|
HC RO ISODOSE TELETHRPY SIMPLE
|
Facility
|
OP
|
$247.86
|
|
|
Service Code
|
CPT 77306
|
| Hospital Charge Code |
33300043
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$122.45 |
| Max. Negotiated Rate |
$410.96 |
| Rate for Payer: Aetna Commercial |
$210.68
|
| Rate for Payer: Aetna Commercial |
$544.85
|
| Rate for Payer: Aetna Medicare |
$341.92
|
| Rate for Payer: Aetna Medicare |
$341.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$416.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$410.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$410.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$410.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$410.96
|
| Rate for Payer: BCBS Complete |
$188.85
|
| Rate for Payer: BCBS Complete |
$188.85
|
| Rate for Payer: BCBS MAPPO |
$328.77
|
| Rate for Payer: BCBS MAPPO |
$328.77
|
| Rate for Payer: BCBS Trust/PPO |
$122.45
|
| Rate for Payer: BCBS Trust/PPO |
$122.45
|
| Rate for Payer: BCN Medicare Advantage |
$328.77
|
| Rate for Payer: BCN Medicare Advantage |
$328.77
|
| Rate for Payer: Cash Price |
$198.29
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cash Price |
$198.29
|
| Rate for Payer: Cofinity Commercial |
$448.70
|
| Rate for Payer: Cofinity Commercial |
$213.16
|
| Rate for Payer: Cofinity Commercial |
$551.26
|
| Rate for Payer: Cofinity Commercial |
$173.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.77
|
| Rate for Payer: Healthscope Commercial |
$223.07
|
| Rate for Payer: Healthscope Commercial |
$576.90
|
| Rate for Payer: Mclaren Medicaid |
$179.84
|
| Rate for Payer: Mclaren Medicaid |
$179.84
|
| Rate for Payer: Mclaren Medicare |
$328.77
|
| Rate for Payer: Mclaren Medicare |
$328.77
|
| Rate for Payer: Meridian Medicaid |
$188.85
|
| Rate for Payer: Meridian Medicaid |
$188.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$345.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$345.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$210.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$544.85
|
| Rate for Payer: PACE Medicare |
$312.33
|
| Rate for Payer: PACE Medicare |
$312.33
|
| Rate for Payer: PACE SWMI |
$328.77
|
| Rate for Payer: PACE SWMI |
$328.77
|
| Rate for Payer: PHP Commercial |
$210.68
|
| Rate for Payer: PHP Commercial |
$544.85
|
| Rate for Payer: PHP Medicare Advantage |
$328.77
|
| Rate for Payer: PHP Medicare Advantage |
$328.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.50
|
| Rate for Payer: Priority Health Medicare |
$328.77
|
| Rate for Payer: Priority Health Medicare |
$328.77
|
| Rate for Payer: Priority Health SBD |
$156.15
|
| Rate for Payer: Priority Health SBD |
$403.83
|
| Rate for Payer: Railroad Medicare Medicare |
$328.77
|
| Rate for Payer: Railroad Medicare Medicare |
$328.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$328.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$328.77
|
| Rate for Payer: UHC Exchange |
$145.71
|
| Rate for Payer: UHC Exchange |
$145.71
|
| Rate for Payer: UHC Medicare Advantage |
$338.63
|
| Rate for Payer: UHC Medicare Advantage |
$338.63
|
| Rate for Payer: VA VA |
$328.77
|
| Rate for Payer: VA VA |
$328.77
|
|
|
HC RO LINAC SBRT PER SESSION
|
Facility
|
IP
|
$3,476.48
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
33300041
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$2,190.18 |
| Max. Negotiated Rate |
$3,128.83 |
| Rate for Payer: Aetna Commercial |
$2,955.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,259.71
|
| Rate for Payer: Cash Price |
$2,781.18
|
| Rate for Payer: Cofinity Commercial |
$2,433.54
|
| Rate for Payer: Cofinity Commercial |
$2,989.77
|
| Rate for Payer: Healthscope Commercial |
$3,128.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,955.01
|
| Rate for Payer: PHP Commercial |
$2,955.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,433.54
|
| Rate for Payer: Priority Health SBD |
