|
HC ULTRATAG RBC PER STUDY
|
Facility
|
OP
|
$210.24
|
|
|
Service Code
|
HCPCS A9560
|
| Hospital Charge Code |
34300023
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$84.10 |
| Max. Negotiated Rate |
$189.22 |
| Rate for Payer: Aetna Commercial |
$178.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.66
|
| Rate for Payer: BCBS Complete |
$84.10
|
| Rate for Payer: BCBS Trust/PPO |
$117.02
|
| Rate for Payer: Cash Price |
$168.19
|
| Rate for Payer: Cash Price |
$168.19
|
| Rate for Payer: Cofinity Commercial |
$147.17
|
| Rate for Payer: Cofinity Commercial |
$180.81
|
| Rate for Payer: Healthscope Commercial |
$189.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$178.70
|
| Rate for Payer: PHP Commercial |
$178.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.17
|
| Rate for Payer: Priority Health SBD |
$132.45
|
|
|
HC ULTRATAG RBC PER STUDY
|
Facility
|
IP
|
$210.24
|
|
|
Service Code
|
HCPCS A9560
|
| Hospital Charge Code |
34300023
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$132.45 |
| Max. Negotiated Rate |
$189.22 |
| Rate for Payer: Aetna Commercial |
$178.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.66
|
| Rate for Payer: Cash Price |
$168.19
|
| Rate for Payer: Cofinity Commercial |
$147.17
|
| Rate for Payer: Cofinity Commercial |
$180.81
|
| Rate for Payer: Healthscope Commercial |
$189.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$178.70
|
| Rate for Payer: PHP Commercial |
$178.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.17
|
| Rate for Payer: Priority Health SBD |
$132.45
|
|
|
HC UMBILICAL ARTERY CATHETER
|
Facility
|
IP
|
$209.45
|
|
|
Service Code
|
CPT 36660
|
| Hospital Charge Code |
36100602
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$131.95 |
| Max. Negotiated Rate |
$188.50 |
| Rate for Payer: Aetna Commercial |
$178.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.14
|
| Rate for Payer: Cash Price |
$167.56
|
| Rate for Payer: Cofinity Commercial |
$146.62
|
| Rate for Payer: Cofinity Commercial |
$180.13
|
| Rate for Payer: Healthscope Commercial |
$188.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$178.03
|
| Rate for Payer: PHP Commercial |
$178.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.62
|
| Rate for Payer: Priority Health SBD |
$131.95
|
|
|
HC UMBILICAL ARTERY CATHETER
|
Facility
|
OP
|
$209.45
|
|
|
Service Code
|
CPT 36660
|
| Hospital Charge Code |
36100602
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$65.82 |
| Max. Negotiated Rate |
$3,138.00 |
| Rate for Payer: Aetna Commercial |
$178.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.14
|
| Rate for Payer: BCBS Complete |
$83.78
|
| Rate for Payer: BCBS Trust/PPO |
$149.99
|
| Rate for Payer: Cash Price |
$167.56
|
| Rate for Payer: Cash Price |
$167.56
|
| Rate for Payer: Cofinity Commercial |
$180.13
|
| Rate for Payer: Cofinity Commercial |
$146.62
|
| Rate for Payer: Healthscope Commercial |
$188.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$178.03
|
| Rate for Payer: PHP Commercial |
$178.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.62
|
| Rate for Payer: Priority Health SBD |
$131.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.40
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Exchange |
$65.82
|
|
|
HC UMBILICAL VEIN CATHETER
|
Facility
|
IP
|
$209.45
|
|
|
Service Code
|
CPT 36510
|
| Hospital Charge Code |
36100584
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$131.95 |
| Max. Negotiated Rate |
$188.50 |
| Rate for Payer: Aetna Commercial |
$178.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.14
|
| Rate for Payer: Cash Price |
$167.56
|
| Rate for Payer: Cofinity Commercial |
$146.62
|
| Rate for Payer: Cofinity Commercial |
$180.13
|
| Rate for Payer: Healthscope Commercial |
$188.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$178.03
|
| Rate for Payer: PHP Commercial |
$178.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.62
|
| Rate for Payer: Priority Health SBD |
$131.95
|
|
|
HC UMBILICAL VEIN CATHETER
|
Facility
|
OP
|
$209.45
|
|
|
Service Code
|
CPT 36510
|
| Hospital Charge Code |
36100584
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$51.41 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$178.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.14
