|
HC TUBE CHANGE OF CYSTOSTOMY SIMPLE
|
Facility
|
IP
|
$394.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
36100253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$248.22 |
| Max. Negotiated Rate |
$354.60 |
| Rate for Payer: Aetna Commercial |
$334.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.10
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cofinity Commercial |
$338.84
|
| Rate for Payer: Cofinity Commercial |
$275.80
|
| Rate for Payer: Healthscope Commercial |
$354.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$334.90
|
| Rate for Payer: PHP Commercial |
$334.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.80
|
| Rate for Payer: Priority Health SBD |
$248.22
|
|
|
HC TUBE CHANGE OF CYSTOSTOMY SIMPLE
|
Facility
|
OP
|
$394.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
36100253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.43 |
| Max. Negotiated Rate |
$354.60 |
| Rate for Payer: Aetna Commercial |
$334.90
|
| Rate for Payer: Aetna Medicare |
$228.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$274.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$274.89
|
| Rate for Payer: BCBS Complete |
$126.32
|
| Rate for Payer: BCBS MAPPO |
$219.91
|
| Rate for Payer: BCBS Trust/PPO |
$134.32
|
| Rate for Payer: BCN Medicare Advantage |
$219.91
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cofinity Commercial |
$275.80
|
| Rate for Payer: Cofinity Commercial |
$338.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.91
|
| Rate for Payer: Healthscope Commercial |
$354.60
|
| Rate for Payer: Mclaren Medicaid |
$120.29
|
| Rate for Payer: Mclaren Medicare |
$219.91
|
| Rate for Payer: Meridian Medicaid |
$126.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$230.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$334.90
|
| Rate for Payer: PACE Medicare |
$208.91
|
| Rate for Payer: PACE SWMI |
$219.91
|
| Rate for Payer: PHP Commercial |
$334.90
|
| Rate for Payer: PHP Medicare Advantage |
$219.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.80
|
| Rate for Payer: Priority Health Medicare |
$219.91
|
| Rate for Payer: Priority Health SBD |
$248.22
|
| Rate for Payer: Railroad Medicare Medicare |
$219.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.91
|
| Rate for Payer: UHC Exchange |
$50.43
|
| Rate for Payer: UHC Medicare Advantage |
$226.51
|
| Rate for Payer: VA VA |
$219.91
|
|
|
HC TUBE CHANGE URETERO VIA ILEALO
|
Facility
|
OP
|
$2,033.83
|
|
|
Service Code
|
CPT 50688
|
| Hospital Charge Code |
36100248
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$75.64 |
| Max. Negotiated Rate |
$5,575.00 |
| Rate for Payer: Aetna Commercial |
$1,728.76
|
| Rate for Payer: Aetna Medicare |
$1,884.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,321.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,265.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,265.42
|
| Rate for Payer: BCBS Complete |
$1,041.01
|
| Rate for Payer: BCBS MAPPO |
$1,812.34
|
| Rate for Payer: BCBS Trust/PPO |
$757.23
|
| Rate for Payer: BCN Medicare Advantage |
$1,812.34
|
| Rate for Payer: Cash Price |
$1,627.06
|
| Rate for Payer: Cash Price |
$1,627.06
|
| Rate for Payer: Cofinity Commercial |
$1,749.09
|
| Rate for Payer: Cofinity Commercial |
$1,423.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,812.34
|
| Rate for Payer: Healthscope Commercial |
$1,830.45
|
| Rate for Payer: Mclaren Medicaid |
$991.35
|
| Rate for Payer: Mclaren Medicare |
$1,812.34
|
| Rate for Payer: Meridian Medicaid |
$1,041.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,902.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,084.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,728.76
|
| Rate for Payer: PACE Medicare |
$1,721.72
|
| Rate for Payer: PACE SWMI |
$1,812.34
|
| Rate for Payer: PHP Commercial |
$1,728.76
|
| Rate for Payer: PHP Medicare Advantage |
$1,812.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$991.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,423.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,575.00
|
| Rate for Payer: Priority Health Medicare |
$1,812.34
|
| Rate for Payer: Priority Health Narrow Network |
$4,460.00
|
| Rate for Payer: Priority Health SBD |
$1,281.31
|
| Rate for Payer: Railroad Medicare Medicare |
$1,812.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.20