$2,190.18
|
|
|
HC RO LINAC SBRT PER SESSION
|
Facility
|
OP
|
$3,476.48
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
33300041
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$868.48 |
| Max. Negotiated Rate |
$3,128.83 |
| Rate for Payer: Aetna Commercial |
$2,955.01
|
| Rate for Payer: Aetna Medicare |
$1,651.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,259.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.64
|
| Rate for Payer: BCBS Complete |
$911.98
|
| Rate for Payer: BCBS MAPPO |
$1,587.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,658.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.71
|
| Rate for Payer: Cash Price |
$2,781.18
|
| Rate for Payer: Cash Price |
$2,781.18
|
| Rate for Payer: Cofinity Commercial |
$2,989.77
|
| Rate for Payer: Cofinity Commercial |
$2,433.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.71
|
| Rate for Payer: Healthscope Commercial |
$3,128.83
|
| Rate for Payer: Mclaren Medicaid |
$868.48
|
| Rate for Payer: Mclaren Medicare |
$1,587.71
|
| Rate for Payer: Meridian Medicaid |
$911.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,667.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,955.01
|
| Rate for Payer: PACE Medicare |
$1,508.32
|
| Rate for Payer: PACE SWMI |
$1,587.71
|
| Rate for Payer: PHP Commercial |
$2,955.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$868.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,433.54
|
| Rate for Payer: Priority Health Medicare |
$1,587.71
|
| Rate for Payer: Priority Health SBD |
$2,190.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,075.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.71
|
| Rate for Payer: UHC Exchange |
$977.41
|
| Rate for Payer: UHC Medicare Advantage |
$1,635.34
|
| Rate for Payer: VA VA |
$1,587.71
|
|
|
HC ROMOSOZUMAB-AQQG INJ 1 MG
|
Facility
|
IP
|
$11.22
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
63600150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$10.10 |
| Rate for Payer: Aetna Commercial |
$9.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.29
|
| Rate for Payer: Cash Price |
$8.98
|
| Rate for Payer: Cofinity Commercial |
$7.85
|
| Rate for Payer: Cofinity Commercial |
$9.65
|
| Rate for Payer: Healthscope Commercial |
$10.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.54
|
| Rate for Payer: PHP Commercial |
$9.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.85
|
| Rate for Payer: Priority Health SBD |
$7.07
|
|
|
HC ROMOSOZUMAB-AQQG INJ 1 MG
|
Facility
|
OP
|
$11.22
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
63600150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.87 |
| Max. Negotiated Rate |
$31.73 |
| Rate for Payer: Aetna Commercial |
$9.54
|
| Rate for Payer: Aetna Medicare |
$11.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.41
|
| Rate for Payer: BCBS Complete |
$6.16
|
| Rate for Payer: BCBS MAPPO |
$10.73
|
| Rate for Payer: BCBS Trust/PPO |
$31.73
|
| Rate for Payer: BCN Medicare Advantage |
$10.73
|
| Rate for Payer: Cash Price |
$8.98
|
| Rate for Payer: Cash Price |
$8.98
|
| Rate for Payer: Cofinity Commercial |
$7.85
|
| Rate for Payer: Cofinity Commercial |
$9.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.73
|
| Rate for Payer: Healthscope Commercial |
$10.10
|
| Rate for Payer: Mclaren Medicaid |
$5.87
|
| Rate for Payer: Mclaren Medicare |
$10.73
|
| Rate for Payer: Meridian Medicaid |
$6.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.54
|
| Rate for Payer: PACE Medicare |
$10.19
|
| Rate for Payer: PACE SWMI |
$10.73
|
| Rate for Payer: PHP Commercial |
$9.54
|
| Rate for Payer: PHP Medicare Advantage |
$10.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.85
|
| Rate for Payer: Priority Health Medicare |
$10.73
|
| Rate for Payer: Priority Health SBD |
$7.07
|
| Rate for Payer: Railroad Medicare Medicare |
$10.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.73
