|
HC LOC INFIL W/CS 15 MIN
|
Facility
|
OP
|
$147.26
|
|
| Hospital Charge Code |
37000007
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$57.87 |
| Max. Negotiated Rate |
$132.53 |
| Rate for Payer: Aetna Commercial |
$125.17
|
| Rate for Payer: Aetna Medicare |
$73.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.72
|
| Rate for Payer: BCBS Complete |
$58.90
|
| Rate for Payer: Cash Price |
$117.81
|
| Rate for Payer: Cofinity Advantage |
$103.08
|
| Rate for Payer: Cofinity Commercial |
$126.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.81
|
| Rate for Payer: Healthscope Commercial |
$132.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.44
|
| Rate for Payer: PHP Commercial |
$125.17
|
| Rate for Payer: Priority Health SBD |
$92.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.72
|
| Rate for Payer: UHC Core |
$76.72
|
| Rate for Payer: UHC Exchange |
$57.87
|
|
|
HC LOC INFIL W/CS 15 MIN
|
Facility
|
IP
|
$147.26
|
|
| Hospital Charge Code |
37000007
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$92.77 |
| Max. Negotiated Rate |
$132.53 |
| Rate for Payer: Aetna Commercial |
$125.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.72
|
| Rate for Payer: Cash Price |
$117.81
|
| Rate for Payer: Cofinity Advantage |
$103.08
|
| Rate for Payer: Cofinity Commercial |
$126.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.81
|
| Rate for Payer: Healthscope Commercial |
$132.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.44
|
| Rate for Payer: PHP Commercial |
$125.17
|
| Rate for Payer: Priority Health SBD |
$92.77
|
|
|
HC LOC INFIL W/CS 30 MIN
|
Facility
|
OP
|
$736.01
|
|
| Hospital Charge Code |
37000008
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$289.25 |
| Max. Negotiated Rate |
$662.41 |
| Rate for Payer: Aetna Commercial |
$625.61
|
| Rate for Payer: Aetna Medicare |
$368.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$478.41
|
| Rate for Payer: BCBS Complete |
$294.40
|
| Rate for Payer: Cash Price |
$588.81
|
| Rate for Payer: Cofinity Advantage |
$515.21
|
| Rate for Payer: Cofinity Commercial |
$632.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.81
|
| Rate for Payer: Healthscope Commercial |
$662.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$588.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$625.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$552.01
|
| Rate for Payer: PHP Commercial |
$625.61
|
| Rate for Payer: Priority Health SBD |
$463.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$478.41
|
| Rate for Payer: UHC Core |
$383.46
|
| Rate for Payer: UHC Exchange |
$289.25
|
|
|
HC LOC INFIL W/CS 30 MIN
|
Facility
|
IP
|
$736.01
|
|
| Hospital Charge Code |
37000008
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$463.69 |
| Max. Negotiated Rate |
$662.41 |
| Rate for Payer: Aetna Commercial |
$625.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$478.41
|
| Rate for Payer: Cash Price |
$588.81
|
| Rate for Payer: Cofinity Advantage |
$515.21
|
| Rate for Payer: Cofinity Commercial |
$632.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.81
|
| Rate for Payer: Healthscope Commercial |
$662.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$625.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$552.01
|
| Rate for Payer: PHP Commercial |
$625.61
|
| Rate for Payer: Priority Health SBD |
$463.69
|
|
|
HC LOCM 100-199 MG/ML IODINE/ML1
|
Facility
|
OP
|
$3.83
|
|
|
Service Code
|
HCPCS Q9965
|
| Hospital Charge Code |
25500002
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$3.45 |
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Aetna Medicare |
$1.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.49
|
| Rate for Payer: BCBS Complete |
$1.53
|
| Rate for Payer: BCBS Trust/PPO |
$2.59
|
| Rate for Payer: BCN Commercial |
$2.59
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cofinity Advantage |
$2.68
|
| Rate for Payer: Cofinity Commercial |
$3.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.06
|
| Rate for Payer: Healthscope Commercial |
$3.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.87
|
