|
HC TOXICOLOGY SCREEN SALIVA
|
Facility
|
OP
|
$163.20
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100665
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$146.88 |
| Rate for Payer: Aetna Commercial |
$138.72
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: BCBS Complete |
$35.69
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$48.67
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| 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: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$146.88
|
| Rate for Payer: Mclaren Medicaid |
$33.99
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Medicaid |
$35.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.72
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$138.72
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.24
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$102.82
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.57
|
| Rate for Payer: UHC Core |
$95.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Exchange |
$62.14
|
| Rate for Payer: UHC Medicare Advantage |
$64.00
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC TOXICOLOGY SCREEN SALIVA
|
Facility
|
IP
|
$163.20
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100665
|
|
Hospital Revenue Code
|
301
|
| 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 |
$140.35
|
| Rate for Payer: Cofinity Commercial |
$114.24
|
| Rate for Payer: Healthscope Commercial |
$146.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.72
|
| Rate for Payer: PHP Commercial |
$138.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.24
|
| Rate for Payer: Priority Health SBD |
$102.82
|
|
|
HC TOXOPLASMA AB IGG
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
30200321
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$101.70 |
| Rate for Payer: Aetna Commercial |
$96.05
|
| Rate for Payer: Aetna Medicare |
$14.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.99
|
| Rate for Payer: BCBS Complete |
$8.27
|
| Rate for Payer: BCBS MAPPO |
$14.39
|
| Rate for Payer: BCBS Trust/PPO |
$11.27
|
| Rate for Payer: BCN Medicare Advantage |
$14.39
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$79.10
|
| Rate for Payer: Cofinity Commercial |
$97.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.39
|
| Rate for Payer: Healthscope Commercial |
$101.70
|
| Rate for Payer: Mclaren Medicaid |
$7.87
|
| Rate for Payer: Mclaren Medicare |
$14.39
|
| Rate for Payer: Meridian Medicaid |
$8.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.05
|
| Rate for Payer: PACE Medicare |
$13.67
|
| Rate for Payer: PACE SWMI |
$14.39
|
| Rate for Payer: PHP Commercial |
$96.05
|
| Rate for Payer: PHP Medicare Advantage |
$14.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
| Rate for Payer: Priority Health Medicare |
$14.39
|
| Rate for Payer: Priority Health SBD |
$71.19
|
| Rate for Payer: Railroad Medicare Medicare |
$14.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.27
|
| Rate for Payer: UHC Core |
$24.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.39
|
| Rate for Payer: UHC Exchange |
$14.39
|
| Rate for Payer: UHC Medicare Advantage |
$14.82
|
| Rate for Payer: VA VA |
$14.39
|
|
|
HC TOXOPLASMA AB IGG
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
30200321
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$71.19 |
| Max. Negotiated Rate |
$101.70 |
| Rate for Payer: Aetna Commercial |
$96.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.45
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$79.10
|
| Rate for Payer: Cofinity Commercial |
$97.18
|
| Rate for Payer: Healthscope Commercial |
$101.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.05
|
| Rate for Payer: PHP Commercial |
$96.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
| Rate for Payer: Priority Health SBD |
$71.19
|
|
|
HC TOXOPLASMA AB IGM
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
30200323
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna Medicare |
$14.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.01
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: BCBS MAPPO |
$14.41
|
| Rate for Payer: BCBS Trust/PPO |
$11.29
|
| Rate for Payer: BCN Medicare Advantage |
$14.41
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.41
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Mclaren Medicaid |
$7.88
|
| Rate for Payer: Mclaren Medicare |
$14.41
|
| Rate for Payer: Meridian Medicaid |