|
| Rate for Payer: UHC Medicare Advantage |
$11.05
|
| Rate for Payer: VA VA |
$10.73
|
|
|
HC ROOM & BOARD PSYCH
|
Facility
|
IP
|
$1,775.22
|
|
| Hospital Charge Code |
12400001
|
|
Hospital Revenue Code
|
124
|
| Min. Negotiated Rate |
$1,118.39 |
| Max. Negotiated Rate |
$2,109.00 |
| Rate for Payer: Aetna Commercial |
$1,508.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,153.89
|
| Rate for Payer: BCBS Trust/PPO |
$2,109.00
|
| Rate for Payer: Cash Price |
$1,420.18
|
| Rate for Payer: Cash Price |
$1,420.18
|
| Rate for Payer: Cofinity Commercial |
$1,526.69
|
| Rate for Payer: Cofinity Commercial |
$1,242.65
|
| Rate for Payer: Healthscope Commercial |
$1,597.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,508.94
|
| Rate for Payer: PHP Commercial |
$1,508.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,242.65
|
| Rate for Payer: Priority Health SBD |
$1,118.39
|
|
|
HC ROOM MED SURG
|
Facility
|
IP
|
$3,291.02
|
|
| Hospital Charge Code |
12100001
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$2,073.34 |
| Max. Negotiated Rate |
$2,961.92 |
| Rate for Payer: Aetna Commercial |
$2,797.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,139.16
|
| Rate for Payer: Cash Price |
$2,632.82
|
| Rate for Payer: Cofinity Commercial |
$2,303.71
|
| Rate for Payer: Cofinity Commercial |
$2,830.28
|
| Rate for Payer: Healthscope Commercial |
$2,961.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,797.37
|
| Rate for Payer: PHP Commercial |
$2,797.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,303.71
|
| Rate for Payer: Priority Health SBD |
$2,073.34
|
|
|
HC ROOM SCU
|
Facility
|
IP
|
$2,305.94
|
|
| Hospital Charge Code |
20000002
|
|
Hospital Revenue Code
|
200
|
| Min. Negotiated Rate |
$1,452.74 |
| Max. Negotiated Rate |
$2,075.35 |
| Rate for Payer: Aetna Commercial |
$1,960.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,498.86
|
| Rate for Payer: Cash Price |
$1,844.75
|
| Rate for Payer: Cofinity Commercial |
$1,614.16
|
| Rate for Payer: Cofinity Commercial |
$1,983.11
|
| Rate for Payer: Healthscope Commercial |
$2,075.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,960.05
|
| Rate for Payer: PHP Commercial |
$1,960.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,614.16
|
| Rate for Payer: Priority Health SBD |
$1,452.74
|
|
|
HC RO OR SSA SJOGRENS AB
|
Facility
|
OP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200162
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$31.03 |
| Rate for Payer: Aetna Commercial |
$29.31
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$10.30
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$14.04
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$29.65
|
| Rate for Payer: Cofinity Commercial |
$24.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$31.03
|
| Rate for Payer: Mclaren Medicaid |
$9.81
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Medicaid |
$10.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$29.31
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$21.72
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.52
|
| Rate for Payer: UHC Core |
$30.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Exchange |
$17.93
|
| Rate for Payer: UHC Medicare Advantage |
$18.47
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC RO OR SSA SJOGRENS AB
|
Facility
|
IP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200162
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$31.03 |
| Rate for Payer: Aetna Commercial |
$29.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.41
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$29.65
|
| Rate for Payer: Cofinity Commercial |
$24.14
|
| Rate for Payer: Healthscope Commercial |
$31.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PHP Commercial |
$29.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health SBD |
$21.72
|
|
|