| Rate for Payer: PHP Commercial |
$3.26
|
| Rate for Payer: Priority Health SBD |
$2.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.49
|
| Rate for Payer: UHC Core |
$2.00
|
| Rate for Payer: UHC Exchange |
$1.51
|
|
|
HC LOCM 100-199 MG/ML IODINE/ML1
|
Facility
|
IP
|
$3.83
|
|
|
Service Code
|
HCPCS Q9965
|
| Hospital Charge Code |
25500002
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$3.45 |
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.49
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cofinity Advantage |
$2.68
|
| Rate for Payer: Cofinity Commercial |
$3.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.06
|
| Rate for Payer: Healthscope Commercial |
$3.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.87
|
| Rate for Payer: PHP Commercial |
$3.26
|
| Rate for Payer: Priority Health SBD |
$2.41
|
|
|
HC LOOP AV 3/8 INCH OR 1/2 INCH
|
Facility
|
IP
|
$220.36
|
|
| Hospital Charge Code |
27000444
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$138.83 |
| Max. Negotiated Rate |
$198.32 |
| Rate for Payer: Aetna Commercial |
$187.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.23
|
| Rate for Payer: Cash Price |
$176.29
|
| Rate for Payer: Cofinity Advantage |
$154.25
|
| Rate for Payer: Cofinity Commercial |
$189.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.29
|
| Rate for Payer: Healthscope Commercial |
$198.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.27
|
| Rate for Payer: PHP Commercial |
$187.31
|
| Rate for Payer: Priority Health SBD |
$138.83
|
|
|
HC LOOP AV 3/8 INCH OR 1/2 INCH
|
Facility
|
OP
|
$220.36
|
|
| Hospital Charge Code |
27000444
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$86.60 |
| Max. Negotiated Rate |
$198.32 |
| Rate for Payer: Aetna Commercial |
$187.31
|
| Rate for Payer: Aetna Medicare |
$110.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.23
|
| Rate for Payer: BCBS Complete |
$88.14
|
| Rate for Payer: Cash Price |
$176.29
|
| Rate for Payer: Cofinity Advantage |
$154.25
|
| Rate for Payer: Cofinity Commercial |
$189.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.29
|
| Rate for Payer: Healthscope Commercial |
$198.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.27
|
| Rate for Payer: PHP Commercial |
$187.31
|
| Rate for Payer: Priority Health SBD |
$138.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.23
|
| Rate for Payer: UHC Core |
$114.81
|
| Rate for Payer: UHC Exchange |
$86.60
|
|
|
HC LOWER EXT FASCIAL PLANE BLOCK UNILAT CONT
|
Facility
|
IP
|
$562.50
|
|
|
Service Code
|
CPT 64474
|
| Hospital Charge Code |
37000030
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$354.38 |
| Max. Negotiated Rate |
$506.25 |
| Rate for Payer: Aetna Commercial |
$478.12
|
| Rate for Payer: Aetna Commercial |
$318.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$365.62
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cofinity Advantage |
$262.50
|
| Rate for Payer: Cofinity Advantage |
$393.75
|
| Rate for Payer: Cofinity Commercial |
$322.50
|
| Rate for Payer: Cofinity Commercial |
$483.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$450.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.00
|
| Rate for Payer: Healthscope Commercial |
$506.25
|
| Rate for Payer: Healthscope Commercial |
$337.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$478.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$421.88
|
| Rate for Payer: PHP Commercial |
$318.75
|
| Rate for Payer: PHP Commercial |
$478.12
|
| Rate for Payer: Priority Health SBD |
$236.25
|
| Rate for Payer: Priority Health SBD |
$354.38
|
|
|
HC LOWER EXT FASCIAL PLANE BLOCK UNILAT CONT
|
Facility
|
OP
|
$562.50
|
|
|
Service Code
|
CPT 64474
|
| Hospital Charge Code |
37000030
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$221.06 |
| Max. Negotiated Rate |
$506.25 |
| Rate for Payer: Aetna Commercial |
$478.12
|
| Rate for Payer: Aetna Commercial |
$318.75
|
| Rate for Payer: Aetna Medicare |
$187.50
|
| Rate for Payer: Aetna Medicare |
$281.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$365.62
|
| Rate for Payer: BCBS Complete |
$225.00
|
| Rate for Payer: BCBS Complete |
