|
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
|
|
|
HC TRANS CATH MITRAL VALVE IMPLNT/REPLACE
|
Facility
|
IP
|
$42,373.86
|
|
|
Service Code
|
CPT 0483T
|
| Hospital Charge Code |
48100121
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$26,695.53 |
| Max. Negotiated Rate |
$38,136.47 |
| Rate for Payer: Aetna Commercial |
$36,017.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27,543.01
|
| Rate for Payer: Cash Price |
$33,899.09
|
| Rate for Payer: Cofinity Commercial |
$29,661.70
|
| Rate for Payer: Cofinity Commercial |
$36,441.52
|
| Rate for Payer: Healthscope Commercial |
$38,136.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36,017.78
|
| Rate for Payer: PHP Commercial |
$36,017.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29,661.70
|
| Rate for Payer: Priority Health SBD |
$26,695.53
|
|
|
HC TRANS CATH MITRAL VALVE IMPLNT/REPLACE
|
Facility
|
OP
|
$42,373.86
|
|
|
Service Code
|
CPT 0483T
|
| Hospital Charge Code |
48100121
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,138.00 |
| Max. Negotiated Rate |
$38,136.47 |
| Rate for Payer: Aetna Commercial |
$36,017.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27,543.01
|
| Rate for Payer: BCBS Complete |
$16,949.54
|
| Rate for Payer: Cash Price |
$33,899.09
|
| Rate for Payer: Cash Price |
$33,899.09
|
| Rate for Payer: Cofinity Commercial |
$29,661.70
|
| Rate for Payer: Cofinity Commercial |
$36,441.52
|
| Rate for Payer: Healthscope Commercial |
$38,136.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36,017.78
|
| Rate for Payer: PHP Commercial |
$36,017.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29,661.70
|
| Rate for Payer: Priority Health SBD |
$26,695.53
|
| Rate for Payer: UHC Core |
$3,138.00
|
|
|
HC TRANSCATH REMOVAL PERM LEADLESS PACEMAKER
|
Facility
|
OP
|
$3,814.80
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
48100116
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$487.23 |
| Max. Negotiated Rate |
$8,913.25 |
| Rate for Payer: Aetna Commercial |
$3,242.58
|
| Rate for Payer: Aetna Medicare |
$2,949.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,479.62
|
| 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 |
$1,259.52
|
| Rate for Payer: BCN Medicare Advantage |
$2,836.20
|
| Rate for Payer: Cash Price |
$3,051.84
|
| Rate for Payer: Cash Price |
$3,051.84
|
| Rate for Payer: Cofinity Commercial |
$3,280.73
|
| Rate for Payer: Cofinity Commercial |
$2,670.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,836.20
|
| Rate for Payer: Healthscope Commercial |
$3,433.32
|
| 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 |
$3,242.58
|
| Rate for Payer: PACE Medicare |
$2,694.39
|
| Rate for Payer: PACE SWMI |
$2,836.20
|
| Rate for Payer: PHP Commercial |
$3,242.58
|
| 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 |
$2,670.36
|
| 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 |
$2,403.32
|
| Rate for Payer: Railroad Medicare Medicare |
$2,836.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$535.95
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,836.20
|
| Rate for Payer: UHC Exchange |
$487.23
|
| Rate for Payer: UHC Medicare Advantage |
$2,921.29
|
| Rate for Payer: VA VA |
$2,836.20
|
|
|
HC TRANSCATH REMOVAL PERM LEADLESS PACEMAKER
|
Facility
|
IP
|
$3,814.80
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
48100116
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,403.32 |
| Max. Negotiated Rate |
$3,433.32 |
| Rate for Payer: Aetna Commercial |
$3,242.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,479.62
|
| Rate for Payer: Cash Price |
$3,051.84
|
| Rate for Payer: Cofinity Commercial |
$2,670.36
|
| Rate for Payer: Cofinity Commercial |
$3,280.73
|
| Rate for Payer: Healthscope Commercial |
$3,433.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,242.58
|
| Rate for Payer: PHP Commercial |
$3,242.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,670.36
|
| Rate for Payer: Priority Health SBD |
$2,403.32
|
|
|
HC TRANSCERVICAL AMNIOINFUSION
|
Facility
|
IP
|
$552.31
|
|
| Hospital Charge Code |
27000647
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$347.96 |
| Max. Negotiated Rate |
$497.08 |
| Rate for Payer: Aetna Commercial |
$469.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$359.00
|
| Rate for Payer: Cash Price |
$441.85
|
| Rate for Payer: Cofinity Commercial |
$386.62
|
| Rate for Payer: Cofinity Commercial |
