|
HC STREPTOCOCCUS PNEUMONIA
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600277
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health SBD |
$32.13
|
|
|
HC STREPTOCOCCUS PNEUMONIA
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600277
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$59.65 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$27.48
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$59.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC STRESS COMPLETE PHYSIOLOGY ARTERIES
|
Facility
|
OP
|
$348.76
|
|
|
Service Code
|
CPT 93924
|
| Hospital Charge Code |
92100021
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$76.03 |
| Max. Negotiated Rate |
$615.57 |
| Rate for Payer: Aetna Commercial |
$296.45
|
| Rate for Payer: Aetna Medicare |
$144.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.74
|
| Rate for Payer: BCBS Complete |
$79.84
|
| Rate for Payer: BCBS MAPPO |
$138.99
|
| Rate for Payer: BCBS Trust/PPO |
$615.57
|
| Rate for Payer: BCN Medicare Advantage |
$138.99
|
| Rate for Payer: Cash Price |
$279.01
|
| Rate for Payer: Cash Price |
$279.01
|
| Rate for Payer: Cofinity Commercial |
$299.93
|
| Rate for Payer: Cofinity Commercial |
$244.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.99
|
| Rate for Payer: Healthscope Commercial |
$313.88
|
| Rate for Payer: Mclaren Medicaid |
$76.03
|
| Rate for Payer: Mclaren Medicare |
$138.99
|
| Rate for Payer: Meridian Medicaid |
$79.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$296.45
|
| Rate for Payer: PACE Medicare |
$132.04
|
| Rate for Payer: PACE SWMI |
$138.99
|
| Rate for Payer: PHP Commercial |
$296.45
|
| Rate for Payer: PHP Medicare Advantage |
$138.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.13
|
| Rate for Payer: Priority Health Medicare |
$138.99
|
| Rate for Payer: Priority Health SBD |
$219.72
|
| Rate for Payer: Railroad Medicare Medicare |
$138.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.99
|
| Rate for Payer: UHC Exchange |
$157.17
|
| Rate for Payer: UHC Medicare Advantage |
$143.16
|
| Rate for Payer: VA VA |
$138.99
|
|
|
HC STRESS COMPLETE PHYSIOLOGY ARTERIES
|
Facility
|
IP
|
$348.76
|
|
|
Service Code
|
CPT 93924
|
| Hospital Charge Code |
92100021
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$219.72 |
| Max. Negotiated Rate |
$313.88 |
| Rate for Payer: Aetna Commercial |
$296.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.69
|
| Rate for Payer: Cash Price |
$279.01
|
| Rate for Payer: Cofinity Commercial |
$244.13
|
| Rate for Payer: Cofinity Commercial |
$299.93
|
| Rate for Payer: Healthscope Commercial |
$313.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$296.45
|
| Rate for Payer: PHP Commercial |
$296.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.13
|
| Rate for Payer: Priority Health SBD |
$219.72
|
|
|
HC STRESS ECHO
|
Facility
|
OP
|
$1,485.66
|
|
|
Service Code
|
CPT 93350
|
| Hospital Charge Code |
48000008
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$182.06 |
| Max. Negotiated Rate |
$1,337.09 |
| Rate for Payer: Aetna Commercial |
$1,262.81
|
| Rate for Payer: Aetna Medicare |
$510.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$965.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$613.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$613.60
|
| Rate for Payer: BCBS Complete |
$281.96
|
| Rate for Payer: BCBS MAPPO |
$490.88
|
| Rate for Payer: BCBS Trust/PPO |
$541.88
|
| Rate for Payer: BCN Medicare Advantage |
$490.88
|
| Rate for Payer: Cash Price |
$1,188.53
|
| Rate for Payer: Cash Price |
$1,188.53
|
| Rate for Payer: Cofinity Commercial |
$1,277.67
|
| Rate for Payer: Cofinity Commercial |
$1,039.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.88
|
| Rate for Payer: Healthscope Commercial |
$1,337.09
|
| Rate for Payer: Mclaren Medicaid |
$268.51
|
| Rate for Payer: Mclaren Medicare |
$490.88
|
| Rate for Payer: Meridian Medicaid |
$281.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$515.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$564.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,262.81
|
| Rate for Payer: PACE Medicare |
$466.34
|