HC ROPIVACAINE HYDROCHLORIDE 1 MG
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
CPT J2795
|
| Hospital Charge Code |
63600236
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.60
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cofinity Commercial |
$2.80
|
| Rate for Payer: Cofinity Commercial |
$3.44
|
| Rate for Payer: Healthscope Commercial |
$3.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.40
|
| Rate for Payer: PHP Commercial |
$3.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.80
|
| Rate for Payer: Priority Health SBD |
$2.52
|
|
|
HC ROPIVACAINE HYDROCHLORIDE 1 MG
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
CPT J2795
|
| Hospital Charge Code |
63600236
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.60
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: BCBS Trust/PPO |
$0.20
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cofinity Commercial |
$2.80
|
| Rate for Payer: Cofinity Commercial |
$3.44
|
| Rate for Payer: Healthscope Commercial |
$3.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.40
|
| Rate for Payer: PHP Commercial |
$3.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.80
|
| Rate for Payer: Priority Health SBD |
$2.52
|
|
|
HC RO SUPERFICIAL AND/OR ORTHO
|
Facility
|
IP
|
$195.84
|
|
|
Service Code
|
CPT 77401
|
| Hospital Charge Code |
33300036
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$123.38 |
| Max. Negotiated Rate |
$176.26 |
| Rate for Payer: Aetna Commercial |
$166.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.30
|
| Rate for Payer: Cash Price |
$156.67
|
| Rate for Payer: Cofinity Commercial |
$137.09
|
| Rate for Payer: Cofinity Commercial |
$168.42
|
| Rate for Payer: Healthscope Commercial |
$176.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$166.46
|
| Rate for Payer: PHP Commercial |
$166.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.09
|
| Rate for Payer: Priority Health SBD |
$123.38
|
|
|
HC RO SUPERFICIAL AND/OR ORTHO
|
Facility
|
OP
|
$195.84
|
|
|
Service Code
|
CPT 77401
|
| Hospital Charge Code |
33300036
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$40.93 |
| Max. Negotiated Rate |
$366.98 |
| Rate for Payer: Aetna Commercial |
$166.46
|
| Rate for Payer: Aetna Medicare |
$110.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$133.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$133.38
|
| Rate for Payer: BCBS Complete |
$61.29
|
| Rate for Payer: BCBS MAPPO |
$106.70
|
| Rate for Payer: BCBS Trust/PPO |
$67.85
|
| Rate for Payer: BCN Medicare Advantage |
$106.70
|
| Rate for Payer: Cash Price |
$156.67
|
| Rate for Payer: Cash Price |
$156.67
|
| Rate for Payer: Cofinity Commercial |
$168.42
|
| Rate for Payer: Cofinity Commercial |
$137.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.70
|
| Rate for Payer: Healthscope Commercial |
$176.26
|
| Rate for Payer: Mclaren Medicaid |
$58.36
|
| Rate for Payer: Mclaren Medicare |
$106.70
|
| Rate for Payer: Meridian Medicaid |
$61.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$112.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$166.46
|
| Rate for Payer: PACE Medicare |
$101.36
|
| Rate for Payer: PACE SWMI |
$106.70
|
| Rate for Payer: PHP Commercial |
$166.46
|
| Rate for Payer: PHP Medicare Advantage |
$106.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$366.98
|
| Rate for Payer: Priority Health Medicare |
$106.70
|
| Rate for Payer: Priority Health Narrow Network |
$293.58
|
| Rate for Payer: Priority Health SBD |
$123.38
|
| Rate for Payer: Railroad Medicare Medicare |
$106.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.70
|
| Rate for Payer: UHC Exchange |
$40.93
|
| Rate for Payer: UHC Medicare Advantage |
$109.90
|
| Rate for Payer: VA VA |
$106.70
|
|
|
HC ROTABLATOR BURR
|
Facility
|
IP
|
$4,102.66
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27200069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,584.68 |
