|
HC LOOP AV 3/8 INCH OR 1/2 INCH
|
Facility
|
OP
|
$216.04
|
|
| Hospital Charge Code |
27000444
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$86.42 |
| Max. Negotiated Rate |
$194.44 |
| Rate for Payer: Aetna Commercial |
$183.63
|
| Rate for Payer: Aetna Medicare |
$108.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.43
|
| Rate for Payer: BCBS Complete |
$86.42
|
| Rate for Payer: Cash Price |
$172.83
|
| Rate for Payer: Cofinity Commercial |
$151.23
|
| Rate for Payer: Cofinity Commercial |
$185.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$151.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.83
|
| Rate for Payer: Healthscope Commercial |
$194.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.63
|
| Rate for Payer: PHP Commercial |
$183.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.43
|
| Rate for Payer: Priority Health SBD |
$136.11
|
|
|
HC LOW-LEVEL LASER THERAPY
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
CPT 0552T
|
| Hospital Charge Code |
43000024
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$36.72 |
| Max. Negotiated Rate |
$296.30 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Medicare |
$45.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: BCBS Complete |
$36.72
|
| Rate for Payer: BCBS Trust/PPO |
$173.92
|
| Rate for Payer: BCN Commercial |
$173.92
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health SBD |
$57.83
|
| Rate for Payer: UHC Core |
$296.30
|
| Rate for Payer: UHC Exchange |
$67.93
|
|
|
HC LOW-LEVEL LASER THERAPY
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
CPT 0552T
|
| Hospital Charge Code |
43000024
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$57.83 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health SBD |
$57.83
|
|
|
HC LP (A) CHOLESTEROL LMPP
|
Facility
|
OP
|
$23.93
|
|
|
Service Code
|
CPT 83700
|
| Hospital Charge Code |
30100636
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$21.54 |
| Rate for Payer: Aetna Commercial |
$20.34
|
| Rate for Payer: Aetna Medicare |
$11.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.08
|
| Rate for Payer: BCBS Complete |
$6.34
|
| Rate for Payer: BCBS MAPPO |
$11.26
|
| Rate for Payer: BCBS Trust/PPO |
$9.97
|
| Rate for Payer: BCN Commercial |
$9.97
|
| Rate for Payer: BCN Medicare Advantage |
$11.26
|
| 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 |
$11.26
|
| Rate for Payer: Healthscope Commercial |
$21.54
|
| Rate for Payer: Mclaren Medicaid |
$6.04
|
| 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 |
$6.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.34
|
| Rate for Payer: Nomi Health Commercial |
$16.89
|
| Rate for Payer: PACE Medicare |
$10.70
|
| Rate for Payer: PACE SWMI |
$11.26
|
| Rate for Payer: PHP Commercial |
$20.34
|
| Rate for Payer: PHP Medicare Advantage |
$11.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.58
|
| Rate for Payer: Priority Health Medicare |
$11.26
|
| Rate for Payer: Priority Health Narrow Network |
$9.26
|
| Rate for Payer: Priority Health SBD |
$15.08
|
| Rate for Payer: Railroad Medicare Medicare |
$11.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.26
|
| Rate for Payer: UHC Medicare Advantage |
$11.26
|
| Rate for Payer: UHCCP Medicaid |
$6.34
|
| Rate for Payer: VA VA |
$11.26
|
|
|
HC LP (A) CHOLESTEROL LMPP
|
Facility
|
IP
|
$23.93
|
|
|
Service Code
|
CPT 83700
|
| Hospital Charge Code |
30100636
|
|
Hospital Revenue Code
|
301
|
| 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 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 Commercial |
$264.18
|
| Rate for Payer: Cofinity Commercial |
$324.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$264.18
|
| 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: PHP Commercial |
$320.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.31
|
| Rate for Payer: Priority Health SBD |
$237.76
|
|
|
HC LT/RT/C'S/CABG'S W INTERVENTION
|
Facility
|
IP
|
$12,357.92
|
|
|
Service Code
|
CPT 93461
|
| Hospital Charge Code |
48100051
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,785.49 |
| Max. Negotiated Rate |
$11,122.13 |
| Rate for Payer: Aetna Commercial |
$10,504.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,032.65
|
| Rate for Payer: Cash Price |
$9,886.34
|
| Rate for Payer: Cofinity Commercial |
$10,627.81
|
| Rate for Payer: Cofinity Commercial |
$8,650.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,650.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,886.34
|
| Rate for Payer: Healthscope Commercial |