|
| Rate for Payer: BCBS Complete |
$83.78
|
| Rate for Payer: BCBS Trust/PPO |
$173.93
|
| Rate for Payer: Cash Price |
$167.56
|
| Rate for Payer: Cash Price |
$167.56
|
| Rate for Payer: Cofinity Commercial |
$180.13
|
| Rate for Payer: Cofinity Commercial |
$146.62
|
| Rate for Payer: Healthscope Commercial |
$188.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$178.03
|
| Rate for Payer: PHP Commercial |
$178.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.62
|
| Rate for Payer: Priority Health SBD |
$131.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.55
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$51.41
|
|
|
HC UNILATERAL SCREENING MAMM WITH CAD
|
Facility
|
OP
|
$323.87
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
40300007
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$125.74 |
| Max. Negotiated Rate |
$291.48 |
| Rate for Payer: Aetna Commercial |
$275.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.52
|
| Rate for Payer: BCBS Complete |
$129.55
|
| Rate for Payer: BCBS Trust/PPO |
$152.79
|
| Rate for Payer: BCCCP Commercial |
$130.78
|
| Rate for Payer: Cash Price |
$259.10
|
| Rate for Payer: Cash Price |
$259.10
|
| Rate for Payer: Cofinity Commercial |
$278.53
|
| Rate for Payer: Cofinity Commercial |
$226.71
|
| Rate for Payer: Healthscope Commercial |
$291.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$275.29
|
| Rate for Payer: PHP Commercial |
$275.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.71
|
| Rate for Payer: Priority Health SBD |
$204.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.31
|
| Rate for Payer: UHC Exchange |
$125.74
|
|
|
HC UNILATERAL SCREENING MAMM WITH CAD
|
Facility
|
IP
|
$323.87
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
40300007
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$204.04 |
| Max. Negotiated Rate |
$291.48 |
| Rate for Payer: Aetna Commercial |
$275.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.52
|
| Rate for Payer: Cash Price |
$259.10
|
| Rate for Payer: Cofinity Commercial |
$226.71
|
| Rate for Payer: Cofinity Commercial |
$278.53
|
| Rate for Payer: Healthscope Commercial |
$291.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$275.29
|
| Rate for Payer: PHP Commercial |
$275.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.71
|
| Rate for Payer: Priority Health SBD |
$204.04
|
|
|
HC UNILATERAL TOMOSYNTHESIS
|
Facility
|
OP
|
$101.19
|
|
|
Service Code
|
CPT 77061
|
| Hospital Charge Code |
32000299
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.48 |
| Max. Negotiated Rate |
$91.07 |
| Rate for Payer: Aetna Commercial |
$86.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.77
|
| Rate for Payer: BCBS Complete |
$40.48
|
| Rate for Payer: BCBS Trust/PPO |
$43.29
|
| Rate for Payer: Cash Price |
$80.95
|
| Rate for Payer: Cash Price |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$87.02
|
| Rate for Payer: Cofinity Commercial |
$70.83
|
| Rate for Payer: Healthscope Commercial |
$91.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.01
|
| Rate for Payer: PHP Commercial |
$86.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.83
|
| Rate for Payer: Priority Health SBD |
$63.75
|
|
|
HC UNILATERAL TOMOSYNTHESIS
|
Facility
|
IP
|
$101.19
|
|
|
Service Code
|
CPT 77061
|
| Hospital Charge Code |
32000299
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$91.07 |
| Rate for Payer: Aetna Commercial |
$86.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.77
|
| Rate for Payer: Cash Price |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$70.83
|
| Rate for Payer: Cofinity Commercial |
$87.02
|
| Rate for Payer: Healthscope Commercial |
$91.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.01
|
| Rate for Payer: PHP Commercial |
$86.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.83
|
| Rate for Payer: Priority Health SBD |
$63.75
|
|
|
HC UNILAT PERC IMPLANT NEUROSTIM ELTRD, SACRAL NERVE W/IMAG
|
Facility
|
OP
|
$9,466.31
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
76100247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$296.66 |
| Max. Negotiated Rate |
$8,519.68 |
| Rate for Payer: Aetna Commercial |
$8,046.36