$8.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PACE Medicare |
$13.69
|
| Rate for Payer: PACE SWMI |
$14.41
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: PHP Medicare Advantage |
$14.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health Medicare |
$14.41
|
| Rate for Payer: Priority Health SBD |
$25.70
|
| Rate for Payer: Railroad Medicare Medicare |
$14.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.29
|
| Rate for Payer: UHC Core |
$24.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.41
|
| Rate for Payer: UHC Exchange |
$14.41
|
| Rate for Payer: UHC Medicare Advantage |
$14.84
|
| Rate for Payer: VA VA |
$14.41
|
|
|
HC TOXOPLASMA AB IGM
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
30200323
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.70 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health SBD |
$25.70
|
|
|
HC TPMT AND NUDT15 GENOTYPE
|
Facility
|
IP
|
$519.09
|
|
|
Service Code
|
CPT 0034U
|
| Hospital Charge Code |
31000138
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$327.03 |
| Max. Negotiated Rate |
$467.18 |
| Rate for Payer: Aetna Commercial |
$441.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$337.41
|
| Rate for Payer: Cash Price |
$415.27
|
| Rate for Payer: Cofinity Commercial |
$363.36
|
| Rate for Payer: Cofinity Commercial |
$446.42
|
| Rate for Payer: Healthscope Commercial |
$467.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$441.23
|
| Rate for Payer: PHP Commercial |
$441.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$363.36
|
| Rate for Payer: Priority Health SBD |
$327.03
|
|
|
HC TPMT AND NUDT15 GENOTYPE
|
Facility
|
OP
|
$519.09
|
|
|
Service Code
|
CPT 0034U
|
| Hospital Charge Code |
31000138
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$254.99 |
| Max. Negotiated Rate |
$582.71 |
| Rate for Payer: Aetna Commercial |
$441.23
|
| Rate for Payer: Aetna Medicare |
$484.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$337.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$582.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$582.71
|
| Rate for Payer: BCBS Complete |
$267.77
|
| Rate for Payer: BCBS MAPPO |
$466.17
|
| Rate for Payer: BCBS Trust/PPO |
$365.05
|
| Rate for Payer: BCN Medicare Advantage |
$466.17
|
| Rate for Payer: Cash Price |
$415.27
|
| Rate for Payer: Cash Price |
$415.27
|
| Rate for Payer: Cofinity Commercial |
$363.36
|
| Rate for Payer: Cofinity Commercial |
$446.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$466.17
|
| Rate for Payer: Healthscope Commercial |
$467.18
|
| Rate for Payer: Mclaren Medicaid |
$254.99
|
| Rate for Payer: Mclaren Medicare |
$466.17
|
| Rate for Payer: Meridian Medicaid |
$267.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$489.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$536.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$441.23
|
| Rate for Payer: PACE Medicare |
$442.86
|
| Rate for Payer: PACE SWMI |
$466.17
|
| Rate for Payer: PHP Commercial |
$441.23
|
| Rate for Payer: PHP Medicare Advantage |
$466.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$254.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$363.36
|
| Rate for Payer: Priority Health Medicare |
$466.17
|
| Rate for Payer: Priority Health SBD |
$327.03
|
| Rate for Payer: Railroad Medicare Medicare |
$466.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$559.40
|
| Rate for Payer: UHC Core |
$559.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$466.17
|
| Rate for Payer: UHC Exchange |
$466.17
|
| Rate for Payer: UHC Medicare Advantage |
$480.16
|
| Rate for Payer: VA VA |
$466.17
|
|
|
HC TRACH BUTTON SUPPLY
|
Facility
|
IP
|
$293.45
|
|
| Hospital Charge Code |
27000159
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$184.87 |
| Max. Negotiated Rate |
$264.10 |
| Rate for Payer: Aetna Commercial |
$249.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.74
|
| Rate for Payer: Cash Price |
$234.76
|
| Rate for Payer: Cofinity Commercial |
$205.42
|
| Rate for Payer: Cofinity Commercial |
$252.37
|
| Rate for Payer: Healthscope Commercial |
$264.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$249.43
|
| Rate for Payer: PHP Commercial |
$249.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.42
|
| Rate for Payer: Priority Health SBD |
$184.87
|
|
|
HC TRACH BUTTON SUPPLY
|
Facility
|
OP
|
$293.45
|
|
| Hospital Charge Code |
27000159
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$117.38 |
| Max. Negotiated Rate |