$11,122.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,504.23
|
| Rate for Payer: PHP Commercial |
$10,504.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,032.65
|
| Rate for Payer: Priority Health SBD |
$7,785.49
|
|
|
HC LT/RT/C'S/CABG'S W INTERVENTION
|
Facility
|
OP
|
$12,357.92
|
|
|
Service Code
|
CPT 93461
|
| Hospital Charge Code |
48100051
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,368.81 |
| Max. Negotiated Rate |
$11,122.13 |
| Rate for Payer: Aetna Commercial |
$10,504.23
|
| Rate for Payer: Aetna Medicare |
$3,277.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,032.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,939.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,939.21
|
| Rate for Payer: BCBS Complete |
$1,773.59
|
| Rate for Payer: BCBS MAPPO |
$3,151.37
|
| Rate for Payer: BCBS Trust/PPO |
$4,203.97
|
| Rate for Payer: BCN Commercial |
$4,203.97
|
| Rate for Payer: BCN Medicare Advantage |
$3,151.37
|
| Rate for Payer: Cash Price |
$9,886.34
|
| Rate for Payer: Cash Price |
$9,886.34
|
| Rate for Payer: Cash Price |
$9,886.34
|
| Rate for Payer: Cofinity Commercial |
$10,627.81
|
| Rate for Payer: Cofinity Commercial |
$8,650.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,650.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,886.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,151.37
|
| Rate for Payer: Healthscope Commercial |
$11,122.13
|
| Rate for Payer: Mclaren Medicaid |
$1,689.13
|
| Rate for Payer: Mclaren Medicare |
$3,151.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,308.94
|
| Rate for Payer: Meridian Medicaid |
$1,773.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,624.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,504.23
|
| Rate for Payer: Nomi Health Commercial |
$6,617.88
|
| Rate for Payer: PACE Medicare |
$2,993.80
|
| Rate for Payer: PACE SWMI |
$3,151.37
|
| Rate for Payer: PHP Commercial |
$10,504.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,151.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,689.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,032.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,904.74
|
| Rate for Payer: Priority Health Medicare |
$3,151.37
|
| Rate for Payer: Priority Health Narrow Network |
$7,923.79
|
| Rate for Payer: Priority Health SBD |
$7,785.49
|
| Rate for Payer: Railroad Medicare Medicare |
$3,151.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,368.81
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,151.37
|
| Rate for Payer: UHC Exchange |
$7,322.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,151.37
|
| Rate for Payer: UHCCP Medicaid |
$1,774.22
|
| Rate for Payer: VA VA |
$3,151.37
|
|
|
HC LUMASON PER ML
|
Facility
|
IP
|
$79.50
|
|
|
Service Code
|
HCPCS Q9950
|
| Hospital Charge Code |
63600066
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.08 |
| Max. Negotiated Rate |
$71.55 |
| Rate for Payer: Aetna Commercial |
$67.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.68
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cofinity Commercial |
$55.65
|
| Rate for Payer: Cofinity Commercial |
$68.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.60
|
| Rate for Payer: Healthscope Commercial |
$71.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.58
|
| Rate for Payer: PHP Commercial |
$67.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.68
|
| Rate for Payer: Priority Health SBD |
$50.08
|
|
|
HC LUMASON PER ML
|
Facility
|
OP
|
$79.50
|
|
|
Service Code
|
HCPCS Q9950
|
| Hospital Charge Code |
63600066
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.89 |
| Max. Negotiated Rate |
$71.55 |
| Rate for Payer: Aetna Commercial |
$67.58
|
| Rate for Payer: Aetna Medicare |
$39.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.68
|
| Rate for Payer: BCBS Complete |
$31.80
|
| Rate for Payer: BCBS Trust/PPO |
$22.89
|
| Rate for Payer: BCN Commercial |
$22.89
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cofinity Commercial |
$55.65
|
| Rate for Payer: Cofinity Commercial |
$68.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.60
|
| Rate for Payer: Healthscope Commercial |
$71.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.58
|
| Rate for Payer: PHP Commercial |
$67.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.68
|
| Rate for Payer: Priority Health SBD |
$50.08
|
|
|
HC LUMBAR PUNCTURE
|
Facility
|
IP
|
$748.54
|
|
| Hospital Charge Code |
45000046
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$471.58 |
| Max. Negotiated Rate |
$673.69 |