| Rate for Payer: PACE SWMI |
$490.88
|
| Rate for Payer: PHP Commercial |
$1,262.81
|
| Rate for Payer: PHP Medicare Advantage |
$490.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$268.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,039.96
|
| Rate for Payer: Priority Health Medicare |
$490.88
|
| Rate for Payer: Priority Health SBD |
$935.97
|
| Rate for Payer: Railroad Medicare Medicare |
$490.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$490.88
|
| Rate for Payer: UHC Exchange |
$182.06
|
| Rate for Payer: UHC Medicare Advantage |
$505.61
|
| Rate for Payer: VA VA |
$490.88
|
|
|
HC STRESS ECHO
|
Facility
|
IP
|
$1,485.66
|
|
|
Service Code
|
CPT 93350
|
| Hospital Charge Code |
48000008
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$935.97 |
| Max. Negotiated Rate |
$1,337.09 |
| Rate for Payer: Aetna Commercial |
$1,262.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$965.68
|
| Rate for Payer: Cash Price |
$1,188.53
|
| Rate for Payer: Cofinity Commercial |
$1,039.96
|
| Rate for Payer: Cofinity Commercial |
$1,277.67
|
| Rate for Payer: Healthscope Commercial |
$1,337.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,262.81
|
| Rate for Payer: PHP Commercial |
$1,262.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,039.96
|
| Rate for Payer: Priority Health SBD |
$935.97
|
|
|
HC STRESS TEST
|
Facility
|
IP
|
$884.25
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
48200001
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$557.08 |
| Max. Negotiated Rate |
$795.82 |
| Rate for Payer: Aetna Commercial |
$751.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$574.76
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cofinity Commercial |
$618.98
|
| Rate for Payer: Cofinity Commercial |
$760.46
|
| Rate for Payer: Healthscope Commercial |
$795.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$751.61
|
| Rate for Payer: PHP Commercial |
$751.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$618.98
|
| Rate for Payer: Priority Health SBD |
$557.08
|
|
|
HC STRESS TEST
|
Facility
|
OP
|
$884.25
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
48200001
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$37.00 |
| Max. Negotiated Rate |
$824.04 |
| Rate for Payer: Aetna Commercial |
$751.61
|
| Rate for Payer: Aetna Medicare |
$290.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$574.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$349.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$349.11
|
| Rate for Payer: BCBS Complete |
$160.42
|
| Rate for Payer: BCBS MAPPO |
$279.29
|
| Rate for Payer: BCBS Trust/PPO |
$161.18
|
| Rate for Payer: BCN Medicare Advantage |
$279.29
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cofinity Commercial |
$760.46
|
| Rate for Payer: Cofinity Commercial |
$618.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.29
|
| Rate for Payer: Healthscope Commercial |
$795.82
|
| Rate for Payer: Mclaren Medicaid |
$152.77
|
| Rate for Payer: Mclaren Medicare |
$279.29
|
| Rate for Payer: Meridian Medicaid |
$160.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$293.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$321.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$751.61
|
| Rate for Payer: PACE Medicare |
$265.33
|
| Rate for Payer: PACE SWMI |
$279.29
|
| Rate for Payer: PHP Commercial |
$751.61
|
| Rate for Payer: PHP Medicare Advantage |
$279.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$618.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$824.04
|
| Rate for Payer: Priority Health Medicare |
$279.29
|
| Rate for Payer: Priority Health Narrow Network |
$659.23
|
| Rate for Payer: Priority Health SBD |
$557.08
|
| Rate for Payer: Railroad Medicare Medicare |
$279.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.29
|
| Rate for Payer: UHC Exchange |
$37.00
|
| Rate for Payer: UHC Medicare Advantage |
$287.67
|
| Rate for Payer: VA VA |
$279.29
|
|
|
HC STRIP PASTE
|
Facility
|
OP
|
$4.41
|
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$3.97 |
| Rate for Payer: Aetna Commercial |
$3.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.87
|
| Rate for Payer: BCBS Complete |
