|
HC KETONES (ACETONE)
|
Facility
|
OP
|
$36.82
|
|
|
Service Code
|
CPT 82009
|
| Hospital Charge Code |
30100067
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$722.52 |
| Rate for Payer: Aetna Commercial |
$31.30
|
| Rate for Payer: Aetna Medicare |
$4.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.65
|
| Rate for Payer: BCBS Complete |
$2.54
|
| Rate for Payer: BCBS MAPPO |
$4.52
|
| Rate for Payer: BCBS Trust/PPO |
$4.00
|
| Rate for Payer: BCN Commercial |
$4.00
|
| Rate for Payer: BCN Medicare Advantage |
$4.52
|
| Rate for Payer: Cash Price |
$29.46
|
| Rate for Payer: Cash Price |
$29.46
|
| Rate for Payer: Cofinity Commercial |
$25.77
|
| Rate for Payer: Cofinity Commercial |
$31.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.52
|
| Rate for Payer: Healthscope Commercial |
$33.14
|
| Rate for Payer: Mclaren Medicaid |
$2.42
|
| Rate for Payer: Mclaren Medicare |
$4.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.75
|
| Rate for Payer: Meridian Medicaid |
$2.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.30
|
| Rate for Payer: Nomi Health Commercial |
$6.78
|
| Rate for Payer: PACE Medicare |
$4.29
|
| Rate for Payer: PACE SWMI |
$4.52
|
| Rate for Payer: PHP Commercial |
$31.30
|
| Rate for Payer: PHP Medicare Advantage |
$4.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.52
|
| Rate for Payer: Priority Health Medicare |
$4.52
|
| Rate for Payer: Priority Health Narrow Network |
$3.62
|
| Rate for Payer: Priority Health SBD |
$23.20
|
| Rate for Payer: Railroad Medicare Medicare |
$4.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.42
|
| Rate for Payer: UHC Core |
$722.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.52
|
| Rate for Payer: UHC Exchange |
$722.52
|
| Rate for Payer: UHC Medicare Advantage |
$4.52
|
| Rate for Payer: UHCCP Medicaid |
$2.54
|
| Rate for Payer: VA VA |
$4.52
|
|
|
HC KETONES (ACETONE)
|
Facility
|
IP
|
$36.82
|
|
|
Service Code
|
CPT 82009
|
| Hospital Charge Code |
30100067
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$33.14 |
| Rate for Payer: Aetna Commercial |
$31.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.93
|
| Rate for Payer: Cash Price |
$29.46
|
| Rate for Payer: Cofinity Commercial |
$25.77
|
| Rate for Payer: Cofinity Commercial |
$31.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.46
|
| Rate for Payer: Healthscope Commercial |
$33.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.30
|
| Rate for Payer: PHP Commercial |
$31.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.93
|
| Rate for Payer: Priority Health SBD |
$23.20
|
|
|
HC KIDNEY ENDOSCOPY
|
Facility
|
IP
|
$5,969.82
|
|
|
Service Code
|
CPT 50551
|
| Hospital Charge Code |
76100307
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,760.99 |
| Max. Negotiated Rate |
$5,372.84 |
| Rate for Payer: Aetna Commercial |
$5,074.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,880.38
|
| Rate for Payer: Cash Price |
$4,775.86
|
| Rate for Payer: Cofinity Commercial |
$4,178.87
|
| Rate for Payer: Cofinity Commercial |
$5,134.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,178.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,775.86
|
| Rate for Payer: Healthscope Commercial |
$5,372.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,074.35
|
| Rate for Payer: PHP Commercial |
$5,074.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,880.38
|
| Rate for Payer: Priority Health SBD |
$3,760.99
|
|
|
HC KIDNEY ENDOSCOPY
|
Facility
|
OP
|
$5,969.82
|
|
|
Service Code
|
CPT 50551
|
| Hospital Charge Code |
76100307
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$308.50 |
| Max. Negotiated Rate |
$15,654.68 |
| Rate for Payer: Aetna Commercial |
$5,074.35
|
| Rate for Payer: Aetna Medicare |
$5,180.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,880.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,226.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,226.04
|
| Rate for Payer: BCBS Complete |
$2,803.21
|
| Rate for Payer: BCBS MAPPO |
$4,980.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,555.60
|
| Rate for Payer: BCN Commercial |
$1,555.60
|