| Rate for Payer: Aetna Commercial |
$636.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$486.55
|
| Rate for Payer: Cash Price |
$598.83
|
| Rate for Payer: Cofinity Commercial |
$523.98
|
| Rate for Payer: Cofinity Commercial |
$643.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$523.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$598.83
|
| Rate for Payer: Healthscope Commercial |
$673.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$636.26
|
| Rate for Payer: PHP Commercial |
$636.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$486.55
|
| Rate for Payer: Priority Health SBD |
$471.58
|
|
|
HC LUMBAR PUNCTURE
|
Facility
|
OP
|
$748.54
|
|
| Hospital Charge Code |
45000046
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$299.42 |
| Max. Negotiated Rate |
$673.69 |
| Rate for Payer: Aetna Commercial |
$636.26
|
| Rate for Payer: Aetna Medicare |
$374.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$486.55
|
| Rate for Payer: BCBS Complete |
$299.42
|
| Rate for Payer: Cash Price |
$598.83
|
| Rate for Payer: Cofinity Commercial |
$523.98
|
| Rate for Payer: Cofinity Commercial |
$643.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$523.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$598.83
|
| Rate for Payer: Healthscope Commercial |
$673.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$636.26
|
| Rate for Payer: PHP Commercial |
$636.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$486.55
|
| Rate for Payer: Priority Health SBD |
$471.58
|
|
|
HC LUMBAR PUNCTURE DIAGNOSTIC
|
Facility
|
IP
|
$916.38
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
36100278
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$577.32 |
| Max. Negotiated Rate |
$824.74 |
| Rate for Payer: Aetna Commercial |
$778.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$595.65
|
| Rate for Payer: Cash Price |
$733.10
|
| Rate for Payer: Cofinity Commercial |
$641.47
|
| Rate for Payer: Cofinity Commercial |
$788.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$641.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$733.10
|
| Rate for Payer: Healthscope Commercial |
$824.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$778.92
|
| Rate for Payer: PHP Commercial |
$778.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$595.65
|
| Rate for Payer: Priority Health SBD |
$577.32
|
|
|
HC LUMBAR PUNCTURE DIAGNOSTIC
|
Facility
|
OP
|
$916.38
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
36100278
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$2,132.58 |
| Rate for Payer: Aetna Commercial |
$778.92
|
| Rate for Payer: Aetna Medicare |
$705.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$595.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$545.99
|
| Rate for Payer: BCN Commercial |
$545.99
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Cash Price |
$733.10
|
| Rate for Payer: Cash Price |
$733.10
|
| Rate for Payer: Cash Price |
$733.10
|
| Rate for Payer: Cofinity Commercial |
$641.47
|
| Rate for Payer: Cofinity Commercial |
$788.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$641.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$733.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$824.74
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$778.92
|
| Rate for Payer: Nomi Health Commercial |
$1,424.89
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$778.92
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$595.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,132.58
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,706.06
|
| Rate for Payer: Priority Health SBD |
$577.32
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.80
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$382.01
|
| Rate for Payer: VA VA |
$678.52
|
|
|
HC LUMBAR PUNCTURE THERAPEUTIC
|
Facility
|
IP
|
$771.00
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
36100279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$485.73 |
| Max. Negotiated Rate |
$693.90 |
| Rate for Payer: Aetna Commercial |
$655.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$501.15
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cofinity Commercial |
$539.70
|
| Rate for Payer: Cofinity Commercial |
$663.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$539.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$616.80
|
| Rate for Payer: Healthscope Commercial |
$693.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$655.35
|
| Rate for Payer: PHP Commercial |
$655.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$501.15