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,812.34
|
| Rate for Payer: UHC Exchange |
$75.64
|
| Rate for Payer: UHC Medicare Advantage |
$1,866.71
|
| Rate for Payer: VA VA |
$1,812.34
|
|
|
HC TUBE CHANGE URETERO VIA ILEALO
|
Facility
|
IP
|
$2,033.83
|
|
|
Service Code
|
CPT 50688
|
| Hospital Charge Code |
36100248
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,281.31 |
| Max. Negotiated Rate |
$1,830.45 |
| Rate for Payer: Aetna Commercial |
$1,728.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,321.99
|
| Rate for Payer: Cash Price |
$1,627.06
|
| Rate for Payer: Cofinity Commercial |
$1,423.68
|
| Rate for Payer: Cofinity Commercial |
$1,749.09
|
| Rate for Payer: Healthscope Commercial |
$1,830.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,728.76
|
| Rate for Payer: PHP Commercial |
$1,728.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,423.68
|
| Rate for Payer: Priority Health SBD |
$1,281.31
|
|
|
HC TUBE CHECK WITH FLUORO
|
Facility
|
OP
|
$214.77
|
|
|
Service Code
|
CPT 49465
|
| Hospital Charge Code |
36100233
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$29.14 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$182.55
|
| Rate for Payer: Aetna Medicare |
$226.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.60
|
| 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 |
$243.82
|
| Rate for Payer: BCN Medicare Advantage |
$218.03
|
| Rate for Payer: Cash Price |
$171.82
|
| Rate for Payer: Cash Price |
$171.82
|
| Rate for Payer: Cofinity Commercial |
$150.34
|
| Rate for Payer: Cofinity Commercial |
$184.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.03
|
| Rate for Payer: Healthscope Commercial |
$193.29
|
| 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 |
$182.55
|
| Rate for Payer: PACE Medicare |
$207.13
|
| Rate for Payer: PACE SWMI |
$218.03
|
| Rate for Payer: PHP Commercial |
$182.55
|
| 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 |
$150.34
|
| Rate for Payer: Priority Health Medicare |
$218.03
|
| Rate for Payer: Priority Health SBD |
$135.31
|
| Rate for Payer: Railroad Medicare Medicare |
$218.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.05
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.03
|
| Rate for Payer: UHC Exchange |
$29.14
|
| Rate for Payer: UHC Medicare Advantage |
$224.57
|
| Rate for Payer: VA VA |
$218.03
|
|
|
HC TUBE CHECK WITH FLUORO
|
Facility
|
IP
|
$214.77
|
|
|
Service Code
|
CPT 49465
|
| Hospital Charge Code |
36100233
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$135.31 |
| Max. Negotiated Rate |
$193.29 |
| Rate for Payer: Aetna Commercial |
$182.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.60
|
| Rate for Payer: Cash Price |
$171.82
|
| Rate for Payer: Cofinity Commercial |
$150.34
|
| Rate for Payer: Cofinity Commercial |
$184.70
|
| Rate for Payer: Healthscope Commercial |
$193.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$182.55
|
| Rate for Payer: PHP Commercial |
$182.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.34
|
| Rate for Payer: Priority Health SBD |
$135.31
|
|
|
HC TUBE PLACEMENT NASOG OR OROG W FLUO
|
Facility
|
IP
|
$471.44
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
36100191
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$297.01 |
| Max. Negotiated Rate |
$424.30 |
| Rate for Payer: Aetna Commercial |
$400.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$306.44
|
| Rate for Payer: Cash Price |
$377.15
|
| Rate for Payer: Cofinity Commercial |
$330.01
|
| Rate for Payer: Cofinity Commercial |
$405.44
|
| Rate for Payer: Healthscope Commercial |
$424.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$400.72
|
| Rate for Payer: PHP Commercial |
$400.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.01
|
| Rate for Payer: Priority Health SBD |
$297.01
|
|
|
HC TUBE PLACEMENT NASOG OR OROG W FLUO
|
Facility
|
OP
|
$471.44
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
36100191
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$38.64 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$400.72
|
| Rate for Payer: Aetna Medicare |
$368.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$306.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.16
|
| Rate for Payer: BCBS Complete |
$203.64
|
| Rate for Payer: BCBS MAPPO |
$354.53
|
| Rate for Payer: BCBS Trust/PPO |