| Rate for Payer: BCN Medicare Advantage |
$4,980.83
|
| Rate for Payer: Cash Price |
$4,775.86
|
| Rate for Payer: Cash Price |
$4,775.86
|
| Rate for Payer: Cash Price |
$4,775.86
|
| Rate for Payer: Cofinity Commercial |
$5,134.05
|
| Rate for Payer: Cofinity Commercial |
$4,178.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,178.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,775.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,980.83
|
| Rate for Payer: Healthscope Commercial |
$5,372.84
|
| Rate for Payer: Mclaren Medicaid |
$2,669.72
|
| Rate for Payer: Mclaren Medicare |
$4,980.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,229.87
|
| Rate for Payer: Meridian Medicaid |
$2,803.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,727.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,074.35
|
| Rate for Payer: Nomi Health Commercial |
$10,459.74
|
| Rate for Payer: PACE Medicare |
$4,731.79
|
| Rate for Payer: PACE SWMI |
$4,980.83
|
| Rate for Payer: PHP Commercial |
$5,074.35
|
| Rate for Payer: PHP Medicare Advantage |
$4,980.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,669.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,880.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,654.68
|
| Rate for Payer: Priority Health Medicare |
$4,980.83
|
| Rate for Payer: Priority Health Narrow Network |
$12,523.74
|
| Rate for Payer: Priority Health SBD |
$3,760.99
|
| Rate for Payer: Railroad Medicare Medicare |
$4,980.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.50
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,980.83
|
| Rate for Payer: UHC Medicare Advantage |
$4,980.83
|
| Rate for Payer: UHCCP Medicaid |
$2,804.21
|
| Rate for Payer: VA VA |
$4,980.83
|
|
|
HC KINEVAC 5 MCG IV
|
Facility
|
IP
|
$138.43
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
63600014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$87.21 |
| Max. Negotiated Rate |
$124.59 |
| Rate for Payer: Aetna Commercial |
$117.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.98
|
| Rate for Payer: Cash Price |
$110.74
|
| Rate for Payer: Cofinity Commercial |
$119.05
|
| Rate for Payer: Cofinity Commercial |
$96.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.74
|
| Rate for Payer: Healthscope Commercial |
$124.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.67
|
| Rate for Payer: PHP Commercial |
$117.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.98
|
| Rate for Payer: Priority Health SBD |
$87.21
|
|
|
HC KINEVAC 5 MCG IV
|
Facility
|
OP
|
$138.43
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
63600014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.37 |
| Max. Negotiated Rate |
$349.20 |
| Rate for Payer: Aetna Commercial |
$117.67
|
| Rate for Payer: Aetna Medicare |
$69.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.98
|
| Rate for Payer: BCBS Complete |
$55.37
|
| Rate for Payer: BCBS Trust/PPO |
$349.20
|
| Rate for Payer: BCN Commercial |
$349.20
|
| Rate for Payer: Cash Price |
$110.74
|
| Rate for Payer: Cash Price |
$110.74
|
| Rate for Payer: Cofinity Commercial |
$119.05
|
| Rate for Payer: Cofinity Commercial |
$96.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.74
|
| Rate for Payer: Healthscope Commercial |
$124.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.67
|
| Rate for Payer: PHP Commercial |
$117.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.98
|
| Rate for Payer: Priority Health SBD |
$87.21
|
|
|
HC KIT ATS
|
Facility
|
OP
|
$153.00
|
|
| Hospital Charge Code |
27000666
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.45
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$107.10
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health SBD |
$96.39
|
|
|
HC KIT ATS
|
Facility
|
IP
|
$153.00
|
|
| Hospital Charge Code |
27000666
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.39 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.45
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$107.10
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health SBD |
$96.39
|
|
|
HC KIT DILATOR VASC
|
Facility
|
OP
|
$535.50
|
|
| Hospital Charge Code |