$264.10 |
| Rate for Payer: Aetna Commercial |
$249.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.74
|
| Rate for Payer: BCBS Complete |
$117.38
|
| Rate for Payer: Cash Price |
$234.76
|
| Rate for Payer: Cofinity Commercial |
$205.42
|
| Rate for Payer: Cofinity Commercial |
$252.37
|
| Rate for Payer: Healthscope Commercial |
$264.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$249.43
|
| Rate for Payer: PHP Commercial |
$249.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.42
|
| Rate for Payer: Priority Health SBD |
$184.87
|
|
|
HC TRACHEOBRNCHSC THRU EST TRACHS INC
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
CPT 31615
|
| Hospital Charge Code |
76100389
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$819.00 |
| Max. Negotiated Rate |
$1,170.00 |
| Rate for Payer: Aetna Commercial |
$1,105.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$845.00
|
| Rate for Payer: Cash Price |
$1,040.00
|
| Rate for Payer: Cofinity Commercial |
$1,118.00
|
| Rate for Payer: Cofinity Commercial |
$910.00
|
| Rate for Payer: Healthscope Commercial |
$1,170.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,105.00
|
| Rate for Payer: PHP Commercial |
$1,105.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$910.00
|
| Rate for Payer: Priority Health SBD |
$819.00
|
|
|
HC TRACHEOBRNCHSC THRU EST TRACHS INC
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
CPT 31615
|
| Hospital Charge Code |
76100389
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.29 |
| Max. Negotiated Rate |
$1,408.21 |
| Rate for Payer: Aetna Commercial |
$1,105.00
|
| Rate for Payer: Aetna Medicare |
$509.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$845.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$611.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$611.96
|
| Rate for Payer: BCBS Complete |
$281.21
|
| Rate for Payer: BCBS MAPPO |
$489.57
|
| Rate for Payer: BCBS Trust/PPO |
$393.95
|
| Rate for Payer: BCN Medicare Advantage |
$489.57
|
| Rate for Payer: Cash Price |
$1,040.00
|
| Rate for Payer: Cash Price |
$1,040.00
|
| Rate for Payer: Cofinity Commercial |
$1,118.00
|
| Rate for Payer: Cofinity Commercial |
$910.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$489.57
|
| Rate for Payer: Healthscope Commercial |
$1,170.00
|
| Rate for Payer: Mclaren Medicaid |
$267.79
|
| Rate for Payer: Mclaren Medicare |
$489.57
|
| Rate for Payer: Meridian Medicaid |
$281.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$514.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$563.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,105.00
|
| Rate for Payer: PACE Medicare |
$465.09
|
| Rate for Payer: PACE SWMI |
$489.57
|
| Rate for Payer: PHP Commercial |
$1,105.00
|
| Rate for Payer: PHP Medicare Advantage |
$489.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$910.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,408.21
|
| Rate for Payer: Priority Health Medicare |
$489.57
|
| Rate for Payer: Priority Health Narrow Network |
$1,126.56
|
| Rate for Payer: Priority Health SBD |
$819.00
|
| Rate for Payer: Railroad Medicare Medicare |
$489.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$489.57
|
| Rate for Payer: UHC Exchange |
$113.29
|
| Rate for Payer: UHC Medicare Advantage |
$504.26
|
| Rate for Payer: VA VA |
$489.57
|
|
|
HC TRACHEOSTOMA REVJ SMPL W/O FLAP ROTATION
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
CPT 31613
|
| Hospital Charge Code |
76100404
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$419.13 |
| Max. Negotiated Rate |
$8,517.99 |
| Rate for Payer: Aetna Commercial |
$6,723.50
|
| Rate for Payer: Aetna Medicare |
$2,979.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,141.50
|
| 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 |
$6,328.00
|
| Rate for Payer: Cash Price |
$6,328.00
|
| Rate for Payer: Cofinity Commercial |
$5,537.00
|
| Rate for Payer: Cofinity Commercial |
$6,802.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,864.79
|
| Rate for Payer: Healthscope Commercial |
$7,119.00
|
| 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 |
$6,723.50
|
| Rate for Payer: PACE Medicare |
$2,721.55
|
| Rate for Payer: PACE SWMI |
$2,864.79
|
| Rate for Payer: PHP Commercial |
$6,723.50
|
| 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 |
$5,537.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,517.99
|
| Rate for Payer: Priority Health Medicare |
$2,864.79
|
| Rate for Payer: Priority Health Narrow Network |