$1.76
|
| Rate for Payer: Cash Price |
$3.53
|
| Rate for Payer: Cofinity Commercial |
$3.09
|
| Rate for Payer: Cofinity Commercial |
$3.79
|
| Rate for Payer: Healthscope Commercial |
$3.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.75
|
| Rate for Payer: PHP Commercial |
$3.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health SBD |
$2.78
|
|
|
HC STRIP PASTE
|
Facility
|
IP
|
$4.41
|
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$3.97 |
| Rate for Payer: Aetna Commercial |
$3.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.87
|
| Rate for Payer: Cash Price |
$3.53
|
| Rate for Payer: Cofinity Commercial |
$3.09
|
| Rate for Payer: Cofinity Commercial |
$3.79
|
| Rate for Payer: Healthscope Commercial |
$3.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.75
|
| Rate for Payer: PHP Commercial |
$3.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health SBD |
$2.78
|
|
|
HC STRONGYLOIDES ANTIBODY, IGG, SERUM
|
Facility
|
OP
|
$85.60
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
30200490
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$77.04 |
| Rate for Payer: Aetna Commercial |
$72.76
|
| Rate for Payer: Aetna Medicare |
$13.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.26
|
| Rate for Payer: BCBS Complete |
$7.47
|
| Rate for Payer: BCBS MAPPO |
$13.01
|
| Rate for Payer: BCBS Trust/PPO |
$10.19
|
| Rate for Payer: BCN Medicare Advantage |
$13.01
|
| Rate for Payer: Cash Price |
$68.48
|
| Rate for Payer: Cash Price |
$68.48
|
| Rate for Payer: Cofinity Commercial |
$73.62
|
| Rate for Payer: Cofinity Commercial |
$59.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.01
|
| Rate for Payer: Healthscope Commercial |
$77.04
|
| Rate for Payer: Mclaren Medicaid |
$7.12
|
| Rate for Payer: Mclaren Medicare |
$13.01
|
| Rate for Payer: Meridian Medicaid |
$7.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.76
|
| Rate for Payer: PACE Medicare |
$12.36
|
| Rate for Payer: PACE SWMI |
$13.01
|
| Rate for Payer: PHP Commercial |
$72.76
|
| Rate for Payer: PHP Medicare Advantage |
$13.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.92
|
| Rate for Payer: Priority Health Medicare |
$13.01
|
| Rate for Payer: Priority Health SBD |
$53.93
|
| Rate for Payer: Railroad Medicare Medicare |
$13.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.61
|
| Rate for Payer: UHC Core |
$22.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.01
|
| Rate for Payer: UHC Exchange |
$13.01
|
| Rate for Payer: UHC Medicare Advantage |
$13.40
|
| Rate for Payer: VA VA |
$13.01
|
|
|
HC STRONGYLOIDES ANTIBODY, IGG, SERUM
|
Facility
|
IP
|
$85.60
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
30200490
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$53.93 |
| Max. Negotiated Rate |
$77.04 |
| Rate for Payer: Aetna Commercial |
$72.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.64
|
| Rate for Payer: Cash Price |
$68.48
|
| Rate for Payer: Cofinity Commercial |
$59.92
|
| Rate for Payer: Cofinity Commercial |
$73.62
|
| Rate for Payer: Healthscope Commercial |
$77.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.76
|
| Rate for Payer: PHP Commercial |
$72.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.92
|
| Rate for Payer: Priority Health SBD |
$53.93
|
|
|
HC STUDY INSERT NON TUNNELED CENTRAL LINE > 5 YRS
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
36100588
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Aetna Commercial |
$33.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.35
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$27.30
|
| Rate for Payer: Cofinity Commercial |
$33.54
|
| Rate for Payer: Healthscope Commercial |
$35.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.15
|
| Rate for Payer: PHP Commercial |
$33.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health SBD |
$24.57
|
|
|
HC STUDY INSERT NON TUNNELED CENTRAL LINE > 5 YRS
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
36100588
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$8,913.25 |
| Rate for Payer: Aetna Commercial |
$33.15
|
| Rate for Payer: Aetna Medicare |