27000101
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$214.20 |
| Max. Negotiated Rate |
$481.95 |
| Rate for Payer: Aetna Commercial |
$455.18
|
| Rate for Payer: Aetna Medicare |
$267.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.08
|
| Rate for Payer: BCBS Complete |
$214.20
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cofinity Commercial |
$374.85
|
| Rate for Payer: Cofinity Commercial |
$460.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$374.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.40
|
| Rate for Payer: Healthscope Commercial |
$481.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.18
|
| Rate for Payer: PHP Commercial |
$455.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.08
|
| Rate for Payer: Priority Health SBD |
$337.36
|
|
|
HC KIT DILATOR VASC
|
Facility
|
IP
|
$535.50
|
|
| Hospital Charge Code |
27000101
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$337.36 |
| Max. Negotiated Rate |
$481.95 |
| Rate for Payer: Aetna Commercial |
$455.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.08
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cofinity Commercial |
$374.85
|
| Rate for Payer: Cofinity Commercial |
$460.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$374.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.40
|
| Rate for Payer: Healthscope Commercial |
$481.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.18
|
| Rate for Payer: PHP Commercial |
$455.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.08
|
| Rate for Payer: Priority Health SBD |
$337.36
|
|
|
HC KLEIHAUER-BETKE STAIN
|
Facility
|
IP
|
$123.22
|
|
|
Service Code
|
CPT 85460
|
| Hospital Charge Code |
30500046
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$77.63 |
| Max. Negotiated Rate |
$110.90 |
| Rate for Payer: Aetna Commercial |
$104.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.09
|
| Rate for Payer: Cash Price |
$98.58
|
| Rate for Payer: Cofinity Commercial |
$105.97
|
| Rate for Payer: Cofinity Commercial |
$86.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.58
|
| Rate for Payer: Healthscope Commercial |
$110.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.74
|
| Rate for Payer: PHP Commercial |
$104.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.09
|
| Rate for Payer: Priority Health SBD |
$77.63
|
|
|
HC KLEIHAUER-BETKE STAIN
|
Facility
|
OP
|
$123.22
|
|
|
Service Code
|
CPT 85460
|
| Hospital Charge Code |
30500046
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$110.90 |
| Rate for Payer: Aetna Commercial |
$104.74
|
| Rate for Payer: Aetna Medicare |
$8.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.66
|
| Rate for Payer: BCBS Complete |
$4.35
|
| Rate for Payer: BCBS MAPPO |
$7.73
|
| Rate for Payer: BCBS Trust/PPO |
$6.85
|
| Rate for Payer: BCN Commercial |
$6.85
|
| Rate for Payer: BCN Medicare Advantage |
$7.73
|
| Rate for Payer: Cash Price |
$98.58
|
| Rate for Payer: Cash Price |
$98.58
|
| Rate for Payer: Cofinity Commercial |
$86.25
|
| Rate for Payer: Cofinity Commercial |
$105.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.73
|
| Rate for Payer: Healthscope Commercial |
$110.90
|
| Rate for Payer: Mclaren Medicaid |
$4.14
|
| Rate for Payer: Mclaren Medicare |
$7.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.12
|
| Rate for Payer: Meridian Medicaid |
$4.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.74
|
| Rate for Payer: Nomi Health Commercial |
$11.60
|
| Rate for Payer: PACE Medicare |
$7.34
|
| Rate for Payer: PACE SWMI |
$7.73
|
| Rate for Payer: PHP Commercial |
$104.74
|
| Rate for Payer: PHP Medicare Advantage |
$7.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.96
|
| Rate for Payer: Priority Health Medicare |
$7.73
|
| Rate for Payer: Priority Health Narrow Network |
$6.37
|
| Rate for Payer: Priority Health SBD |
$77.63
|
| Rate for Payer: Railroad Medicare Medicare |
$7.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.73
|
| Rate for Payer: UHC Medicare Advantage |
$7.73
|
| Rate for Payer: UHCCP Medicaid |
$4.35
|
| Rate for Payer: VA VA |
$7.73
|
|
|
HC KOH PREPARATION
|
Facility
|
IP
|
$23.93