$6,814.39
|
| Rate for Payer: Priority Health SBD |
$4,983.30
|
| Rate for Payer: Railroad Medicare Medicare |
$2,864.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$461.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,864.79
|
| Rate for Payer: UHC Exchange |
$419.13
|
| Rate for Payer: UHC Medicare Advantage |
$2,950.73
|
| Rate for Payer: VA VA |
$2,864.79
|
|
|
HC TRACHEOSTOMA REVJ SMPL W/O FLAP ROTATION
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
CPT 31613
|
| Hospital Charge Code |
76100404
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,983.30 |
| Max. Negotiated Rate |
$7,119.00 |
| Rate for Payer: Aetna Commercial |
$6,723.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,141.50
|
| Rate for Payer: Cash Price |
$6,328.00
|
| Rate for Payer: Cofinity Commercial |
$5,537.00
|
| Rate for Payer: Cofinity Commercial |
$6,802.60
|
| Rate for Payer: Healthscope Commercial |
$7,119.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,723.50
|
| Rate for Payer: PHP Commercial |
$6,723.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,537.00
|
| Rate for Payer: Priority Health SBD |
$4,983.30
|
|
|
HC TRACH TUBE INSERTION
|
Facility
|
OP
|
$497.59
|
|
| Hospital Charge Code |
27000160
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$199.04 |
| Max. Negotiated Rate |
$447.83 |
| Rate for Payer: Aetna Commercial |
$422.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.43
|
| Rate for Payer: BCBS Complete |
$199.04
|
| Rate for Payer: Cash Price |
$398.07
|
| Rate for Payer: Cofinity Commercial |
$348.31
|
| Rate for Payer: Cofinity Commercial |
$427.93
|
| Rate for Payer: Healthscope Commercial |
$447.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$422.95
|
| Rate for Payer: PHP Commercial |
$422.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.31
|
| Rate for Payer: Priority Health SBD |
$313.48
|
|
|
HC TRACH TUBE INSERTION
|
Facility
|
IP
|
$497.59
|
|
| Hospital Charge Code |
27000160
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$313.48 |
| Max. Negotiated Rate |
$447.83 |
| Rate for Payer: Aetna Commercial |
$422.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.43
|
| Rate for Payer: Cash Price |
$398.07
|
| Rate for Payer: Cofinity Commercial |
$348.31
|
| Rate for Payer: Cofinity Commercial |
$427.93
|
| Rate for Payer: Healthscope Commercial |
$447.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$422.95
|
| Rate for Payer: PHP Commercial |
$422.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.31
|
| Rate for Payer: Priority Health SBD |
$313.48
|
|
|
HC TRACH TUBE REPLACEMENT
|
Facility
|
IP
|
$174.08
|
|
|
Service Code
|
CPT 31502
|
| Hospital Charge Code |
45000072
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$109.67 |
| Max. Negotiated Rate |
$156.67 |
| Rate for Payer: Aetna Commercial |
$147.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.15
|
| Rate for Payer: Cash Price |
$139.26
|
| Rate for Payer: Cofinity Commercial |
$121.86
|
| Rate for Payer: Cofinity Commercial |
$149.71
|
| Rate for Payer: Healthscope Commercial |
$156.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.97
|
| Rate for Payer: PHP Commercial |
$147.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.86
|
| Rate for Payer: Priority Health SBD |
$109.67
|
|
|
HC TRACH TUBE REPLACEMENT
|
Facility
|
OP
|
$174.08
|
|
|
Service Code
|
CPT 31502
|
| Hospital Charge Code |
45000072
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$34.05 |
| Max. Negotiated Rate |
$623.17 |
| Rate for Payer: Aetna Commercial |
$147.97
|
| Rate for Payer: Aetna Medicare |
$226.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$271.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$271.68
|
| Rate for Payer: BCBS Complete |
$124.84
|
| Rate for Payer: BCBS MAPPO |
$217.34
|
| Rate for Payer: BCBS Trust/PPO |
$83.07
|
| Rate for Payer: BCN Medicare Advantage |
$217.34
|
| Rate for Payer: Cash Price |
$139.26
|
| Rate for Payer: Cash Price |
$139.26
|
| Rate for Payer: Cofinity Commercial |
$121.86
|
| Rate for Payer: Cofinity Commercial |
$149.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.34
|
| Rate for Payer: Healthscope Commercial |
$156.67
|
| Rate for Payer: Mclaren Medicaid |
$118.88
|
| Rate for Payer: Mclaren Medicare |
$217.34
|
| Rate for Payer: Meridian Medicaid |
$124.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$249.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.97
|
| Rate for Payer: PACE Medicare |