| Max. Negotiated Rate |
$3,692.39 |
| Rate for Payer: Aetna Commercial |
$3,487.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,666.73
|
| Rate for Payer: Cash Price |
$3,282.13
|
| Rate for Payer: Cofinity Commercial |
$2,871.86
|
| Rate for Payer: Cofinity Commercial |
$3,528.29
|
| Rate for Payer: Healthscope Commercial |
$3,692.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,487.26
|
| Rate for Payer: PHP Commercial |
$3,487.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,871.86
|
| Rate for Payer: Priority Health SBD |
$2,584.68
|
|
|
HC ROTABLATOR BURR
|
Facility
|
OP
|
$4,102.66
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27200069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$3,692.39 |
| Rate for Payer: Aetna Commercial |
$3,487.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,666.73
|
| Rate for Payer: BCBS Complete |
$1,641.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$3,282.13
|
| Rate for Payer: Cash Price |
$3,282.13
|
| Rate for Payer: Cofinity Commercial |
$2,871.86
|
| Rate for Payer: Cofinity Commercial |
$3,528.29
|
| Rate for Payer: Healthscope Commercial |
$3,692.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,487.26
|
| Rate for Payer: PHP Commercial |
$3,487.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,871.86
|
| Rate for Payer: Priority Health SBD |
$2,584.68
|
|
|
HC ROTAVIRUS ANTIGEN
|
Facility
|
OP
|
$107.60
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
30600145
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$96.84 |
| Rate for Payer: Aetna Commercial |
$91.46
|
| Rate for Payer: Aetna Medicare |
$12.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.98
|
| Rate for Payer: BCBS Complete |
$6.88
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$9.39
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$86.08
|
| Rate for Payer: Cash Price |
$86.08
|
| Rate for Payer: Cofinity Commercial |
$92.54
|
| Rate for Payer: Cofinity Commercial |
$75.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$96.84
|
| Rate for Payer: Mclaren Medicaid |
$6.55
|
| Rate for Payer: Mclaren Medicare |
$11.98
|
| Rate for Payer: Meridian Medicaid |
$6.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.46
|
| Rate for Payer: PACE Medicare |
$11.38
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$91.46
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.32
|
| Rate for Payer: Priority Health Medicare |
$11.98
|
| Rate for Payer: Priority Health SBD |
$67.79
|
| Rate for Payer: Railroad Medicare Medicare |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.38
|
| Rate for Payer: UHC Core |
$20.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.98
|
| Rate for Payer: UHC Exchange |
$11.98
|
| Rate for Payer: UHC Medicare Advantage |
$12.34
|
| Rate for Payer: VA VA |
$11.98
|
|
|
HC ROTAVIRUS ANTIGEN
|
Facility
|
IP
|
$107.60
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
30600145
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$67.79 |
| Max. Negotiated Rate |
$96.84 |
| Rate for Payer: Aetna Commercial |
$91.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.94
|
| Rate for Payer: Cash Price |
$86.08
|
| Rate for Payer: Cofinity Commercial |
$75.32
|
| Rate for Payer: Cofinity Commercial |
$92.54
|
| Rate for Payer: Healthscope Commercial |
$96.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.46
|
| Rate for Payer: PHP Commercial |
$91.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.32
|
| Rate for Payer: Priority Health SBD |
$67.79
|
|
|
HC ROTAVIRUS ATTEN 2 DOSE SCHED LIVE ORAL
|
Facility
|
OP
|
$175.03
|
|
|
Service Code
|
CPT 90681
|
| Hospital Charge Code |
63600121
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.01 |
| Max. Negotiated Rate |
$375.24 |
| Rate for Payer: Aetna Commercial |
$148.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.77
|
| Rate for Payer: BCBS Complete |