$474.99
|
| Rate for Payer: Healthscope Commercial |
$497.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$469.46
|
| Rate for Payer: PHP Commercial |
$469.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$386.62
|
| Rate for Payer: Priority Health SBD |
$347.96
|
|
|
HC TRANSCERVICAL AMNIOINFUSION
|
Facility
|
OP
|
$552.31
|
|
| Hospital Charge Code |
27000647
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$220.92 |
| Max. Negotiated Rate |
$497.08 |
| Rate for Payer: Aetna Commercial |
$469.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$359.00
|
| Rate for Payer: BCBS Complete |
$220.92
|
| Rate for Payer: Cash Price |
$441.85
|
| Rate for Payer: Cofinity Commercial |
$386.62
|
| Rate for Payer: Cofinity Commercial |
$474.99
|
| Rate for Payer: Healthscope Commercial |
$497.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$469.46
|
| Rate for Payer: PHP Commercial |
$469.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$386.62
|
| Rate for Payer: Priority Health SBD |
$347.96
|
|
|
HC TRANSCRANIAL USN IMAGING COMPL
|
Facility
|
OP
|
$1,586.54
|
|
|
Service Code
|
CPT 93886
|
| Hospital Charge Code |
92100002
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$119.26 |
| Max. Negotiated Rate |
$1,427.89 |
| Rate for Payer: Aetna Commercial |
$1,348.56
|
| Rate for Payer: Aetna Medicare |
$226.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,031.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.54
|
| Rate for Payer: BCBS Complete |
$125.24
|
| Rate for Payer: BCBS MAPPO |
$218.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,036.17
|
| Rate for Payer: BCN Medicare Advantage |
$218.03
|
| Rate for Payer: Cash Price |
$1,269.23
|
| Rate for Payer: Cash Price |
$1,269.23
|
| Rate for Payer: Cofinity Commercial |
$1,364.42
|
| Rate for Payer: Cofinity Commercial |
$1,110.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.03
|
| Rate for Payer: Healthscope Commercial |
$1,427.89
|
| Rate for Payer: Mclaren Medicaid |
$119.26
|
| Rate for Payer: Mclaren Medicare |
$218.03
|
| Rate for Payer: Meridian Medicaid |
$125.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,348.56
|
| Rate for Payer: PACE Medicare |
$207.13
|
| Rate for Payer: PACE SWMI |
$218.03
|
| Rate for Payer: PHP Commercial |
$1,348.56
|
| Rate for Payer: PHP Medicare Advantage |
$218.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,110.58
|
| Rate for Payer: Priority Health Medicare |
$218.03
|
| Rate for Payer: Priority Health SBD |
$999.52
|
| Rate for Payer: Railroad Medicare Medicare |
$218.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.03
|
| Rate for Payer: UHC Exchange |
$269.48
|
| Rate for Payer: UHC Medicare Advantage |
$224.57
|
| Rate for Payer: VA VA |
$218.03
|
|
|
HC TRANSCRANIAL USN IMAGING COMPL
|
Facility
|
IP
|
$1,586.54
|
|
|
Service Code
|
CPT 93886
|
| Hospital Charge Code |
92100002
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$999.52 |
| Max. Negotiated Rate |
$1,427.89 |
| Rate for Payer: Aetna Commercial |
$1,348.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,031.25
|
| Rate for Payer: Cash Price |
$1,269.23
|
| Rate for Payer: Cofinity Commercial |
$1,364.42
|
| Rate for Payer: Cofinity Commercial |
$1,110.58
|
| Rate for Payer: Healthscope Commercial |
$1,427.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,348.56
|
| Rate for Payer: PHP Commercial |
$1,348.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,110.58
|
| Rate for Payer: Priority Health SBD |
$999.52
|
|
|
HC TRANSCRANIAL USN IMAGING LIMIT
|
Facility
|
OP
|
$599.45
|
|
|
Service Code
|
CPT 93888
|
| Hospital Charge Code |
92100003
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$618.62 |
| Rate for Payer: Aetna Commercial |
$509.53
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$389.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$618.62
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$479.56
|
| Rate for Payer: Cash Price |
$479.56
|
| Rate for Payer: Cofinity Commercial |
$515.53
|
| Rate for Payer: Cofinity Commercial |
$419.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$539.50
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$509.53
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$509.53
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.62
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health SBD |
$377.65
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$156.84