|
|
|
Service Code
|
CPT 87220
|
| Hospital Charge Code |
30600111
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$21.54 |
| Rate for Payer: Aetna Commercial |
$20.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.55
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$16.75
|
| Rate for Payer: Cofinity Commercial |
$20.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.14
|
| Rate for Payer: Healthscope Commercial |
$21.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.34
|
| Rate for Payer: PHP Commercial |
$20.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.55
|
| Rate for Payer: Priority Health SBD |
$15.08
|
|
|
HC KOH PREPARATION
|
Facility
|
OP
|
$23.93
|
|
|
Service Code
|
CPT 87220
|
| Hospital Charge Code |
30600111
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$21.54 |
| Rate for Payer: Aetna Commercial |
$20.34
|
| Rate for Payer: Aetna Medicare |
$4.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.34
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS MAPPO |
$4.27
|
| Rate for Payer: BCBS Trust/PPO |
$3.78
|
| Rate for Payer: BCN Commercial |
$3.78
|
| Rate for Payer: BCN Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$20.58
|
| Rate for Payer: Cofinity Commercial |
$16.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.27
|
| Rate for Payer: Healthscope Commercial |
$21.54
|
| Rate for Payer: Mclaren Medicaid |
$2.29
|
| Rate for Payer: Mclaren Medicare |
$4.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.48
|
| Rate for Payer: Meridian Medicaid |
$2.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.34
|
| Rate for Payer: Nomi Health Commercial |
$6.40
|
| Rate for Payer: PACE Medicare |
$4.06
|
| Rate for Payer: PACE SWMI |
$4.27
|
| Rate for Payer: PHP Commercial |
$20.34
|
| Rate for Payer: PHP Medicare Advantage |
$4.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.40
|
| Rate for Payer: Priority Health Medicare |
$4.27
|
| Rate for Payer: Priority Health Narrow Network |
$3.52
|
| Rate for Payer: Priority Health SBD |
$15.08
|
| Rate for Payer: Railroad Medicare Medicare |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.27
|
| Rate for Payer: UHC Medicare Advantage |
$4.27
|
| Rate for Payer: UHCCP Medicaid |
$2.40
|
| Rate for Payer: VA VA |
$4.27
|
|
|
HC KYLEENA 19.5MG
|
Facility
|
OP
|
$2,936.43
|
|
|
Service Code
|
CPT J7296
|
| Hospital Charge Code |
63600165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$980.96 |
| Max. Negotiated Rate |
$3,428.83 |
| Rate for Payer: Aetna Commercial |
$2,495.97
|
| Rate for Payer: Aetna Medicare |
$1,468.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,908.68
|
| Rate for Payer: BCBS Complete |
$1,174.57
|
| Rate for Payer: BCBS Trust/PPO |
$3,428.83
|
| Rate for Payer: BCN Commercial |
$3,428.83
|
| Rate for Payer: Cash Price |
$2,349.14
|
| Rate for Payer: Cash Price |
$2,349.14
|
| Rate for Payer: Cofinity Commercial |
$2,525.33
|
| Rate for Payer: Cofinity Commercial |
$2,055.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,055.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,349.14
|
| Rate for Payer: Healthscope Commercial |
$2,642.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,495.97
|
| Rate for Payer: PHP Commercial |
$2,495.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,908.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,226.20
|
| Rate for Payer: Priority Health Narrow Network |
$980.96
|
| Rate for Payer: Priority Health SBD |
$1,849.95
|
|
|
HC KYLEENA 19.5MG
|
Facility
|
IP
|
$2,936.43
|
|
|
Service Code
|
CPT J7296
|
| Hospital Charge Code |
63600165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,849.95 |
| Max. Negotiated Rate |
$2,642.79 |
| Rate for Payer: Aetna Commercial |
$2,495.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,908.68
|
| Rate for Payer: Cash Price |
$2,349.14
|
| Rate for Payer: Cofinity Commercial |
$2,055.50
|
| Rate for Payer: Cofinity Commercial |
$2,525.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,055.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,349.14
|
| Rate for Payer: Healthscope Commercial |
$2,642.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,495.97