$150.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cofinity Advantage |
$393.75
|
| Rate for Payer: Cofinity Advantage |
$262.50
|
| Rate for Payer: Cofinity Commercial |
$322.50
|
| Rate for Payer: Cofinity Commercial |
$483.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$450.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.00
|
| Rate for Payer: Healthscope Commercial |
$337.50
|
| Rate for Payer: Healthscope Commercial |
$506.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$300.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$478.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$421.88
|
| Rate for Payer: PHP Commercial |
$478.12
|
| Rate for Payer: PHP Commercial |
$318.75
|
| Rate for Payer: Priority Health SBD |
$236.25
|
| Rate for Payer: Priority Health SBD |
$354.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$365.62
|
| Rate for Payer: UHC Core |
$195.38
|
| Rate for Payer: UHC Core |
$293.06
|
| Rate for Payer: UHC Exchange |
$147.38
|
| Rate for Payer: UHC Exchange |
$221.06
|
|
|
HC LOWER EXT FASCIAL PLANE BLOCK UNILAT INJ
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 64473
|
| Hospital Charge Code |
37000029
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$283.50 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.50
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Advantage |
$315.00
|
| Rate for Payer: Cofinity Advantage |
$210.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$337.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: Priority Health SBD |
$189.00
|
| Rate for Payer: Priority Health SBD |
$283.50
|
|
|
HC LOWER EXT FASCIAL PLANE BLOCK UNILAT INJ
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 64473
|
| Hospital Charge Code |
37000029
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$117.90 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna Medicare |
$150.00
|
| Rate for Payer: Aetna Medicare |
$225.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.50
|
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: BCBS Complete |
$180.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Advantage |
$315.00
|
| Rate for Payer: Cofinity Advantage |
$210.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$240.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$360.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$337.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.00
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: Priority Health SBD |
$189.00
|
| Rate for Payer: Priority Health SBD |
$283.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.50
|
| Rate for Payer: UHC Core |
$156.30
|
| Rate for Payer: UHC Core |
$234.45
|
| Rate for Payer: UHC Exchange |
$117.90
|
| Rate for Payer: UHC Exchange |
$176.85
|
|
|
HC LOW-LEVEL LASER THERAPY
|
Facility
|
OP
|
$93.64
|
|
|
Service Code
|
CPT 0552T
|
| Hospital Charge Code |
43000024
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$174.37 |
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna Medicare |
$46.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.87
|
| Rate for Payer: BCBS Complete |
$37.46
|
| Rate for Payer: BCBS Trust/PPO |
$174.37
|
| Rate for Payer: BCN Commercial |
$174.37
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Advantage |
$65.55
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: Priority Health SBD |
$58.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.87
|
| Rate for Payer: UHC Core |
$48.79
|
| Rate for Payer: UHC Exchange |
$36.80
|
|
|
HC LOW-LEVEL LASER THERAPY
|
Facility
|
IP
|
$93.64
|
|
|
Service Code
|
CPT 0552T
|
| Hospital Charge Code |
43000024
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$58.99 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.87
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Advantage |
$65.55
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: Priority Health SBD |
$58.99
|
|
|
HC LP (A) CHOLESTEROL LMPP
|
Facility
|
OP
|
$24.41
|
|
|
Service Code
|
CPT 83700
|
| Hospital Charge Code |
30100636
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.89 |
| Max. Negotiated Rate |
$21.97 |