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC TRANSCRANIAL USN IMAGING LIMIT
|
Facility
|
IP
|
$599.45
|
|
|
Service Code
|
CPT 93888
|
| Hospital Charge Code |
92100003
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$377.65 |
| Max. Negotiated Rate |
$539.50 |
| Rate for Payer: Aetna Commercial |
$509.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$389.64
|
| Rate for Payer: Cash Price |
$479.56
|
| Rate for Payer: Cofinity Commercial |
$515.53
|
| Rate for Payer: Cofinity Commercial |
$419.62
|
| Rate for Payer: Healthscope Commercial |
$539.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$509.53
|
| Rate for Payer: PHP Commercial |
$509.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.62
|
| Rate for Payer: Priority Health SBD |
$377.65
|
|
|
HC TRANSCRAN LE MOTOR STIM
|
Facility
|
OP
|
$429.05
|
|
|
Service Code
|
CPT 95929
|
| Hospital Charge Code |
92200017
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$239.03 |
| Max. Negotiated Rate |
$744.53 |
| Rate for Payer: Aetna Commercial |
$364.69
|
| Rate for Payer: Aetna Medicare |
$495.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$596.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$596.14
|
| Rate for Payer: BCBS Complete |
$273.94
|
| Rate for Payer: BCBS MAPPO |
$476.91
|
| Rate for Payer: BCBS Trust/PPO |
$744.53
|
| Rate for Payer: BCN Medicare Advantage |
$476.91
|
| Rate for Payer: Cash Price |
$343.24
|
| Rate for Payer: Cash Price |
$343.24
|
| Rate for Payer: Cofinity Commercial |
$368.98
|
| Rate for Payer: Cofinity Commercial |
$300.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.91
|
| Rate for Payer: Healthscope Commercial |
$386.14
|
| Rate for Payer: Mclaren Medicaid |
$260.87
|
| Rate for Payer: Mclaren Medicare |
$476.91
|
| Rate for Payer: Meridian Medicaid |
$273.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$500.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$548.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.69
|
| Rate for Payer: PACE Medicare |
$453.06
|
| Rate for Payer: PACE SWMI |
$476.91
|
| Rate for Payer: PHP Commercial |
$364.69
|
| Rate for Payer: PHP Medicare Advantage |
$476.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.34
|
| Rate for Payer: Priority Health Medicare |
$476.91
|
| Rate for Payer: Priority Health SBD |
$270.30
|
| Rate for Payer: Railroad Medicare Medicare |
$476.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$476.91
|
| Rate for Payer: UHC Exchange |
$239.03
|
| Rate for Payer: UHC Medicare Advantage |
$491.22
|
| Rate for Payer: VA VA |
$476.91
|
|
|
HC TRANSCRAN LE MOTOR STIM
|
Facility
|
IP
|
$429.05
|
|
|
Service Code
|
CPT 95929
|
| Hospital Charge Code |
92200017
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$270.30 |
| Max. Negotiated Rate |
$386.14 |
| Rate for Payer: Aetna Commercial |
$364.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.88
|
| Rate for Payer: Cash Price |
$343.24
|
| Rate for Payer: Cofinity Commercial |
$300.34
|
| Rate for Payer: Cofinity Commercial |
$368.98
|
| Rate for Payer: Healthscope Commercial |
$386.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.69
|
| Rate for Payer: PHP Commercial |
$364.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.34
|
| Rate for Payer: Priority Health SBD |
$270.30
|
|
|
HC TRANSCRAN UE MOTOR STIM
|
Facility
|
IP
|
$613.96
|
|
|
Service Code
|
CPT 95928
|
| Hospital Charge Code |
92200016
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$386.79 |
| Max. Negotiated Rate |
$552.56 |
| Rate for Payer: Aetna Commercial |
$521.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$399.07
|
| Rate for Payer: Cash Price |
$491.17
|
| Rate for Payer: Cofinity Commercial |
$429.77
|
| Rate for Payer: Cofinity Commercial |
$528.01
|
| Rate for Payer: Healthscope Commercial |
$552.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$521.87
|
| Rate for Payer: PHP Commercial |
$521.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$429.77
|
| Rate for Payer: Priority Health SBD |
$386.79
|
|
|
HC TRANSCRAN UE MOTOR STIM
|
Facility
|
OP
|
$613.96
|
|
|
Service Code
|
CPT 95928
|
| Hospital Charge Code |
92200016
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$236.41 |
| Max. Negotiated Rate |
$1,162.89 |
| Rate for Payer: Aetna Commercial |
$521.87
|
| Rate for Payer: Aetna Medicare |