$206.47
|
| Rate for Payer: PACE SWMI |
$217.34
|
| Rate for Payer: PHP Commercial |
$147.97
|
| Rate for Payer: PHP Medicare Advantage |
$217.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$118.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$623.17
|
| Rate for Payer: Priority Health Medicare |
$217.34
|
| Rate for Payer: Priority Health Narrow Network |
$498.54
|
| Rate for Payer: Priority Health SBD |
$109.67
|
| Rate for Payer: Railroad Medicare Medicare |
$217.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$217.34
|
| Rate for Payer: UHC Exchange |
$34.05
|
| Rate for Payer: UHC Medicare Advantage |
$223.86
|
| Rate for Payer: VA VA |
$217.34
|
|
|
HC TRACTION MECHANICAL
|
Facility
|
IP
|
$117.30
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
42000009
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$73.90 |
| Max. Negotiated Rate |
$105.57 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.24
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$100.88
|
| Rate for Payer: Cofinity Commercial |
$82.11
|
| Rate for Payer: Healthscope Commercial |
$105.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.70
|
| Rate for Payer: PHP Commercial |
$99.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.11
|
| Rate for Payer: Priority Health SBD |
$73.90
|
|
|
HC TRACTION MECHANICAL
|
Facility
|
OP
|
$117.30
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
42000009
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$105.57 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.24
|
| Rate for Payer: BCBS Complete |
$46.92
|
| Rate for Payer: BCBS Trust/PPO |
$9.60
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$82.11
|
| Rate for Payer: Cofinity Commercial |
$100.88
|
| Rate for Payer: Healthscope Commercial |
$105.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.70
|
| Rate for Payer: PHP Commercial |
$99.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.11
|
| Rate for Payer: Priority Health SBD |
$73.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.12
|
| Rate for Payer: UHC Exchange |
$13.75
|
|
|
HC TRANS CARE MGMT 14 DAYS
|
Facility
|
OP
|
$117.30
|
|
|
Service Code
|
CPT 99495
|
| Hospital Charge Code |
51000086
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.34 |
| Max. Negotiated Rate |
$369.96 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: Aetna Medicare |
$122.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$147.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$147.02
|
| Rate for Payer: BCBS Complete |
$67.56
|
| Rate for Payer: BCBS MAPPO |
$117.62
|
| Rate for Payer: BCN Medicare Advantage |
$117.62
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$100.88
|
| Rate for Payer: Cofinity Commercial |
$82.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.62
|
| Rate for Payer: Healthscope Commercial |
$105.57
|
| Rate for Payer: Mclaren Medicaid |
$64.34
|
| Rate for Payer: Mclaren Medicare |
$117.62
|
| Rate for Payer: Meridian Medicaid |
$67.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$123.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.70
|
| Rate for Payer: PACE Medicare |
$111.74
|
| Rate for Payer: PACE SWMI |
$117.62
|
| Rate for Payer: PHP Commercial |
$99.70
|
| Rate for Payer: PHP Medicare Advantage |
$117.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$369.96
|
| Rate for Payer: Priority Health Medicare |
$117.62
|
| Rate for Payer: Priority Health Narrow Network |
$295.97
|
| Rate for Payer: Priority Health SBD |
$73.90
|
| Rate for Payer: Railroad Medicare Medicare |
$117.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$117.62
|
| Rate for Payer: UHC Exchange |
$136.22
|
| Rate for Payer: UHC Medicare Advantage |
$121.15
|
| Rate for Payer: VA VA |
$117.62
|
|
|
HC TRANS CARE MGMT 14 DAYS
|
Facility
|
IP
|
$117.30
|
|
|
Service Code
|
CPT 99495
|
| Hospital Charge Code |
51000086
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.90 |
| Max. Negotiated Rate |
$105.57 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.24
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$100.88
|
| Rate for Payer: Cofinity Commercial |
$82.11
|
| Rate for Payer: Healthscope Commercial |
$105.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.70
|
| Rate for Payer: PHP Commercial |
$99.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.11
|
| Rate for Payer: Priority Health SBD |
$73.90
|
|
|
HC TRANS CARE MGMT 7 DAYS
|
Facility
|
IP
|
$117.30
|
|
|
Service Code
