payer: Priority Health Narrow Network |
$1,723.79
|
| Rate for Payer: Priority Health SBD |
$610.47
|
| Rate for Payer: Railroad Medicare Medicare |
$685.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,929.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$685.57
|
| Rate for Payer: UHC Medicare Advantage |
$685.57
|
| Rate for Payer: UHCCP Medicaid |
$385.98
|
| Rate for Payer: VA VA |
$685.57
|
|
|
HC IPPB/IPV TREATMENT
|
Facility
|
OP
|
$138.64
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
41000015
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$626.34 |
| Rate for Payer: Aetna Commercial |
$117.84
|
| Rate for Payer: Aetna Medicare |
$207.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.10
|
| Rate for Payer: BCBS Complete |
$112.15
|
| Rate for Payer: BCBS MAPPO |
$199.28
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: BCN Commercial |
$33.96
|
| Rate for Payer: BCN Medicare Advantage |
$199.28
|
| 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 |
$199.28
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Mclaren Medicaid |
$106.81
|
| Rate for Payer: Mclaren Medicare |
$199.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.24
|
| Rate for Payer: Meridian Medicaid |
$112.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.84
|
| Rate for Payer: Nomi Health Commercial |
$597.84
|
| Rate for Payer: PACE Medicare |
$189.32
|
| Rate for Payer: PACE SWMI |
$199.28
|
| Rate for Payer: PHP Commercial |
$117.84
|
| Rate for Payer: PHP Medicare Advantage |
$199.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$626.34
|
| Rate for Payer: Priority Health Medicare |
$199.28
|
| Rate for Payer: Priority Health Narrow Network |
$501.07
|
| Rate for Payer: Priority Health SBD |
$87.34
|
| Rate for Payer: Railroad Medicare Medicare |
$199.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$199.28
|
| Rate for Payer: UHC Exchange |
$102.59
|
| Rate for Payer: UHC Medicare Advantage |
$199.28
|
| Rate for Payer: UHCCP Medicaid |
$112.19
|
| Rate for Payer: VA VA |
$199.28
|
|
|
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 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
|
|
|
HC IPRATROPIUM BROMIDE, INHALATION SOLUTION, UNIT DOSE/MILLIGRAM
|
Facility
|
OP
|
$4.16
|
|
|
Service Code
|
CPT J7644
|
| Hospital Charge Code |
63600112
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Aetna Medicare |
$2.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.70
|
| Rate for Payer: BCBS Complete |
$1.66
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$3.58
|
| Rate for Payer: Cofinity Commercial |
$2.91
|
| 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 HMO/PPO/Tiered Network |
$0.37
|
| Rate for Payer: Priority Health Narrow Network |
$0.30
|
| Rate for Payer: Priority Health SBD |
$2.62
|
|
|
HC IR ABSCESS DRAIN CATH PLACE
|
Facility
|
OP
|
$878.12
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
35000021
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$107.49 |
| Max. Negotiated Rate |
$790.31 |
| Rate for Payer: Aetna Commercial |
$746.40
|
| Rate for Payer: Aetna Medicare |
$439.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$570.78
|
| Rate for Payer: BCBS Complete |
$351.25
|
| Rate for Payer: BCBS Trust/PPO |
$107.49
|
| Rate for Payer: BCN Commercial |
$107.49
|
| Rate for Payer: Cash Price |
$702.50
|
| Rate for Payer: Cash Price |
$702.50
|
| Rate for Payer: Cofinity Commercial |
$614.68
|
| Rate for Payer: Cofinity Commercial |
$755.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$614.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$702.50
|
| Rate for Payer: Healthscope Commercial |
$790.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$746.40
|
| Rate for Payer: PHP Commercial |
$746.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$570.78
|
| Rate for Payer: Priority Health SBD |
$553.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.26
|
| Rate for Payer: UHC Exchange |
$649.81
|
|
|
HC IR ABSCESS DRAIN CATH PLACE
|
Facility
|
IP
|
$878.12
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
35000021
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$553.22 |
| Max. Negotiated Rate |
$790.31 |
| Rate for Payer: Aetna Commercial |
$746.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$570.78
|
| Rate for Payer: Cash Price |
$702.50
|
| Rate for Payer: Cofinity Commercial |
$614.68
|
| Rate for Payer: Cofinity Commercial |
$755.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$614.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$702.50
|
| Rate for Payer: Healthscope Commercial |
$790.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$746.40
|
| Rate for Payer: PHP Commercial |
$746.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$570.78
|
| Rate for Payer: Priority Health SBD |
$553.22
|
|
|
HC IR ABSCESS DRAIN TUBE CHECK
|
Facility
|
OP
|
$388.71
|
|
|
Service Code
|
CPT 76080
|
| Hospital Charge Code |
32000236
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$60.94 |
| Max. Negotiated Rate |
$1,688.45 |
| Rate for Payer: Aetna Commercial |
$330.40
|
| Rate for Payer: Aetna Medicare |
$558.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.51
|
| Rate for Payer: BCBS Complete |
$302.34
|
| Rate for Payer: BCBS MAPPO |
$537.21
|
| Rate for Payer: BCBS Trust/PPO |
$66.64
|
| Rate for Payer: BCN Commercial |
$66.64
|
| Rate for Payer: BCN Medicare Advantage |
$537.21
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$334.29
|
| Rate for Payer: Cofinity Commercial |
$272.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$272.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.21
|
| Rate for Payer: Healthscope Commercial |
$349.84
|
| Rate for Payer: Mclaren Medicaid |
$287.94
|
| Rate for Payer: Mclaren Medicare |
$537.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.07
|
| Rate for Payer: Meridian Medicaid |
$302.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$617.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: Nomi Health Commercial |
$1,611.63
|
| Rate for Payer: PACE Medicare |
$510.35
|
| Rate for Payer: PACE SWMI |
$537.21
|
| Rate for Payer: PHP Commercial |