$967.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$399.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,162.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,162.89
|
| Rate for Payer: BCBS Complete |
$534.37
|
| Rate for Payer: BCBS MAPPO |
$930.31
|
| Rate for Payer: BCBS Trust/PPO |
$726.11
|
| Rate for Payer: BCN Medicare Advantage |
$930.31
|
| Rate for Payer: Cash Price |
$491.17
|
| Rate for Payer: Cash Price |
$491.17
|
| Rate for Payer: Cofinity Commercial |
$528.01
|
| Rate for Payer: Cofinity Commercial |
$429.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$930.31
|
| Rate for Payer: Healthscope Commercial |
$552.56
|
| Rate for Payer: Mclaren Medicaid |
$508.88
|
| Rate for Payer: Mclaren Medicare |
$930.31
|
| Rate for Payer: Meridian Medicaid |
$534.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$976.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,069.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$521.87
|
| Rate for Payer: PACE Medicare |
$883.79
|
| Rate for Payer: PACE SWMI |
$930.31
|
| Rate for Payer: PHP Commercial |
$521.87
|
| Rate for Payer: PHP Medicare Advantage |
$930.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$429.77
|
| Rate for Payer: Priority Health Medicare |
$930.31
|
| Rate for Payer: Priority Health SBD |
$386.79
|
| Rate for Payer: Railroad Medicare Medicare |
$930.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$930.31
|
| Rate for Payer: UHC Exchange |
$236.41
|
| Rate for Payer: UHC Medicare Advantage |
$958.22
|
| Rate for Payer: VA VA |
$930.31
|
|
|
HC TRANSFERRIN
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
30100443
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$13.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.95
|
| Rate for Payer: BCBS Complete |
$7.33
|
| Rate for Payer: BCBS MAPPO |
$12.76
|
| Rate for Payer: BCBS Trust/PPO |
$9.99
|
| Rate for Payer: BCN Medicare Advantage |
$12.76
|
| 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 |
$12.76
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$6.98
|
| Rate for Payer: Mclaren Medicare |
$12.76
|
| Rate for Payer: Meridian Medicaid |
$7.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Medicare |
$12.12
|
| Rate for Payer: PACE SWMI |
$12.76
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$12.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health Medicare |
$12.76
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: Railroad Medicare Medicare |
$12.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.31
|
| Rate for Payer: UHC Core |
$21.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.76
|
| Rate for Payer: UHC Exchange |
$12.76
|
| Rate for Payer: UHC Medicare Advantage |
$13.14
|
| Rate for Payer: VA VA |
$12.76
|
|
|
HC TRANSFERRIN
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
30100443
|
|
Hospital Revenue Code
|
301
|
| 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 TRANSFUSION
|
Facility
|
OP
|
$1,173.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
39100000
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$41.59 |
| Max. Negotiated Rate |
$1,222.66 |
| Rate for Payer: Aetna Commercial |
$997.05
|
| Rate for Payer: Aetna Medicare |
$401.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$762.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$482.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$482.82
|
| Rate for Payer: BCBS Complete |
$221.87
|
| Rate for Payer: BCBS MAPPO |
$386.26
|
| Rate for Payer: BCBS Trust/PPO |
$176.52
|
| Rate for Payer: BCN Medicare Advantage |
$386.26
|
| Rate for Payer: Cash Price |
$938.40
|
| Rate for Payer: Cash Price |
$938.40
|
| Rate for Payer: Cofinity Commercial |
$821.10
|
| Rate for Payer: Cofinity Commercial |
$1,008.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$386.26
|
| Rate for Payer: Healthscope Commercial |
$1,055.70
|
| Rate for Payer: Mclaren Medicaid |
$211.28
|
| Rate for Payer: Mclaren Medicare |
$386.26
|
| Rate for Payer: Meridian Medicaid |
$221.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$405.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$444.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$997.05
|
| Rate for Payer: PACE Medicare |
$366.95
|
| Rate for Payer: PACE SWMI |
$386.26
|
| Rate for Payer: PHP Commercial |
$997.05
|
| Rate for Payer: PHP Medicare Advantage |
$386.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$821.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,222.66