$70.01
|
| Rate for Payer: BCBS Trust/PPO |
$375.24
|
| Rate for Payer: Cash Price |
$140.02
|
| Rate for Payer: Cash Price |
$140.02
|
| Rate for Payer: Cofinity Commercial |
$122.52
|
| Rate for Payer: Cofinity Commercial |
$150.53
|
| Rate for Payer: Healthscope Commercial |
$157.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.78
|
| Rate for Payer: PHP Commercial |
$148.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.52
|
| Rate for Payer: Priority Health SBD |
$110.27
|
|
|
HC ROTAVIRUS ATTEN 2 DOSE SCHED LIVE ORAL
|
Facility
|
IP
|
$175.03
|
|
|
Service Code
|
CPT 90681
|
| Hospital Charge Code |
63600121
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$110.27 |
| Max. Negotiated Rate |
$157.53 |
| Rate for Payer: Aetna Commercial |
$148.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.77
|
| Rate for Payer: Cash Price |
$140.02
|
| Rate for Payer: Cofinity Commercial |
$122.52
|
| Rate for Payer: Cofinity Commercial |
$150.53
|
| Rate for Payer: Healthscope Commercial |
$157.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.78
|
| Rate for Payer: PHP Commercial |
$148.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.52
|
| Rate for Payer: Priority Health SBD |
$110.27
|
|
|
HC ROTAVIRUS VACCINE, PENTAVALENT (RV5), 3 DOSE SCHEDULE, LIVE ORAL
|
Facility
|
IP
|
$75.89
|
|
|
Service Code
|
CPT 90680
|
| Hospital Charge Code |
63600076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$68.30 |
| Rate for Payer: Aetna Commercial |
$64.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.33
|
| Rate for Payer: Cash Price |
$60.71
|
| Rate for Payer: Cofinity Commercial |
$53.12
|
| Rate for Payer: Cofinity Commercial |
$65.27
|
| Rate for Payer: Healthscope Commercial |
$68.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.51
|
| Rate for Payer: PHP Commercial |
$64.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.12
|
| Rate for Payer: Priority Health SBD |
$47.81
|
|
|
HC ROTAVIRUS VACCINE, PENTAVALENT (RV5), 3 DOSE SCHEDULE, LIVE ORAL
|
Facility
|
OP
|
$75.89
|
|
|
Service Code
|
CPT 90680
|
| Hospital Charge Code |
63600076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.36 |
| Max. Negotiated Rate |
$267.21 |
| Rate for Payer: Aetna Commercial |
$64.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.33
|
| Rate for Payer: BCBS Complete |
$30.36
|
| Rate for Payer: BCBS Trust/PPO |
$267.21
|
| Rate for Payer: Cash Price |
$60.71
|
| Rate for Payer: Cash Price |
$60.71
|
| Rate for Payer: Cofinity Commercial |
$53.12
|
| Rate for Payer: Cofinity Commercial |
$65.27
|
| Rate for Payer: Healthscope Commercial |
$68.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.51
|
| Rate for Payer: PHP Commercial |
$64.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.12
|
| Rate for Payer: Priority Health SBD |
$47.81
|
|
|
HC RO TREATMENT DEVICE INTERMED
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
33300037
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$150.91 |
| Rate for Payer: Aetna Commercial |
$135.15
|
| Rate for Payer: Aetna Commercial |
$434.37
|
| Rate for Payer: Aetna Medicare |
$125.56
|
| Rate for Payer: Aetna Medicare |
$125.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$332.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.91
|
| Rate for Payer: BCBS Complete |
$69.35
|
| Rate for Payer: BCBS Complete |
$69.35
|
| Rate for Payer: BCBS MAPPO |
$120.73
|
| Rate for Payer: BCBS MAPPO |
$120.73
|
| Rate for Payer: BCBS Trust/PPO |
$15.40
|
| Rate for Payer: BCBS Trust/PPO |
$15.40
|
| Rate for Payer: BCN Medicare Advantage |
$120.73
|
| Rate for Payer: BCN Medicare Advantage |
$120.73
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$408.82
|
| Rate for Payer: Cash Price |
$408.82
|
| Rate for Payer: Cofinity Commercial |
$111.30
|
| Rate for Payer: Cofinity Commercial |
$357.71
|
| Rate for Payer: Cofinity Commercial |
$136.74
|
| Rate for Payer: Cofinity Commercial |