|
| Rate for Payer: Priority Health SBD |
$485.73
|
|
|
HC LUMBAR PUNCTURE THERAPEUTIC
|
Facility
|
OP
|
$771.00
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
36100279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$99.64 |
| Max. Negotiated Rate |
$2,132.58 |
| Rate for Payer: Aetna Commercial |
$655.35
|
| Rate for Payer: Aetna Medicare |
$705.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$501.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$245.00
|
| Rate for Payer: BCN Commercial |
$245.00
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cofinity Commercial |
$663.06
|
| Rate for Payer: Cofinity Commercial |
$539.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$539.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$616.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$693.90
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$655.35
|
| Rate for Payer: Nomi Health Commercial |
$1,424.89
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$655.35
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$501.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,132.58
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,706.06
|
| Rate for Payer: Priority Health SBD |
$485.73
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.64
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$382.01
|
| Rate for Payer: VA VA |
$678.52
|
|
|
HC LUNG/MED BIOPSY
|
Facility
|
IP
|
$2,107.93
|
|
|
Service Code
|
CPT 32408
|
| Hospital Charge Code |
36100609
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,328.00 |
| Max. Negotiated Rate |
$1,897.14 |
| Rate for Payer: Aetna Commercial |
$1,791.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,370.15
|
| Rate for Payer: Cash Price |
$1,686.34
|
| Rate for Payer: Cofinity Commercial |
$1,475.55
|
| Rate for Payer: Cofinity Commercial |
$1,812.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,475.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,686.34
|
| Rate for Payer: Healthscope Commercial |
$1,897.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,791.74
|
| Rate for Payer: PHP Commercial |
$1,791.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,370.15
|
| Rate for Payer: Priority Health SBD |
$1,328.00
|
|
|
HC LUNG/MED BIOPSY
|
Facility
|
OP
|
$2,107.93
|
|
|
Service Code
|
CPT 32408
|
| Hospital Charge Code |
36100609
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$159.56 |
| Max. Negotiated Rate |
$4,989.41 |
| Rate for Payer: Aetna Commercial |
$1,791.74
|
| Rate for Payer: Aetna Medicare |
$1,650.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,370.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$579.29
|
| Rate for Payer: BCN Commercial |
$579.29
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$1,686.34
|
| Rate for Payer: Cash Price |
$1,686.34
|
| Rate for Payer: Cash Price |
$1,686.34
|
| Rate for Payer: Cofinity Commercial |
$1,475.55
|
| Rate for Payer: Cofinity Commercial |
$1,812.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,475.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,686.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$1,897.14
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,791.74
|
| Rate for Payer: Nomi Health Commercial |
$3,333.71
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$1,791.74
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,370.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,989.41
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,991.53
|
| Rate for Payer: Priority Health SBD |
$1,328.00
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.56
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$893.75
|
| Rate for Payer: VA VA |
$1,587.48
|
|
|
HC LUPUS ANTICOAGULANT HEX PHASE
|
Facility
|
OP
|
$163.20
|
|
|
Service Code
|
CPT 85598
|
| Hospital Charge Code |
30500057
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$146.88 |
| Rate for Payer: Aetna Commercial |
$138.72
|
| Rate for Payer: Aetna Medicare |
$18.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.48
|
| Rate for Payer: BCBS Complete |
$10.12
|
| Rate for Payer: BCBS MAPPO |
$17.98
|
| Rate for Payer: BCBS Trust/PPO |
$15.92
|
| Rate for Payer: BCN Commercial |
$15.92
|
| Rate for Payer: BCN Medicare Advantage |
$17.98
|
| Rate for Payer: Cash Price |
$130.56
|
| Rate for Payer: Cash Price |
$130.56
|
| Rate for Payer: Cofinity Commercial |
$140.35
|
| Rate for Payer: Cofinity Commercial |
$114.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$114.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.98