|
| Rate for Payer: Priority Health Medicare |
$386.26
|
| Rate for Payer: Priority Health Narrow Network |
$978.13
|
| Rate for Payer: Priority Health SBD |
$738.99
|
| Rate for Payer: Railroad Medicare Medicare |
$386.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$386.26
|
| Rate for Payer: UHC Exchange |
$41.59
|
| Rate for Payer: UHC Medicare Advantage |
$397.85
|
| Rate for Payer: VA VA |
$386.26
|
|
|
HC TRANSFUSION
|
Facility
|
IP
|
$1,173.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
39100000
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$738.99 |
| Max. Negotiated Rate |
$1,055.70 |
| Rate for Payer: Aetna Commercial |
$997.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$762.45
|
| Rate for Payer: Cash Price |
$938.40
|
| Rate for Payer: Cofinity Commercial |
$1,008.78
|
| Rate for Payer: Cofinity Commercial |
$821.10
|
| Rate for Payer: Healthscope Commercial |
$1,055.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$997.05
|
| Rate for Payer: PHP Commercial |
$997.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$821.10
|
| Rate for Payer: Priority Health SBD |
$738.99
|
|
|
HC TRANSFUSION INTRAUTERINE FETAL
|
Facility
|
OP
|
$619.65
|
|
|
Service Code
|
CPT 36460
|
| Hospital Charge Code |
36100115
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$211.28 |
| Max. Negotiated Rate |
$1,222.66 |
| Rate for Payer: Aetna Commercial |
$526.70
|
| Rate for Payer: Aetna Medicare |
$401.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$402.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$482.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$482.82
|
| Rate for Payer: BCBS Complete |
$221.87
|
| Rate for Payer: BCBS MAPPO |
$386.26
|
| Rate for Payer: BCBS Trust/PPO |
$391.46
|
| Rate for Payer: BCN Medicare Advantage |
$386.26
|
| Rate for Payer: Cash Price |
$495.72
|
| Rate for Payer: Cash Price |
$495.72
|
| Rate for Payer: Cofinity Commercial |
$433.76
|
| Rate for Payer: Cofinity Commercial |
$532.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$386.26
|
| Rate for Payer: Healthscope Commercial |
$557.68
|
| Rate for Payer: Mclaren Medicaid |
$211.28
|
| Rate for Payer: Mclaren Medicare |
$386.26
|
| Rate for Payer: Meridian Medicaid |
$221.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$405.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$444.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$526.70
|
| Rate for Payer: PACE Medicare |
$366.95
|
| Rate for Payer: PACE SWMI |
$386.26
|
| Rate for Payer: PHP Commercial |
$526.70
|
| Rate for Payer: PHP Medicare Advantage |
$386.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$433.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,222.66
|
| Rate for Payer: Priority Health Medicare |
$386.26
|
| Rate for Payer: Priority Health Narrow Network |
$978.13
|
| Rate for Payer: Priority Health SBD |
$390.38
|
| Rate for Payer: Railroad Medicare Medicare |
$386.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$368.83
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$386.26
|
| Rate for Payer: UHC Exchange |
$335.30
|
| Rate for Payer: UHC Medicare Advantage |
$397.85
|
| Rate for Payer: VA VA |
$386.26
|
|
|
HC TRANSFUSION INTRAUTERINE FETAL
|
Facility
|
IP
|
$619.65
|
|
|
Service Code
|
CPT 36460
|
| Hospital Charge Code |
36100115
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$390.38 |
| Max. Negotiated Rate |
$557.68 |
| Rate for Payer: Aetna Commercial |
$526.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$402.77
|
| Rate for Payer: Cash Price |
$495.72
|
| Rate for Payer: Cofinity Commercial |
$433.76
|
| Rate for Payer: Cofinity Commercial |
$532.90
|
| Rate for Payer: Healthscope Commercial |
$557.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$526.70
|
| Rate for Payer: PHP Commercial |
$526.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$433.76
|
| Rate for Payer: Priority Health SBD |
$390.38
|
|
|
HC TRANSHEPATIC PORTOGRAPHY
|
Facility
|
OP
|
$3,106.01
|
|
|
Service Code
|
CPT 75887
|
| Hospital Charge Code |
32000321
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$121.36 |
| Max. Negotiated Rate |
$8,913.25 |
| Rate for Payer: Aetna Commercial |
$2,640.11
|
| Rate for Payer: Aetna Medicare |
$2,949.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,018.91
|
| 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 |
$121.36
|
| Rate for Payer: BCN Medicare Advantage |