$439.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.73
|
| Rate for Payer: Healthscope Commercial |
$459.92
|
| Rate for Payer: Healthscope Commercial |
$143.10
|
| Rate for Payer: Mclaren Medicaid |
$66.04
|
| Rate for Payer: Mclaren Medicaid |
$66.04
|
| Rate for Payer: Mclaren Medicare |
$120.73
|
| Rate for Payer: Mclaren Medicare |
$120.73
|
| Rate for Payer: Meridian Medicaid |
$69.35
|
| Rate for Payer: Meridian Medicaid |
$69.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$126.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$126.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$434.37
|
| Rate for Payer: PACE Medicare |
$114.69
|
| Rate for Payer: PACE Medicare |
$114.69
|
| Rate for Payer: PACE SWMI |
$120.73
|
| Rate for Payer: PACE SWMI |
$120.73
|
| Rate for Payer: PHP Commercial |
$434.37
|
| Rate for Payer: PHP Commercial |
$135.15
|
| Rate for Payer: PHP Medicare Advantage |
$120.73
|
| Rate for Payer: PHP Medicare Advantage |
$120.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.71
|
| Rate for Payer: Priority Health Medicare |
$120.73
|
| Rate for Payer: Priority Health Medicare |
$120.73
|
| Rate for Payer: Priority Health SBD |
$321.94
|
| Rate for Payer: Priority Health SBD |
$100.17
|
| Rate for Payer: Railroad Medicare Medicare |
$120.73
|
| Rate for Payer: Railroad Medicare Medicare |
$120.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.73
|
| Rate for Payer: UHC Exchange |
$134.58
|
| Rate for Payer: UHC Exchange |
$134.58
|
| Rate for Payer: UHC Medicare Advantage |
$124.35
|
| Rate for Payer: UHC Medicare Advantage |
$124.35
|
| Rate for Payer: VA VA |
$120.73
|
| Rate for Payer: VA VA |
$120.73
|
|
|
HC RO TREATMENT DEVICE INTERMED
|
Facility
|
IP
|
$511.02
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
33300037
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$321.94 |
| Max. Negotiated Rate |
$459.92 |
| Rate for Payer: Aetna Commercial |
$434.37
|
| Rate for Payer: Aetna Commercial |
$135.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$332.16
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$408.82
|
| Rate for Payer: Cofinity Commercial |
$111.30
|
| Rate for Payer: Cofinity Commercial |
$357.71
|
| Rate for Payer: Cofinity Commercial |
$439.48
|
| Rate for Payer: Cofinity Commercial |
$136.74
|
| Rate for Payer: Healthscope Commercial |
$459.92
|
| Rate for Payer: Healthscope Commercial |
$143.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$434.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.15
|
| Rate for Payer: PHP Commercial |
$135.15
|
| Rate for Payer: PHP Commercial |
$434.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.71
|
| Rate for Payer: Priority Health SBD |
$321.94
|
| Rate for Payer: Priority Health SBD |
$100.17
|
|
|
HC RO TREATMENT DEVICE SIMPLE
|
Facility
|
IP
|
$405.96
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
33300038
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$255.75 |
| Max. Negotiated Rate |
$365.36 |
| Rate for Payer: Aetna Commercial |
$345.07
|
| Rate for Payer: Aetna Commercial |
$288.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.35
|
| Rate for Payer: Cash Price |
$324.77
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cofinity Commercial |
$291.54
|
| Rate for Payer: Cofinity Commercial |
$284.17
|
| Rate for Payer: Cofinity Commercial |
$349.13
|
| Rate for Payer: Cofinity Commercial |
$237.30
|
| Rate for Payer: Healthscope Commercial |
$365.36
|
| Rate for Payer: Healthscope Commercial |
$305.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$288.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$345.07
|
| Rate for Payer: PHP Commercial |
$288.15
|
| Rate for Payer: PHP Commercial |
$345.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.17
|
| Rate for Payer: Priority Health SBD |
$213.57
|
| Rate for Payer: Priority Health SBD |
$255.75
|
|