|
| Rate for Payer: Aetna Medicare |
$6,328.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,153.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,606.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,606.78
|
| Rate for Payer: BCBS Complete |
$3,495.47
|
| Rate for Payer: BCBS MAPPO |
$6,085.42
|
| Rate for Payer: BCBS Trust/PPO |
$4,505.13
|
| Rate for Payer: BCN Medicare Advantage |
$6,085.42
|
| Rate for Payer: Cash Price |
$7,573.05
|
| Rate for Payer: Cash Price |
$7,573.05
|
| Rate for Payer: Cofinity Commercial |
$8,141.03
|
| Rate for Payer: Cofinity Commercial |
$6,626.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,085.42
|
| Rate for Payer: Healthscope Commercial |
$8,519.68
|
| Rate for Payer: Mclaren Medicaid |
$3,328.72
|
| Rate for Payer: Mclaren Medicare |
$6,085.42
|
| Rate for Payer: Meridian Medicaid |
$3,495.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,389.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,998.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,046.36
|
| Rate for Payer: PACE Medicare |
$5,781.15
|
| Rate for Payer: PACE SWMI |
$6,085.42
|
| Rate for Payer: PHP Commercial |
$8,046.36
|
| Rate for Payer: PHP Medicare Advantage |
$6,085.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,328.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,626.42
|
| Rate for Payer: Priority Health Medicare |
$6,085.42
|
| Rate for Payer: Priority Health SBD |
$5,963.78
|
| Rate for Payer: Railroad Medicare Medicare |
$6,085.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,085.42
|
| Rate for Payer: UHC Exchange |
$296.66
|
| Rate for Payer: UHC Medicare Advantage |
$6,267.98
|
| Rate for Payer: VA VA |
$6,085.42
|
|
|
HC UNILAT PERC IMPLANT NEUROSTIM ELTRD, SACRAL NERVE W/IMAG
|
Facility
|
IP
|
$9,466.31
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
76100247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,963.78 |
| Max. Negotiated Rate |
$8,519.68 |
| Rate for Payer: Aetna Commercial |
$8,046.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,153.10
|
| Rate for Payer: Cash Price |
$7,573.05
|
| Rate for Payer: Cofinity Commercial |
$6,626.42
|
| Rate for Payer: Cofinity Commercial |
$8,141.03
|
| Rate for Payer: Healthscope Commercial |
$8,519.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,046.36
|
| Rate for Payer: PHP Commercial |
$8,046.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,626.42
|
| Rate for Payer: Priority Health SBD |
$5,963.78
|
|
|
HC UNLISTED FEMALE GENITAL SYSTEM
|
Facility
|
OP
|
$1,103.27
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
36100387
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$79.23 |
| Max. Negotiated Rate |
$992.94 |
| Rate for Payer: Aetna Commercial |
$937.78
|
| Rate for Payer: Aetna Medicare |
$184.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$717.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$221.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$221.64
|
| Rate for Payer: BCBS Complete |
$101.85
|
| Rate for Payer: BCBS MAPPO |
$177.31
|
| Rate for Payer: BCBS Trust/PPO |
$79.23
|
| Rate for Payer: BCN Medicare Advantage |
$177.31
|
| Rate for Payer: Cash Price |
$882.62
|
| Rate for Payer: Cash Price |
$882.62
|
| Rate for Payer: Cofinity Commercial |
$948.81
|
| Rate for Payer: Cofinity Commercial |
$772.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.31
|
| Rate for Payer: Healthscope Commercial |
$992.94
|
| Rate for Payer: Mclaren Medicaid |
$96.99
|
| Rate for Payer: Mclaren Medicare |
$177.31
|
| Rate for Payer: Meridian Medicaid |
$101.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$203.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$937.78
|
| Rate for Payer: PACE Medicare |
$168.44
|
| Rate for Payer: PACE SWMI |
$177.31
|
| Rate for Payer: PHP Commercial |
$937.78
|
| Rate for Payer: PHP Medicare Advantage |
$177.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$772.29
|
| Rate for Payer: Priority Health Medicare |
$177.31
|
| Rate for Payer: Priority Health SBD |
$695.06
|
| Rate for Payer: Railroad Medicare Medicare |
$177.31
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.31
|
| Rate for Payer: UHC Medicare Advantage |
$182.63
|
| Rate for Payer: VA VA |
$177.31