$2,836.20
|
| Rate for Payer: Cash Price |
$2,484.81
|
| Rate for Payer: Cash Price |
$2,484.81
|
| Rate for Payer: Cofinity Commercial |
$2,671.17
|
| Rate for Payer: Cofinity Commercial |
$2,174.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,836.20
|
| Rate for Payer: Healthscope Commercial |
$2,795.41
|
| 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 |
$2,640.11
|
| Rate for Payer: PACE Medicare |
$2,694.39
|
| Rate for Payer: PACE SWMI |
$2,836.20
|
| Rate for Payer: PHP Commercial |
$2,640.11
|
| 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 |
$2,174.21
|
| 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 |
$1,956.79
|
| Rate for Payer: Railroad Medicare Medicare |
$2,836.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,836.20
|
| Rate for Payer: UHC Exchange |
$134.91
|
| Rate for Payer: UHC Medicare Advantage |
$2,921.29
|
| Rate for Payer: VA VA |
$2,836.20
|
|
|
HC TRANSHEPATIC PORTOGRAPHY
|
Facility
|
IP
|
$3,106.01
|
|
|
Service Code
|
CPT 75887
|
| Hospital Charge Code |
32000321
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,956.79 |
| Max. Negotiated Rate |
$2,795.41 |
| Rate for Payer: Aetna Commercial |
$2,640.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,018.91
|
| Rate for Payer: Cash Price |
$2,484.81
|
| Rate for Payer: Cofinity Commercial |
$2,671.17
|
| Rate for Payer: Cofinity Commercial |
$2,174.21
|
| Rate for Payer: Healthscope Commercial |
$2,795.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,640.11
|
| Rate for Payer: PHP Commercial |
$2,640.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,174.21
|
| Rate for Payer: Priority Health SBD |
$1,956.79
|
|
|
HC TRANSPERINEAL PLMT BIODEGRADABLE MATRL
|
Facility
|
OP
|
$6,130.20
|
|
|
Service Code
|
CPT 55874
|
| Hospital Charge Code |
36100574
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.46 |
| Max. Negotiated Rate |
$5,755.12 |
| Rate for Payer: Aetna Commercial |
$5,210.67
|
| Rate for Payer: Aetna Medicare |
$4,788.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,984.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,755.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,755.12
|
| Rate for Payer: BCBS Complete |
$2,644.60
|
| Rate for Payer: BCBS MAPPO |
$4,604.10
|
| Rate for Payer: BCBS Trust/PPO |
$4,808.08
|
| Rate for Payer: BCN Medicare Advantage |
$4,604.10
|
| Rate for Payer: Cash Price |
$4,904.16
|
| Rate for Payer: Cash Price |
$4,904.16
|
| Rate for Payer: Cofinity Commercial |
$5,271.97
|
| Rate for Payer: Cofinity Commercial |
$4,291.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,604.10
|
| Rate for Payer: Healthscope Commercial |
$5,517.18
|
| Rate for Payer: Mclaren Medicaid |
$2,518.44
|
| Rate for Payer: Mclaren Medicare |
$4,604.10
|
| Rate for Payer: Meridian Medicaid |
$2,644.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,834.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,294.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,210.67
|
| Rate for Payer: PACE Medicare |
$4,373.90
|
| Rate for Payer: PACE SWMI |
$4,604.10
|
| Rate for Payer: PHP Commercial |
$5,210.67
|
| Rate for Payer: PHP Medicare Advantage |
$4,604.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,518.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,291.14
|
| Rate for Payer: Priority Health Medicare |
$4,604.10
|
| Rate for Payer: Priority Health SBD |
$3,862.03
|
| Rate for Payer: Railroad Medicare Medicare |
$4,604.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,604.10
|
| Rate for Payer: UHC Exchange |
$159.46
|
| Rate for Payer: UHC Medicare Advantage |
$4,742.22
|
| Rate for Payer: VA VA |
$4,604.10
|
|
|
HC TRANSPERINEAL PLMT BIODEGRADABLE MATRL
|
Facility
|
IP
|
$6,130.20
|
|
|
Service Code
|
CPT 55874
|
| Hospital Charge Code |
36100574
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,862.03 |
| Max. Negotiated Rate |
$5,517.18 |
| Rate for Payer: Aetna Commercial |
$5,210.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,984.63
|
| Rate for Payer: Cash Price |
$4,904.16
|
| Rate for Payer: Cofinity Commercial |
$4,291.14
|
| Rate for Payer: Cofinity Commercial |
$5,271.97
|
| Rate for Payer: Healthscope Commercial |
$5,517.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,210.67
|
| Rate for Payer: PHP Commercial |
$5,210.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,291.14
|
| Rate for Payer: Priority Health SBD |
$3,862.03
|
|