$236.02
|
| Rate for Payer: BCN Medicare Advantage |
$354.53
|
| Rate for Payer: Cash Price |
$377.15
|
| Rate for Payer: Cash Price |
$377.15
|
| Rate for Payer: Cofinity Commercial |
$405.44
|
| Rate for Payer: Cofinity Commercial |
$330.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.53
|
| Rate for Payer: Healthscope Commercial |
$424.30
|
| Rate for Payer: Mclaren Medicaid |
$193.93
|
| Rate for Payer: Mclaren Medicare |
$354.53
|
| Rate for Payer: Meridian Medicaid |
$203.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$400.72
|
| Rate for Payer: PACE Medicare |
$336.80
|
| Rate for Payer: PACE SWMI |
$354.53
|
| Rate for Payer: PHP Commercial |
$400.72
|
| Rate for Payer: PHP Medicare Advantage |
$354.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.01
|
| Rate for Payer: Priority Health Medicare |
$354.53
|
| Rate for Payer: Priority Health SBD |
$297.01
|
| Rate for Payer: Railroad Medicare Medicare |
$354.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.50
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.53
|
| Rate for Payer: UHC Exchange |
$38.64
|
| Rate for Payer: UHC Medicare Advantage |
$365.17
|
| Rate for Payer: VA VA |
$354.53
|
|
|
HC TUBE REPLACEMENT BY PHYSICIAN
|
Facility
|
OP
|
$303.31
|
|
| Hospital Charge Code |
45000055
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$121.32 |
| Max. Negotiated Rate |
$272.98 |
| Rate for Payer: Aetna Commercial |
$257.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.15
|
| Rate for Payer: BCBS Complete |
$121.32
|
| Rate for Payer: Cash Price |
$242.65
|
| Rate for Payer: Cofinity Commercial |
$212.32
|
| Rate for Payer: Cofinity Commercial |
$260.85
|
| Rate for Payer: Healthscope Commercial |
$272.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.81
|
| Rate for Payer: PHP Commercial |
$257.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.32
|
| Rate for Payer: Priority Health SBD |
$191.09
|
|
|
HC TUBE REPLACEMENT BY PHYSICIAN
|
Facility
|
IP
|
$303.31
|
|
| Hospital Charge Code |
45000055
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$191.09 |
| Max. Negotiated Rate |
$272.98 |
| Rate for Payer: Aetna Commercial |
$257.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.15
|
| Rate for Payer: Cash Price |
$242.65
|
| Rate for Payer: Cofinity Commercial |
$212.32
|
| Rate for Payer: Cofinity Commercial |
$260.85
|
| Rate for Payer: Healthscope Commercial |
$272.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.81
|
| Rate for Payer: PHP Commercial |
$257.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.32
|
| Rate for Payer: Priority Health SBD |
$191.09
|
|
|
HC TUBING 1/2
|
Facility
|
IP
|
$18.00
|
|
| Hospital Charge Code |
27000663
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.34 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Aetna Commercial |
$15.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.70
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$12.60
|
| Rate for Payer: Cofinity Commercial |
$15.48
|
| Rate for Payer: Healthscope Commercial |
$16.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.30
|
| Rate for Payer: PHP Commercial |
$15.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.60
|
| Rate for Payer: Priority Health SBD |
$11.34
|
|
|
HC TUBING 1/2
|
Facility
|
OP
|
$18.00
|
|
| Hospital Charge Code |
27000663
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Aetna Commercial |
$15.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.70
|
| Rate for Payer: BCBS Complete |
$7.20
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$12.60
|
| Rate for Payer: Cofinity Commercial |
$15.48
|
| Rate for Payer: Healthscope Commercial |
$16.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.30
|
| Rate for Payer: PHP Commercial |
$15.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.60
|
| Rate for Payer: Priority Health SBD |
$11.34
|
|
|
HC TUBING 1/4
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
27000162
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna Commercial |
$20.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.60
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$20.64
|
| Rate for Payer: Healthscope Commercial |
$21.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.40
|
| Rate for Payer: PHP Commercial |
$20.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.80
|