$330.40
|
| Rate for Payer: PHP Medicare Advantage |
$537.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$287.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,688.45
|
| Rate for Payer: Priority Health Medicare |
$537.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,350.76
|
| Rate for Payer: Priority Health SBD |
$244.89
|
| Rate for Payer: Railroad Medicare Medicare |
$537.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$537.21
|
| Rate for Payer: UHC Exchange |
$287.65
|
| Rate for Payer: UHC Medicare Advantage |
$537.21
|
| Rate for Payer: UHCCP Medicaid |
$302.45
|
| Rate for Payer: VA VA |
$537.21
|
|
|
HC IR ABSCESS DRAIN TUBE CHECK
|
Facility
|
IP
|
$388.71
|
|
|
Service Code
|
CPT 76080
|
| Hospital Charge Code |
32000236
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$244.89 |
| Max. Negotiated Rate |
$349.84 |
| Rate for Payer: Aetna Commercial |
$330.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.66
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$272.10
|
| Rate for Payer: Cofinity Commercial |
$334.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$272.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Healthscope Commercial |
$349.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: PHP Commercial |
$330.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.66
|
| Rate for Payer: Priority Health SBD |
$244.89
|
|
|
HC IR ANGIO FU EMBO THROMBOLYSIS
|
Facility
|
IP
|
$1,716.86
|
|
|
Service Code
|
CPT 75898
|
| Hospital Charge Code |
32000212
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,081.62 |
| Max. Negotiated Rate |
$1,545.17 |
| Rate for Payer: Aetna Commercial |
$1,459.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,115.96
|
| Rate for Payer: Cash Price |
$1,373.49
|
| Rate for Payer: Cofinity Commercial |
$1,201.80
|
| Rate for Payer: Cofinity Commercial |
$1,476.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,201.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,373.49
|
| Rate for Payer: Healthscope Commercial |
$1,545.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,459.33
|
| Rate for Payer: PHP Commercial |
$1,459.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,115.96
|
| Rate for Payer: Priority Health SBD |
$1,081.62
|
|
|
HC IR ANGIO FU EMBO THROMBOLYSIS
|
Facility
|
OP
|
$1,716.86
|
|
|
Service Code
|
CPT 75898
|
| Hospital Charge Code |
32000212
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,081.62 |
| Max. Negotiated Rate |
$9,692.51 |
| Rate for Payer: Aetna Commercial |
$1,459.33
|
| Rate for Payer: Aetna Medicare |
$3,207.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,115.96
|
| 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 |
$3,584.58
|
| Rate for Payer: BCN Commercial |
$3,584.58
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Cash Price |
$1,373.49
|
| Rate for Payer: Cash Price |
$1,373.49
|
| Rate for Payer: Cash Price |
$1,373.49
|
| Rate for Payer: Cofinity Commercial |
$1,476.50
|
| Rate for Payer: Cofinity Commercial |
$1,201.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,201.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,373.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Healthscope Commercial |
$1,545.17
|
| 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 |
$1,459.33
|
| 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 |
$1,459.33
|
| 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 |
$1,115.96
|
| 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 |
$1,081.62
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,680.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$1,270.48
|
| 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 IR ANGIOGRAM PELVIC
|
Facility
|
OP
|
$3,266.13
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
32000194
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$145.88 |
| Max. Negotiated Rate |
$16,646.50 |
| Rate for Payer: Aetna Commercial |
$2,776.21
|
| Rate for Payer: Aetna Medicare |
$5,508.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,122.98
|
| 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 |
$174.13
|
| Rate for Payer: BCN Commercial |
$174.13
|
| Rate for Payer: BCN Medicare Advantage |
$5,296.40
|
| Rate for Payer: Cash Price |
$2,612.90
|
| Rate for Payer: Cash Price |
$2,612.90
|
| Rate for Payer: Cofinity Commercial |
$2,808.87
|
| Rate for Payer: Cofinity Commercial |
$2,286.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,286.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,612.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,296.40
|
| Rate for Payer: Healthscope Commercial |
$2,939.52
|
| 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 |
$2,776.21
|
| Rate for Payer: Nomi Health Commercial |
$15,889.20
|
| Rate for Payer: PACE Medicare |
$5,031.58
|
| Rate for Payer: PACE SWMI |
$5,296.40
|
| Rate for Payer: PHP Commercial |
$2,776.21
|
| 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 |
$2,122.98
|
| 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 |
$2,057.66
|
| Rate for Payer: Railroad Medicare Medicare |
$5,296.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,296.40
|
| Rate for Payer: UHC Exchange |
$2,416.94
|
| 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 IR ANGIOGRAM PELVIC
|
Facility
|
IP
|
$3,266.13
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
32000194
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,057.66 |
| Max. Negotiated Rate |
$2,939.52 |
| Rate for Payer: Aetna Commercial |
$2,776.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,122.98
|
| Rate for Payer: Cash Price |
$2,612.90
|
| Rate for Payer: Cofinity Commercial |
$2,286.29
|
| Rate for Payer: Cofinity Commercial |
$2,808.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,286.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,612.90
|
| Rate for Payer: Healthscope Commercial |
$2,939.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,776.21
|
| Rate for Payer: PHP Commercial |
$2,776.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,122.98
|
| Rate for Payer: Priority Health SBD |
$2,057.66
|
|