| Rate for Payer: Aetna Commercial |
$20.75
|
| Rate for Payer: Aetna Medicare |
$11.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.07
|
| Rate for Payer: BCBS Complete |
$6.18
|
| Rate for Payer: BCBS MAPPO |
$11.26
|
| Rate for Payer: BCBS Trust/PPO |
$12.01
|
| Rate for Payer: BCN Commercial |
$12.01
|
| Rate for Payer: BCN Medicare Advantage |
$11.26
|
| Rate for Payer: Cash Price |
$19.53
|
| Rate for Payer: Cash Price |
$19.53
|
| Rate for Payer: Cofinity Advantage |
$17.09
|
| Rate for Payer: Cofinity Commercial |
$20.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.26
|
| Rate for Payer: Healthscope Commercial |
$21.97
|
| Rate for Payer: Mclaren Medicaid |
$5.89
|
| Rate for Payer: Mclaren Medicare |
$11.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.82
|
| Rate for Payer: Meridian Medicaid |
$11.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.75
|
| Rate for Payer: Nomi Health Commercial |
$16.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.31
|
| Rate for Payer: PACE Medicare |
$10.70
|
| Rate for Payer: PACE SWMI |
$11.26
|
| Rate for Payer: PHP Commercial |
$20.75
|
| Rate for Payer: PHP Medicare Advantage |
$11.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11.26
|
| Rate for Payer: Priority Health Medicare |
$11.26
|
| Rate for Payer: Priority Health SBD |
$15.38
|
| Rate for Payer: Priority Health Tiered Network |
$9.01
|
| Rate for Payer: Railroad Medicare Medicare |
$11.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.89
|
| Rate for Payer: UHC Core |
$16.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.26
|
| Rate for Payer: UHC Exchange |
$16.89
|
| Rate for Payer: UHC Medicaid |
$5.89
|
| Rate for Payer: UHCCP Medicaid |
$5.89
|
| Rate for Payer: VA VA |
$11.26
|
|
|
HC LP (A) CHOLESTEROL LMPP
|
Facility
|
IP
|
$24.41
|
|
|
Service Code
|
CPT 83700
|
| Hospital Charge Code |
30100636
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.38 |
| Max. Negotiated Rate |
$21.97 |
| Rate for Payer: Aetna Commercial |
$20.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.87
|
| Rate for Payer: Cash Price |
$19.53
|
| Rate for Payer: Cofinity Advantage |
$17.09
|
| Rate for Payer: Cofinity Commercial |
$20.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.53
|
| Rate for Payer: Healthscope Commercial |
$21.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.31
|
| Rate for Payer: PHP Commercial |
$20.75
|
| Rate for Payer: Priority Health SBD |
$15.38
|
|
|
HC LTC ROOM AND BOARD
|
Facility
|
IP
|
$377.40
|
|
| Hospital Charge Code |
11000003
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$237.76 |
| Max. Negotiated Rate |
$339.66 |
| Rate for Payer: Aetna Commercial |
$320.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.31
|
| Rate for Payer: Cash Price |
$301.92
|
| Rate for Payer: Cofinity Advantage |
$264.18
|
| Rate for Payer: Cofinity Commercial |
$324.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.92
|
| Rate for Payer: Healthscope Commercial |
$339.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$320.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$283.05
|
| Rate for Payer: PHP Commercial |
$320.79
|
| Rate for Payer: Priority Health SBD |
$237.76
|
|
|
HC LT/RT/C'S/CABG'S W INTERVENTION
|
Facility
|
IP
|
$12,605.08
|
|
|
Service Code
|
CPT 93461
|
| Hospital Charge Code |
48100051
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,941.20 |
| Max. Negotiated Rate |
$11,344.57 |
| Rate for Payer: Aetna Commercial |
$10,714.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,193.30
|
| Rate for Payer: Cash Price |
$10,084.06
|
| Rate for Payer: Cofinity Advantage |
$8,823.56
|
| Rate for Payer: Cofinity Commercial |
$10,840.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,084.06
|
| Rate for Payer: Healthscope Commercial |
$11,344.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,714.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,453.81
|
| Rate for Payer: PHP Commercial |
$10,714.32
|
| Rate for Payer: Priority Health SBD |
$7,941.20
|
|
|
HC LT/RT/C'S/CABG'S W INTERVENTION
|
Facility
|
OP
|
$12,605.08
|
|
|
Service Code
|
CPT 93461
|