|
CPT 99496
|
| Hospital Charge Code |
51000087
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.90 |
| Max. Negotiated Rate |
$105.57 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.24
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$100.88
|
| Rate for Payer: Cofinity Commercial |
$82.11
|
| Rate for Payer: Healthscope Commercial |
$105.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.70
|
| Rate for Payer: PHP Commercial |
$99.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.11
|
| Rate for Payer: Priority Health SBD |
$73.90
|
|
|
HC TRANS CARE MGMT 7 DAYS
|
Facility
|
OP
|
$117.30
|
|
|
Service Code
|
CPT 99496
|
| Hospital Charge Code |
51000087
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.34 |
| Max. Negotiated Rate |
$369.96 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: Aetna Medicare |
$122.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$147.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$147.02
|
| Rate for Payer: BCBS Complete |
$67.56
|
| Rate for Payer: BCBS MAPPO |
$117.62
|
| Rate for Payer: BCN Medicare Advantage |
$117.62
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$100.88
|
| Rate for Payer: Cofinity Commercial |
$82.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.62
|
| Rate for Payer: Healthscope Commercial |
$105.57
|
| Rate for Payer: Mclaren Medicaid |
$64.34
|
| Rate for Payer: Mclaren Medicare |
$117.62
|
| Rate for Payer: Meridian Medicaid |
$67.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$123.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.70
|
| Rate for Payer: PACE Medicare |
$111.74
|
| Rate for Payer: PACE SWMI |
$117.62
|
| Rate for Payer: PHP Commercial |
$99.70
|
| Rate for Payer: PHP Medicare Advantage |
$117.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$369.96
|
| Rate for Payer: Priority Health Medicare |
$117.62
|
| Rate for Payer: Priority Health Narrow Network |
$295.97
|
| Rate for Payer: Priority Health SBD |
$73.90
|
| Rate for Payer: Railroad Medicare Medicare |
$117.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$117.62
|
| Rate for Payer: UHC Exchange |
$185.00
|
| Rate for Payer: UHC Medicare Advantage |
$121.15
|
| Rate for Payer: VA VA |
$117.62
|
|
|
HC TRANSCATH INSERT/REPLACE PERM LEADLESS PACEMAKER
|
Facility
|
OP
|
$24,480.00
|
|
|
Service Code
|
CPT 33274
|
| Hospital Charge Code |
48100115
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$461.04 |
| Max. Negotiated Rate |
$51,507.72 |
| Rate for Payer: Aetna Commercial |
$20,808.00
|
| Rate for Payer: Aetna Medicare |
$18,031.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,912.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,672.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,672.26
|
| Rate for Payer: BCBS Complete |
$9,958.84
|
| Rate for Payer: BCBS MAPPO |
$17,337.81
|
| Rate for Payer: BCBS Trust/PPO |
$10,239.60
|
| Rate for Payer: BCN Medicare Advantage |
$17,337.81
|
| Rate for Payer: Cash Price |
$19,584.00
|
| Rate for Payer: Cash Price |
$19,584.00
|
| Rate for Payer: Cofinity Commercial |
$21,052.80
|
| Rate for Payer: Cofinity Commercial |
$17,136.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,337.81
|
| Rate for Payer: Healthscope Commercial |
$22,032.00
|
| Rate for Payer: Mclaren Medicaid |
$9,483.78
|
| Rate for Payer: Mclaren Medicare |
$17,337.81
|
| Rate for Payer: Meridian Medicaid |
$9,958.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,204.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,938.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20,808.00
|
| Rate for Payer: PACE Medicare |
$16,470.92
|
| Rate for Payer: PACE SWMI |
$17,337.81
|
| Rate for Payer: PHP Commercial |
$20,808.00
|
| Rate for Payer: PHP Medicare Advantage |
$17,337.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,483.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,136.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51,507.72
|
| Rate for Payer: Priority Health Medicare |
$17,337.81
|
| Rate for Payer: Priority Health Narrow Network |
$41,206.18
|
| Rate for Payer: Priority Health SBD |
$15,422.40
|
| Rate for Payer: Railroad Medicare Medicare |
$17,337.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$507.14
|
| Rate for Payer: UHC Core |
$11,194.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,337.81
|
| Rate for Payer: UHC Exchange |
$461.04
|
| Rate for Payer: UHC Medicare Advantage |
$17,857.94
|
| Rate for Payer: VA VA |
$17,337.81
|
|