|
| Rate for Payer: Healthscope Commercial |
$146.88
|
| Rate for Payer: Mclaren Medicaid |
$9.64
|
| Rate for Payer: Mclaren Medicare |
$17.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.88
|
| Rate for Payer: Meridian Medicaid |
$10.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.72
|
| Rate for Payer: Nomi Health Commercial |
$26.97
|
| Rate for Payer: PACE Medicare |
$17.08
|
| Rate for Payer: PACE SWMI |
$17.98
|
| Rate for Payer: PHP Commercial |
$138.72
|
| Rate for Payer: PHP Medicare Advantage |
$17.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.98
|
| Rate for Payer: Priority Health Medicare |
$17.98
|
| Rate for Payer: Priority Health Narrow Network |
$14.38
|
| Rate for Payer: Priority Health SBD |
$102.82
|
| Rate for Payer: Railroad Medicare Medicare |
$17.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.98
|
| Rate for Payer: UHC Medicare Advantage |
$17.98
|
| Rate for Payer: UHCCP Medicaid |
$10.12
|
| Rate for Payer: VA VA |
$17.98
|
|
|
HC LUPUS ANTICOAGULANT HEX PHASE
|
Facility
|
IP
|
$163.20
|
|
|
Service Code
|
CPT 85598
|
| Hospital Charge Code |
30500057
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$102.82 |
| Max. Negotiated Rate |
$146.88 |
| Rate for Payer: Aetna Commercial |
$138.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.08
|
| Rate for Payer: Cash Price |
$130.56
|
| Rate for Payer: Cofinity Commercial |
$114.24
|
| Rate for Payer: Cofinity Commercial |
$140.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$114.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.56
|
| Rate for Payer: Healthscope Commercial |
$146.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.72
|
| Rate for Payer: PHP Commercial |
$138.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.08
|
| Rate for Payer: Priority Health SBD |
$102.82
|
|
|
HC LV4RP GROSS_MICRO (BILL ONLY)
|
Facility
|
IP
|
$311.10
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
31000087
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$195.99 |
| Max. Negotiated Rate |
$279.99 |
| Rate for Payer: Aetna Commercial |
$264.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.22
|
| Rate for Payer: Cash Price |
$248.88
|
| Rate for Payer: Cofinity Commercial |
$217.77
|
| Rate for Payer: Cofinity Commercial |
$267.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$217.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.88
|
| Rate for Payer: Healthscope Commercial |
$279.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.44
|
| Rate for Payer: PHP Commercial |
$264.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.22
|
| Rate for Payer: Priority Health SBD |
$195.99
|
|
|
HC LV4RP GROSS_MICRO (BILL ONLY)
|
Facility
|
OP
|
$311.10
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
31000087
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.06 |
| Max. Negotiated Rate |
$279.99 |
| Rate for Payer: Aetna Commercial |
$264.44
|
| Rate for Payer: Aetna Medicare |
$54.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.44
|
| Rate for Payer: BCBS Complete |
$29.46
|
| Rate for Payer: BCBS MAPPO |
$52.35
|
| Rate for Payer: BCBS Trust/PPO |
$59.05
|
| Rate for Payer: BCCCP Commercial |
$67.27
|
| Rate for Payer: BCN Commercial |
$59.05
|
| Rate for Payer: BCN Medicare Advantage |
$52.35
|
| Rate for Payer: Cash Price |
$248.88
|
| Rate for Payer: Cash Price |
$248.88
|
| Rate for Payer: Cofinity Commercial |
$267.55
|
| Rate for Payer: Cofinity Commercial |
$217.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$217.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.35
|
| Rate for Payer: Healthscope Commercial |
$279.99
|
| Rate for Payer: Mclaren Medicaid |
$28.06
|
| Rate for Payer: Mclaren Medicare |
$52.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.97
|
| Rate for Payer: Meridian Medicaid |
$29.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.44
|
| Rate for Payer: Nomi Health Commercial |
$157.05
|
| Rate for Payer: PACE Medicare |
$49.73
|
| Rate for Payer: PACE SWMI |
$52.35
|
| Rate for Payer: PHP Commercial |
$264.44
|
| Rate for Payer: PHP Medicare Advantage |
$52.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$164.53
|
| Rate for Payer: Priority Health Medicare |
$52.35
|
| Rate for Payer: Priority Health Narrow Network |
$131.62
|
| Rate for Payer: Priority Health SBD |
$195.99
|
| Rate for Payer: Railroad Medicare Medicare |
$52.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.35
|
| Rate for Payer: UHC Medicare Advantage |
$52.35
|