$2,949.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,545.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,545.25
|
| Rate for Payer: BCBS Complete |
$1,629.11
|
| Rate for Payer: BCBS MAPPO |
$2,836.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,862.15
|
| Rate for Payer: BCN Medicare Advantage |
$2,836.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$33.54
|
| Rate for Payer: Cofinity Commercial |
$27.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,836.20
|
| Rate for Payer: Healthscope Commercial |
$35.10
|
| Rate for Payer: Mclaren Medicaid |
$1,551.40
|
| Rate for Payer: Mclaren Medicare |
$2,836.20
|
| Rate for Payer: Meridian Medicaid |
$1,629.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,978.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,261.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.15
|
| Rate for Payer: PACE Medicare |
$2,694.39
|
| Rate for Payer: PACE SWMI |
$2,836.20
|
| Rate for Payer: PHP Commercial |
$33.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,836.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,551.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,913.25
|
| Rate for Payer: Priority Health Medicare |
$2,836.20
|
| Rate for Payer: Priority Health Narrow Network |
$7,130.60
|
| Rate for Payer: Priority Health SBD |
$24.57
|
| Rate for Payer: Railroad Medicare Medicare |
$2,836.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.68
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,836.20
|
| Rate for Payer: UHC Exchange |
$81.53
|
| Rate for Payer: UHC Medicare Advantage |
$2,921.29
|
| Rate for Payer: VA VA |
$2,836.20
|
|
|
HC SUBCLASS IGG4, SERUM
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
30100720
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna Commercial |
$110.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.50
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cofinity Commercial |
$91.00
|
| Rate for Payer: Cofinity Commercial |
$111.80
|
| Rate for Payer: Healthscope Commercial |
$117.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.50
|
| Rate for Payer: PHP Commercial |
$110.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.00
|
| Rate for Payer: Priority Health SBD |
$81.90
|
|
|
HC SUBCLASS IGG4, SERUM
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
30100720
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna Commercial |
$110.50
|
| Rate for Payer: Aetna Medicare |
$8.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.02
|
| Rate for Payer: BCBS Complete |
$4.61
|
| Rate for Payer: BCBS MAPPO |
$8.02
|
| Rate for Payer: BCBS Trust/PPO |
$6.29
|
| Rate for Payer: BCN Medicare Advantage |
$8.02
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cofinity Commercial |
$111.80
|
| Rate for Payer: Cofinity Commercial |
$91.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.02
|
| Rate for Payer: Healthscope Commercial |
$117.00
|
| Rate for Payer: Mclaren Medicaid |
$4.39
|
| Rate for Payer: Mclaren Medicare |
$8.02
|
| Rate for Payer: Meridian Medicaid |
$4.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.50
|
| Rate for Payer: PACE Medicare |
$7.62
|
| Rate for Payer: PACE SWMI |
$8.02
|
| Rate for Payer: PHP Commercial |
$110.50
|
| Rate for Payer: PHP Medicare Advantage |
$8.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.00
|
| Rate for Payer: Priority Health Medicare |
$8.02
|
| Rate for Payer: Priority Health SBD |
$81.90
|
| Rate for Payer: Railroad Medicare Medicare |
$8.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.62
|
| Rate for Payer: UHC Core |
$13.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.02
|
| Rate for Payer: UHC Exchange |
$8.02
|
| Rate for Payer: UHC Medicare Advantage |
$8.26
|
| Rate for Payer: VA VA |
$8.02
|
|
|
HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL
|
Facility
|
IP
|
$7,950.00
|
|
|
Service Code
|
CPT 30140
|
| Hospital Charge Code |
76100377
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,008.50 |
| Max. Negotiated Rate |
$7,155.00 |
| Rate for Payer: Aetna Commercial |
$6,757.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,167.50
|
| Rate for Payer: Cash Price |
$6,360.00
|
| Rate for Payer: Cofinity Commercial |