| Rate for Payer: Priority Health SBD |
$15.12
|
|
|
HC TUBING 1/4
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
27000162
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna Commercial |
$20.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.60
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$20.64
|
| Rate for Payer: Healthscope Commercial |
$21.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.40
|
| Rate for Payer: PHP Commercial |
$20.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.80
|
| Rate for Payer: Priority Health SBD |
$15.12
|
|
|
HC TUBING 3/8
|
Facility
|
OP
|
$28.50
|
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$25.65 |
| Rate for Payer: Aetna Commercial |
$24.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.52
|
| Rate for Payer: BCBS Complete |
$11.40
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cofinity Commercial |
$19.95
|
| Rate for Payer: Cofinity Commercial |
$24.51
|
| Rate for Payer: Healthscope Commercial |
$25.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.22
|
| Rate for Payer: PHP Commercial |
$24.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.95
|
| Rate for Payer: Priority Health SBD |
$17.96
|
|
|
HC TUBING 3/8
|
Facility
|
IP
|
$28.50
|
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$25.65 |
| Rate for Payer: Aetna Commercial |
$24.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.52
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cofinity Commercial |
$19.95
|
| Rate for Payer: Cofinity Commercial |
$24.51
|
| Rate for Payer: Healthscope Commercial |
$25.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.22
|
| Rate for Payer: PHP Commercial |
$24.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.95
|
| Rate for Payer: Priority Health SBD |
$17.96
|
|
|
HC TUMOR IMMUNOHISTOCHEMISTRY
|
Facility
|
OP
|
$198.39
|
|
|
Service Code
|
CPT 88360
|
| Hospital Charge Code |
31200001
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$44.17 |
| Max. Negotiated Rate |
$189.98 |
| Rate for Payer: Aetna Commercial |
$168.63
|
| Rate for Payer: Aetna Medicare |
$158.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.98
|
| Rate for Payer: BCBS Complete |
$87.30
|
| Rate for Payer: BCBS MAPPO |
$151.98
|
| Rate for Payer: BCBS Trust/PPO |
$95.57
|
| Rate for Payer: BCCCP Commercial |
$119.02
|
| Rate for Payer: BCN Medicare Advantage |
$151.98
|
| Rate for Payer: Cash Price |
$158.71
|
| Rate for Payer: Cash Price |
$158.71
|
| Rate for Payer: Cofinity Commercial |
$138.87
|
| Rate for Payer: Cofinity Commercial |
$170.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.98
|
| Rate for Payer: Healthscope Commercial |
$178.55
|
| Rate for Payer: Mclaren Medicaid |
$83.13
|
| Rate for Payer: Mclaren Medicare |
$151.98
|
| Rate for Payer: Meridian Medicaid |
$87.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$159.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$168.63
|
| Rate for Payer: PACE Medicare |
$144.38
|
| Rate for Payer: PACE SWMI |
$151.98
|
| Rate for Payer: PHP Commercial |
$168.63
|
| Rate for Payer: PHP Medicare Advantage |
$151.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.87
|
| Rate for Payer: Priority Health Medicare |
$151.98
|
| Rate for Payer: Priority Health SBD |
$124.99
|
| Rate for Payer: Railroad Medicare Medicare |
$151.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.03
|
| Rate for Payer: UHC Core |
$44.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.98
|
| Rate for Payer: UHC Exchange |
$118.21
|
| Rate for Payer: UHC Medicare Advantage |
$156.54
|
| Rate for Payer: VA VA |
$151.98
|
|
|
HC TUMOR IMMUNOHISTOCHEMISTRY
|
Facility
|
IP
|
$198.39
|
|
|
Service Code
|
CPT 88360
|
| Hospital Charge Code |
31200001
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$124.99 |
| Max. Negotiated Rate |
$178.55 |
| Rate for Payer: Aetna Commercial |
$168.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.95
|
| Rate for Payer: Cash Price |
$158.71
|
| Rate for Payer: Cofinity Commercial |
$138.87
|
| Rate for Payer: Cofinity Commercial |
$170.62
|
| Rate for Payer: Healthscope Commercial |
$178.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$168.63
|
| Rate for Payer: PHP Commercial |
$168.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.87
|
| Rate for Payer: Priority Health SBD |
$124.99
|
|
|