| Hospital Charge Code |
48100051
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,689.43 |
| Max. Negotiated Rate |
$11,344.57 |
| Rate for Payer: Aetna Commercial |
$10,714.32
|
| Rate for Payer: Aetna Medicare |
$3,359.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,193.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,037.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,037.84
|
| Rate for Payer: BCBS Complete |
$1,774.06
|
| Rate for Payer: BCBS MAPPO |
$3,230.27
|
| Rate for Payer: BCBS Trust/PPO |
$4,023.92
|
| Rate for Payer: BCN Commercial |
$4,023.92
|
| Rate for Payer: BCN Medicare Advantage |
$3,230.27
|
| Rate for Payer: Cash Price |
$10,084.06
|
| Rate for Payer: Cash Price |
$10,084.06
|
| Rate for Payer: Cofinity Advantage |
$8,823.56
|
| Rate for Payer: Cofinity Commercial |
$10,840.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,084.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,230.27
|
| Rate for Payer: Healthscope Commercial |
$11,344.57
|
| Rate for Payer: Mclaren Medicaid |
$1,689.43
|
| Rate for Payer: Mclaren Medicare |
$3,230.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,391.78
|
| Rate for Payer: Meridian Medicaid |
$3,391.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,714.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,553.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,714.32
|
| Rate for Payer: Nomi Health Commercial |
$9,690.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,453.81
|
| Rate for Payer: PACE Medicare |
$3,068.76
|
| Rate for Payer: PACE SWMI |
$3,230.27
|
| Rate for Payer: PHP Commercial |
$10,714.32
|
| Rate for Payer: PHP Medicare Advantage |
$3,230.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,689.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,446.41
|
| Rate for Payer: Priority Health Medicare |
$3,230.27
|
| Rate for Payer: Priority Health SBD |
$7,941.20
|
| Rate for Payer: Priority Health Tiered Network |
$8,357.13
|
| Rate for Payer: Railroad Medicare Medicare |
$3,230.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,230.27
|
| Rate for Payer: UHC Medicaid |
$1,689.43
|
| Rate for Payer: UHCCP Medicaid |
$1,689.43
|
| Rate for Payer: VA VA |
$3,230.27
|
|
|
HC LUMASON PER ML
|
Facility
|
IP
|
$81.09
|
|
|
Service Code
|
HCPCS Q9950
|
| Hospital Charge Code |
63600066
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.09 |
| Max. Negotiated Rate |
$72.98 |
| Rate for Payer: Aetna Commercial |
$68.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.71
|
| Rate for Payer: Cash Price |
$64.87
|
| Rate for Payer: Cofinity Advantage |
$56.76
|
| Rate for Payer: Cofinity Commercial |
$69.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.87
|
| Rate for Payer: Healthscope Commercial |
$72.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.82
|
| Rate for Payer: PHP Commercial |
$68.93
|
| Rate for Payer: Priority Health SBD |
$51.09
|
|
|
HC LUMASON PER ML
|
Facility
|
OP
|
$81.09
|
|
|
Service Code
|
HCPCS Q9950
|
| Hospital Charge Code |
63600066
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.93 |
| Max. Negotiated Rate |
$72.98 |
| Rate for Payer: Aetna Commercial |
$68.93
|
| Rate for Payer: Aetna Medicare |
$40.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.71
|
| Rate for Payer: BCBS Complete |
$32.44
|
| Rate for Payer: BCBS Trust/PPO |
$26.93
|
| Rate for Payer: BCN Commercial |
$26.93
|
| Rate for Payer: Cash Price |
$64.87
|
| Rate for Payer: Cash Price |
$64.87
|
| Rate for Payer: Cofinity Advantage |
$56.76
|
| Rate for Payer: Cofinity Commercial |
$69.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.87
|
| Rate for Payer: Healthscope Commercial |
$72.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.82
|
| Rate for Payer: PHP Commercial |
$68.93
|
| Rate for Payer: Priority Health SBD |
$51.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.98
|
| Rate for Payer: UHC Core |
$29.98
|
| Rate for Payer: UHC Exchange |
$29.98
|
|
|
HC LUMBAR PUNCTURE
|
Facility
|
IP
|
$763.51
|
|
| Hospital Charge Code |
45000046
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$481.01 |
| Max. Negotiated Rate |