|
| Rate for Payer: PHP Commercial |
$2,495.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,908.68
|
| Rate for Payer: Priority Health SBD |
$1,849.95
|
|
|
HC LAAC IMPLANT
|
Facility
|
OP
|
$18,571.14
|
|
| Hospital Charge Code |
27800117
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,428.46 |
| Max. Negotiated Rate |
$16,714.03 |
| Rate for Payer: Aetna Commercial |
$15,785.47
|
| Rate for Payer: Aetna Medicare |
$9,285.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,071.24
|
| Rate for Payer: BCBS Complete |
$7,428.46
|
| Rate for Payer: Cash Price |
$14,856.91
|
| Rate for Payer: Cofinity Commercial |
$12,999.80
|
| Rate for Payer: Cofinity Commercial |
$15,971.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,999.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,856.91
|
| Rate for Payer: Healthscope Commercial |
$16,714.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,785.47
|
| Rate for Payer: PHP Commercial |
$15,785.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,071.24
|
| Rate for Payer: Priority Health SBD |
$11,699.82
|
|
|
HC LAAC IMPLANT
|
Facility
|
IP
|
$18,571.14
|
|
| Hospital Charge Code |
27800117
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,699.82 |
| Max. Negotiated Rate |
$16,714.03 |
| Rate for Payer: Aetna Commercial |
$15,785.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,071.24
|
| Rate for Payer: Cash Price |
$14,856.91
|
| Rate for Payer: Cofinity Commercial |
$12,999.80
|
| Rate for Payer: Cofinity Commercial |
$15,971.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,999.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,856.91
|
| Rate for Payer: Healthscope Commercial |
$16,714.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,785.47
|
| Rate for Payer: PHP Commercial |
$15,785.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,071.24
|
| Rate for Payer: Priority Health SBD |
$11,699.82
|
|
|
HC LABOR CAT (1) 0-2HRS
|
Facility
|
IP
|
$1,531.01
|
|
| Hospital Charge Code |
72000001
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$964.54 |
| Max. Negotiated Rate |
$1,377.91 |
| Rate for Payer: Aetna Commercial |
$1,301.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$995.16
|
| Rate for Payer: Cash Price |
$1,224.81
|
| Rate for Payer: Cofinity Commercial |
$1,071.71
|
| Rate for Payer: Cofinity Commercial |
$1,316.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,071.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,224.81
|
| Rate for Payer: Healthscope Commercial |
$1,377.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,301.36
|
| Rate for Payer: PHP Commercial |
$1,301.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$995.16
|
| Rate for Payer: Priority Health SBD |
$964.54
|
|
|
HC LABOR CAT (1) 0-2HRS
|
Facility
|
OP
|
$1,531.01
|
|
| Hospital Charge Code |
72000001
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$612.40 |
| Max. Negotiated Rate |
$1,377.91 |
| Rate for Payer: Aetna Commercial |
$1,301.36
|
| Rate for Payer: Aetna Medicare |
$765.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$995.16
|
| Rate for Payer: BCBS Complete |
$612.40
|
| Rate for Payer: Cash Price |
$1,224.81
|
| Rate for Payer: Cofinity Commercial |
$1,071.71
|
| Rate for Payer: Cofinity Commercial |
$1,316.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,071.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,224.81
|
| Rate for Payer: Healthscope Commercial |
$1,377.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,301.36
|
| Rate for Payer: PHP Commercial |
$1,301.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$995.16
|
| Rate for Payer: Priority Health SBD |
$964.54
|
| Rate for Payer: UHC Core |
$1,132.95
|
| Rate for Payer: UHC Exchange |
$1,132.95
|
|
|
HC LABOR CAT (2) 2-5HRS
|
Facility
|
OP
|
$2,041.41
|
|
| Hospital Charge Code |
72000002
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$816.56 |
| Max. Negotiated Rate |
$1,837.27 |
| Rate for Payer: Aetna Commercial |
$1,735.20
|
| Rate for Payer: Aetna Medicare |
$1,020.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,326.92
|
| Rate for Payer: BCBS Complete |