HC TUNA IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200067
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.09
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC TUNA IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200067
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
|
|
HC TVT DEVICE KIT
|
Facility
|
IP
|
$4,086.47
|
|
|
Service Code
|
HCPCS C2631
|
| Hospital Charge Code |
27200076
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,574.48 |
| Max. Negotiated Rate |
$3,677.82 |
| Rate for Payer: Aetna Commercial |
$3,473.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,656.21
|
| Rate for Payer: Cash Price |
$3,269.18
|
| Rate for Payer: Cofinity Commercial |
$2,860.53
|
| Rate for Payer: Cofinity Commercial |
$3,514.36
|
| Rate for Payer: Healthscope Commercial |
$3,677.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,473.50
|
| Rate for Payer: PHP Commercial |
$3,473.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,860.53
|
| Rate for Payer: Priority Health SBD |
$2,574.48
|
|
|
HC TVT DEVICE KIT
|
Facility
|
OP
|
$4,086.47
|
|
|
Service Code
|
HCPCS C2631
|
| Hospital Charge Code |
27200076
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,634.59 |
| Max. Negotiated Rate |
$3,677.82 |
| Rate for Payer: Aetna Commercial |
$3,473.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,656.21
|
| Rate for Payer: BCBS Complete |
$1,634.59
|
| Rate for Payer: Cash Price |
$3,269.18
|
| Rate for Payer: Cofinity Commercial |
$2,860.53
|
| Rate for Payer: Cofinity Commercial |
$3,514.36
|
| Rate for Payer: Healthscope Commercial |
$3,677.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,473.50
|
| Rate for Payer: PHP Commercial |
$3,473.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,860.53
|
| Rate for Payer: Priority Health SBD |
$2,574.48
|
|
|
HC TWIST DRILL HOLE IMPLT VENTRICULAR CATH/DEVICE
|
Facility
|
IP
|
$3,600.00
|
|
|
Service Code
|
CPT 61107
|
| Hospital Charge Code |
36100620
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,268.00 |
| Max. Negotiated Rate |
$3,240.00 |
| Rate for Payer: Aetna Commercial |
$3,060.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,340.00
|
| Rate for Payer: Cash Price |
$2,880.00
|
| Rate for Payer: Cofinity Commercial |
$3,096.00
|
| Rate for Payer: Cofinity Commercial |
$2,520.00
|
| Rate for Payer: Healthscope Commercial |
$3,240.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,060.00
|
| Rate for Payer: PHP Commercial |
$3,060.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,520.00
|
| Rate for Payer: Priority Health SBD |
$2,268.00
|
|
|
HC TWIST DRILL HOLE IMPLT VENTRICULAR CATH/DEVICE
|
Facility
|
OP
|
$3,600.00
|
|
|
Service Code
|
CPT 61107
|
| Hospital Charge Code |
36100620
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$308.12 |
| Max. Negotiated Rate |
$3,240.00 |
| Rate for Payer: Aetna Commercial |
$3,060.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,340.00
|
| Rate for Payer: BCBS Complete |
$1,440.00
|
| Rate for Payer: BCBS Trust/PPO |
$652.77
|
| Rate for Payer: Cash Price |
$2,880.00
|
| Rate for Payer: Cash Price |
$2,880.00
|
| Rate for Payer: Cofinity Commercial |
$3,096.00
|
| Rate for Payer: Cofinity Commercial |
$2,520.00
|
| Rate for Payer: Healthscope Commercial |
$3,240.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,060.00
|
| Rate for Payer: PHP Commercial |
$3,060.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,520.00
|
| Rate for Payer: Priority Health SBD |
$2,268.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$338.93
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Exchange |
$308.12
|
|
|
HC TX INCOMPLETE AB ANY TRI SURG
|
Facility
|
IP
|
$7,789.74
|
|
|
Service Code
|
CPT 59812
|
| Hospital Charge Code |
76100342
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,907.54 |
| Max. Negotiated Rate |
$7,010.77 |
| Rate for Payer: Aetna Commercial |
$6,621.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,063.33
|
| Rate for Payer: Cash Price |
$6,231.79
|
| Rate for Payer: Cofinity Commercial |
$5,452.82
|
| Rate for Payer: Cofinity Commercial |
$6,699.18
|
| Rate for Payer: Healthscope Commercial |
$7,010.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,621.28
|
| Rate for Payer: PHP Commercial |
$6,621.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,452.82
|
| Rate for Payer: Priority Health SBD |
$4,907.54
|
|