| Rate for Payer: UHCCP Medicaid |
$29.47
|
| Rate for Payer: VA VA |
$52.35
|
|
|
HC LVAD INSERTION
|
Facility
|
OP
|
$3,223.64
|
|
|
Service Code
|
CPT 33990
|
| Hospital Charge Code |
36100084
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$382.35 |
| Max. Negotiated Rate |
$3,362.00 |
| Rate for Payer: Aetna Commercial |
$2,740.09
|
| Rate for Payer: Aetna Medicare |
$1,611.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,095.37
|
| Rate for Payer: BCBS Complete |
$1,289.46
|
| Rate for Payer: BCBS Trust/PPO |
$899.88
|
| Rate for Payer: BCN Commercial |
$899.88
|
| Rate for Payer: Cash Price |
$2,578.91
|
| Rate for Payer: Cash Price |
$2,578.91
|
| Rate for Payer: Cash Price |
$2,578.91
|
| Rate for Payer: Cofinity Commercial |
$2,256.55
|
| Rate for Payer: Cofinity Commercial |
$2,772.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,256.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,578.91
|
| Rate for Payer: Healthscope Commercial |
$2,901.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,740.09
|
| Rate for Payer: PHP Commercial |
$2,740.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,095.37
|
| Rate for Payer: Priority Health SBD |
$2,030.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$382.35
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
|
|
HC LVAD INSERTION
|
Facility
|
IP
|
$3,223.64
|
|
|
Service Code
|
CPT 33990
|
| Hospital Charge Code |
36100084
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,030.89 |
| Max. Negotiated Rate |
$2,901.28 |
| Rate for Payer: Aetna Commercial |
$2,740.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,095.37
|
| Rate for Payer: Cash Price |
$2,578.91
|
| Rate for Payer: Cofinity Commercial |
$2,256.55
|
| Rate for Payer: Cofinity Commercial |
$2,772.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,256.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,578.91
|
| Rate for Payer: Healthscope Commercial |
$2,901.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,740.09
|
| Rate for Payer: PHP Commercial |
$2,740.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,095.37
|
| Rate for Payer: Priority Health SBD |
$2,030.89
|
|
|
HC LVDS PLT PER LEUKO RED IRRAD
|
Facility
|
OP
|
$2,832.80
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000088
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$354.83 |
| Max. Negotiated Rate |
$2,549.52 |
| Rate for Payer: Aetna Commercial |
$2,407.88
|
| Rate for Payer: Aetna Medicare |
$688.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,841.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$827.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$827.50
|
| Rate for Payer: BCBS Complete |
$372.57
|
| Rate for Payer: BCBS MAPPO |
$662.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,864.45
|
| Rate for Payer: BCN Commercial |
$1,864.45
|
| Rate for Payer: BCN Medicare Advantage |
$662.00
|
| Rate for Payer: Cash Price |
$2,266.24
|
| Rate for Payer: Cash Price |
$2,266.24
|
| Rate for Payer: Cofinity Commercial |
$2,436.21
|
| Rate for Payer: Cofinity Commercial |
$1,982.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,982.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,266.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$662.00
|
| Rate for Payer: Healthscope Commercial |
$2,549.52
|
| Rate for Payer: Mclaren Medicaid |
$354.83
|
| Rate for Payer: Mclaren Medicare |
$662.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$695.10
|
| Rate for Payer: Meridian Medicaid |
$372.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$761.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,407.88
|
| Rate for Payer: Nomi Health Commercial |
$1,986.00
|
| Rate for Payer: PACE Medicare |
$628.90
|
| Rate for Payer: PACE SWMI |
$662.00
|
| Rate for Payer: PHP Commercial |
$2,407.88
|
| Rate for Payer: PHP Medicare Advantage |
$662.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$354.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,841.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,080.65
|
| Rate for Payer: Priority Health Medicare |
$662.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,664.52
|
| Rate for Payer: Priority Health SBD |
$1,784.66
|
| Rate for Payer: Railroad Medicare Medicare |
$662.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,863.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$662.00
|
| Rate for Payer: UHC Exchange |
$2,096.27
|
| Rate for Payer: UHC Medicare Advantage |
$662.00
|
| Rate for Payer: UHCCP Medicaid |
$372.71
|
| Rate for Payer: VA VA |
$662.00
|
|