$687.16 |
| Rate for Payer: Aetna Commercial |
$648.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$496.28
|
| Rate for Payer: Cash Price |
$610.81
|
| Rate for Payer: Cofinity Advantage |
$534.46
|
| Rate for Payer: Cofinity Commercial |
$656.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$610.81
|
| Rate for Payer: Healthscope Commercial |
$687.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$648.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$572.63
|
| Rate for Payer: PHP Commercial |
$648.98
|
| Rate for Payer: Priority Health SBD |
$481.01
|
|
|
HC LUMBAR PUNCTURE
|
Facility
|
OP
|
$763.51
|
|
| Hospital Charge Code |
45000046
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$687.16 |
| Rate for Payer: Aetna Commercial |
$648.98
|
| Rate for Payer: Aetna Medicare |
$381.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$496.28
|
| Rate for Payer: BCBS Complete |
$305.40
|
| Rate for Payer: Cash Price |
$610.81
|
| Rate for Payer: Cash Price |
$610.81
|
| Rate for Payer: Cofinity Advantage |
$534.46
|
| Rate for Payer: Cofinity Commercial |
$656.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$610.81
|
| Rate for Payer: Healthscope Commercial |
$687.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$610.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$648.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$572.63
|
| Rate for Payer: PHP Commercial |
$648.98
|
| Rate for Payer: Priority Health SBD |
$481.01
|
| Rate for Payer: UHCCP Medicaid |
$144.00
|
|
|
HC LUMBAR PUNCTURE DIAGNOSTIC
|
Facility
|
OP
|
$934.71
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
36100278
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.34 |
| Max. Negotiated Rate |
$2,274.56 |
| Rate for Payer: Aetna Commercial |
$794.50
|
| Rate for Payer: Aetna Medicare |
$731.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$607.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS Trust/PPO |
$699.34
|
| Rate for Payer: BCN Commercial |
$699.34
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: Cash Price |
$747.77
|
| Rate for Payer: Cash Price |
$747.77
|
| Rate for Payer: Cash Price |
$747.77
|
| Rate for Payer: Cofinity Advantage |
$654.30
|
| Rate for Payer: Cofinity Commercial |
$803.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$747.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Healthscope Commercial |
$841.24
|
| Rate for Payer: Mclaren Medicaid |
$367.85
|
| Rate for Payer: Mclaren Medicare |
$703.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.51
|
| Rate for Payer: Meridian Medicaid |
$738.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$794.50
|
| Rate for Payer: Nomi Health Commercial |
$2,110.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$701.03
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PHP Commercial |
$794.50
|
| Rate for Payer: PHP Medicare Advantage |
$703.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,274.56
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health SBD |
$588.87
|
| Rate for Payer: Priority Health Tiered Network |
$1,819.65
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$607.56
|
| Rate for Payer: UHC Core |
$486.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Exchange |
$367.34
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: VA VA |
$703.34
|
|
|
HC LUMBAR PUNCTURE DIAGNOSTIC
|
Facility
|
IP
|
$934.71
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
36100278
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$588.87 |
| Max. Negotiated Rate |
$841.24 |
| Rate for Payer: Aetna Commercial |
$794.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$607.56
|
| Rate for Payer: Cash Price |
$747.77
|
| Rate for Payer: Cofinity Advantage |
$654.30
|
| Rate for Payer: Cofinity Commercial |
$803.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$747.77
|
| Rate for Payer: Healthscope Commercial |
$841.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$794.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$701.03
|
| Rate for Payer: PHP Commercial |
$794.50
|
| Rate for Payer: Priority Health SBD |
$588.87
|
|