$5,565.00
|
| Rate for Payer: Cofinity Commercial |
$6,837.00
|
| Rate for Payer: Healthscope Commercial |
$7,155.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,757.50
|
| Rate for Payer: PHP Commercial |
$6,757.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,565.00
|
| Rate for Payer: Priority Health SBD |
$5,008.50
|
|
|
HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL
|
Facility
|
OP
|
$7,950.00
|
|
|
Service Code
|
CPT 30140
|
| Hospital Charge Code |
76100377
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$174.53 |
| Max. Negotiated Rate |
$7,155.00 |
| Rate for Payer: Aetna Commercial |
$6,757.50
|
| Rate for Payer: Aetna Medicare |
$2,979.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,167.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,580.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,580.99
|
| Rate for Payer: BCBS Complete |
$1,645.54
|
| Rate for Payer: BCBS MAPPO |
$2,864.79
|
| Rate for Payer: BCBS Trust/PPO |
$952.38
|
| Rate for Payer: BCN Medicare Advantage |
$2,864.79
|
| Rate for Payer: Cash Price |
$6,360.00
|
| Rate for Payer: Cash Price |
$6,360.00
|
| Rate for Payer: Cofinity Commercial |
$6,837.00
|
| Rate for Payer: Cofinity Commercial |
$5,565.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,864.79
|
| Rate for Payer: Healthscope Commercial |
$7,155.00
|
| Rate for Payer: Mclaren Medicaid |
$1,567.04
|
| Rate for Payer: Mclaren Medicare |
$2,864.79
|
| Rate for Payer: Meridian Medicaid |
$1,645.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,008.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,294.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,757.50
|
| Rate for Payer: PACE Medicare |
$2,721.55
|
| Rate for Payer: PACE SWMI |
$2,864.79
|
| Rate for Payer: PHP Commercial |
$6,757.50
|
| Rate for Payer: PHP Medicare Advantage |
$2,864.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,567.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,565.00
|
| Rate for Payer: Priority Health Medicare |
$2,864.79
|
| Rate for Payer: Priority Health SBD |
$5,008.50
|
| Rate for Payer: Railroad Medicare Medicare |
$2,864.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,864.79
|
| Rate for Payer: UHC Exchange |
$174.53
|
| Rate for Payer: UHC Medicare Advantage |
$2,950.73
|
| Rate for Payer: VA VA |
$2,864.79
|
|
|
HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL BILAT
|
Facility
|
IP
|
$11,925.00
|
|
|
Service Code
|
CPT 30140
|
| Hospital Charge Code |
76100378
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7,512.75 |
| Max. Negotiated Rate |
$10,732.50 |
| Rate for Payer: Aetna Commercial |
$10,136.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,751.25
|
| Rate for Payer: Cash Price |
$9,540.00
|
| Rate for Payer: Cofinity Commercial |
$10,255.50
|
| Rate for Payer: Cofinity Commercial |
$8,347.50
|
| Rate for Payer: Healthscope Commercial |
$10,732.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,136.25
|
| Rate for Payer: PHP Commercial |
$10,136.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,347.50
|
| Rate for Payer: Priority Health SBD |
$7,512.75
|
|
|
HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL BILAT
|
Facility
|
OP
|
$11,925.00
|
|
|
Service Code
|
CPT 30140
|
| Hospital Charge Code |
76100378
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$174.53 |
| Max. Negotiated Rate |
$10,732.50 |
| Rate for Payer: Aetna Commercial |
$10,136.25
|
| Rate for Payer: Aetna Medicare |
$2,979.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,751.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,580.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,580.99
|
| Rate for Payer: BCBS Complete |
$1,645.54
|
| Rate for Payer: BCBS MAPPO |
$2,864.79
|
| Rate for Payer: BCBS Trust/PPO |
$952.38
|
| Rate for Payer: BCN Medicare Advantage |
$2,864.79
|
| Rate for Payer: Cash Price |
$9,540.00
|
| Rate for Payer: Cash Price |
$9,540.00
|
| Rate for Payer: Cofinity Commercial |
$8,347.50
|
| Rate for Payer: Cofinity Commercial |
$10,255.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,864.79
|
| Rate for Payer: Healthscope Commercial |
$10,732.50
|
| Rate for Payer: Mclaren Medicaid |