$816.56
|
| Rate for Payer: Cash Price |
$1,633.13
|
| Rate for Payer: Cofinity Commercial |
$1,428.99
|
| Rate for Payer: Cofinity Commercial |
$1,755.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,428.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,633.13
|
| Rate for Payer: Healthscope Commercial |
$1,837.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,735.20
|
| Rate for Payer: PHP Commercial |
$1,735.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,326.92
|
| Rate for Payer: Priority Health SBD |
$1,286.09
|
| Rate for Payer: UHC Core |
$1,510.64
|
| Rate for Payer: UHC Exchange |
$1,510.64
|
|
|
HC LABOR CAT (2) 2-5HRS
|
Facility
|
IP
|
$2,041.41
|
|
| Hospital Charge Code |
72000002
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,286.09 |
| Max. Negotiated Rate |
$1,837.27 |
| Rate for Payer: Aetna Commercial |
$1,735.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,326.92
|
| Rate for Payer: Cash Price |
$1,633.13
|
| Rate for Payer: Cofinity Commercial |
$1,428.99
|
| Rate for Payer: Cofinity Commercial |
$1,755.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,428.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,633.13
|
| Rate for Payer: Healthscope Commercial |
$1,837.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,735.20
|
| Rate for Payer: PHP Commercial |
$1,735.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,326.92
|
| Rate for Payer: Priority Health SBD |
$1,286.09
|
|
|
HC LABOR CAT (3) 5-8HRS
|
Facility
|
OP
|
$2,551.65
|
|
| Hospital Charge Code |
72000003
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,020.66 |
| Max. Negotiated Rate |
$2,296.48 |
| Rate for Payer: Aetna Commercial |
$2,168.90
|
| Rate for Payer: Aetna Medicare |
$1,275.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,658.57
|
| Rate for Payer: BCBS Complete |
$1,020.66
|
| Rate for Payer: Cash Price |
$2,041.32
|
| Rate for Payer: Cofinity Commercial |
$1,786.16
|
| Rate for Payer: Cofinity Commercial |
$2,194.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,786.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,041.32
|
| Rate for Payer: Healthscope Commercial |
$2,296.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,168.90
|
| Rate for Payer: PHP Commercial |
$2,168.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,658.57
|
| Rate for Payer: Priority Health SBD |
$1,607.54
|
| Rate for Payer: UHC Core |
$1,888.22
|
| Rate for Payer: UHC Exchange |
$1,888.22
|
|
|
HC LABOR CAT (3) 5-8HRS
|
Facility
|
IP
|
$2,551.65
|
|
| Hospital Charge Code |
72000003
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,607.54 |
| Max. Negotiated Rate |
$2,296.48 |
| Rate for Payer: Aetna Commercial |
$2,168.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,658.57
|
| Rate for Payer: Cash Price |
$2,041.32
|
| Rate for Payer: Cofinity Commercial |
$1,786.16
|
| Rate for Payer: Cofinity Commercial |
$2,194.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,786.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,041.32
|
| Rate for Payer: Healthscope Commercial |
$2,296.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,168.90
|
| Rate for Payer: PHP Commercial |
$2,168.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,658.57
|
| Rate for Payer: Priority Health SBD |
$1,607.54
|
|
|
HC LABOR CAT (4) 8-12HRS
|
Facility
|
IP
|
$3,062.03
|
|
| Hospital Charge Code |
72000004
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,929.08 |
| Max. Negotiated Rate |
$2,755.83 |
| Rate for Payer: Aetna Commercial |
$2,602.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,990.32
|
| Rate for Payer: Cash Price |
$2,449.62
|
| Rate for Payer: Cofinity Commercial |
$2,143.42
|
| Rate for Payer: Cofinity Commercial |
$2,633.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,143.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,449.62
|
| Rate for Payer: Healthscope Commercial |
$2,755.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,602.73
|
| Rate for Payer: PHP Commercial |
$2,602.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,990.32
|
| Rate for Payer: Priority Health SBD |
$1,929.08
|
|