$1,567.04
|
| Rate for Payer: Mclaren Medicare |
$2,864.79
|
| Rate for Payer: Meridian Medicaid |
$1,645.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,008.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,294.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,136.25
|
| Rate for Payer: PACE Medicare |
$2,721.55
|
| Rate for Payer: PACE SWMI |
$2,864.79
|
| Rate for Payer: PHP Commercial |
$10,136.25
|
| Rate for Payer: PHP Medicare Advantage |
$2,864.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,567.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,347.50
|
| Rate for Payer: Priority Health Medicare |
$2,864.79
|
| Rate for Payer: Priority Health SBD |
$7,512.75
|
| Rate for Payer: Railroad Medicare Medicare |
$2,864.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,864.79
|
| Rate for Payer: UHC Exchange |
$174.53
|
| Rate for Payer: UHC Medicare Advantage |
$2,950.73
|
| Rate for Payer: VA VA |
$2,864.79
|
|
|
HC SUCTION A&A LINE
|
Facility
|
OP
|
$31.50
|
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$28.35 |
| Rate for Payer: Aetna Commercial |
$26.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.48
|
| Rate for Payer: BCBS Complete |
$12.60
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cofinity Commercial |
$22.05
|
| Rate for Payer: Cofinity Commercial |
$27.09
|
| Rate for Payer: Healthscope Commercial |
$28.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.78
|
| Rate for Payer: PHP Commercial |
$26.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.05
|
| Rate for Payer: Priority Health SBD |
$19.84
|
|
|
HC SUCTION A&A LINE
|
Facility
|
IP
|
$31.50
|
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.84 |
| Max. Negotiated Rate |
$28.35 |
| Rate for Payer: Aetna Commercial |
$26.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.48
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cofinity Commercial |
$22.05
|
| Rate for Payer: Cofinity Commercial |
$27.09
|
| Rate for Payer: Healthscope Commercial |
$28.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.78
|
| Rate for Payer: PHP Commercial |
$26.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.05
|
| Rate for Payer: Priority Health SBD |
$19.84
|
|
|
HC SUMP VENTRICULAR LIVANOVA
|
Facility
|
OP
|
$43.50
|
|
| Hospital Charge Code |
27000659
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$39.15 |
| Rate for Payer: Aetna Commercial |
$36.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.28
|
| Rate for Payer: BCBS Complete |
$17.40
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cofinity Commercial |
$30.45
|
| Rate for Payer: Cofinity Commercial |
$37.41
|
| Rate for Payer: Healthscope Commercial |
$39.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.98
|
| Rate for Payer: PHP Commercial |
$36.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.45
|
| Rate for Payer: Priority Health SBD |
$27.40
|
|
|
HC SUMP VENTRICULAR LIVANOVA
|
Facility
|
IP
|
$43.50
|
|
| Hospital Charge Code |
27000659
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.40 |
| Max. Negotiated Rate |
$39.15 |
| Rate for Payer: Aetna Commercial |
$36.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.28
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cofinity Commercial |
$30.45
|
| Rate for Payer: Cofinity Commercial |
$37.41
|
| Rate for Payer: Healthscope Commercial |
$39.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.98
|
| Rate for Payer: PHP Commercial |
$36.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.45
|
| Rate for Payer: Priority Health SBD |
$27.40
|
|
|
HC SUMP VENTRICULAR MEDTRONIC
|
Facility
|
OP
|
$42.00
|
|
| Hospital Charge Code |
27000122
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Aetna Commercial |
$35.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.30
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$29.40
|
| Rate for Payer: Cofinity Commercial |
$36.12
|
| Rate for Payer: Healthscope Commercial |
$37.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.70
|
| Rate for Payer: PHP Commercial |
$35.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.40
|
| Rate for Payer: Priority Health SBD |
$26.46
|
|