|
|
|
HC UNLISTED FEMALE GENITAL SYSTEM
|
Facility
|
IP
|
$1,103.27
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
36100387
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$695.06 |
| Max. Negotiated Rate |
$992.94 |
| Rate for Payer: Aetna Commercial |
$937.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$717.13
|
| Rate for Payer: Cash Price |
$882.62
|
| Rate for Payer: Cofinity Commercial |
$772.29
|
| Rate for Payer: Cofinity Commercial |
$948.81
|
| Rate for Payer: Healthscope Commercial |
$992.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$937.78
|
| Rate for Payer: PHP Commercial |
$937.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$772.29
|
| Rate for Payer: Priority Health SBD |
$695.06
|
|
|
HC UNLISTED PROCEDURE NERVOUS SYSTEM 64999
|
Facility
|
OP
|
$712.41
|
|
|
Service Code
|
CPT 64999
|
| Hospital Charge Code |
36100437
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$120.24 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$605.55
|
| Rate for Payer: Aetna Medicare |
$274.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$463.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.42
|
| Rate for Payer: BCBS Complete |
$151.38
|
| Rate for Payer: BCBS MAPPO |
$263.54
|
| Rate for Payer: BCBS Trust/PPO |
$120.24
|
| Rate for Payer: BCN Medicare Advantage |
$263.54
|
| Rate for Payer: Cash Price |
$569.93
|
| Rate for Payer: Cash Price |
$569.93
|
| Rate for Payer: Cofinity Commercial |
$612.67
|
| Rate for Payer: Cofinity Commercial |
$498.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.54
|
| Rate for Payer: Healthscope Commercial |
$641.17
|
| Rate for Payer: Mclaren Medicaid |
$144.16
|
| Rate for Payer: Mclaren Medicare |
$263.54
|
| Rate for Payer: Meridian Medicaid |
$151.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$303.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$605.55
|
| Rate for Payer: PACE Medicare |
$250.36
|
| Rate for Payer: PACE SWMI |
$263.54
|
| Rate for Payer: PHP Commercial |
$605.55
|
| Rate for Payer: PHP Medicare Advantage |
$263.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$498.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$815.29
|
| Rate for Payer: Priority Health Medicare |
$263.54
|
| Rate for Payer: Priority Health Narrow Network |
$652.23
|
| Rate for Payer: Priority Health SBD |
$448.82
|
| Rate for Payer: Railroad Medicare Medicare |
$263.54
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.54
|
| Rate for Payer: UHC Medicare Advantage |
$271.45
|
| Rate for Payer: VA VA |
$263.54
|
|
|
HC UNLISTED PROCEDURE NERVOUS SYSTEM 64999
|
Facility
|
IP
|
$712.41
|
|
|
Service Code
|
CPT 64999
|
| Hospital Charge Code |
36100437
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$448.82 |
| Max. Negotiated Rate |
$641.17 |
| Rate for Payer: Aetna Commercial |
$605.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$463.07
|
| Rate for Payer: Cash Price |
$569.93
|
| Rate for Payer: Cofinity Commercial |
$498.69
|
| Rate for Payer: Cofinity Commercial |
$612.67
|
| Rate for Payer: Healthscope Commercial |
$641.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$605.55
|
| Rate for Payer: PHP Commercial |
$605.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$498.69
|
| Rate for Payer: Priority Health SBD |
$448.82
|
|
|
HC UNLISTED PROCEDURE NOSE
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
CPT 30999
|
| Hospital Charge Code |
76100453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$409.50 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Aetna Commercial |
$552.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$422.50
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cofinity Commercial |
$455.00
|
| Rate for Payer: Cofinity Commercial |
$559.00
|
| Rate for Payer: Healthscope Commercial |
$585.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$552.50
|
| Rate for Payer: PHP Commercial |
$552.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.00
|
| Rate for Payer: Priority Health SBD |
$409.50
|
|
|
HC UNLISTED PROCEDURE NOSE
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
CPT 30999
|
| Hospital Charge Code |
76100453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.18 |
| Max. Negotiated Rate |
$623.17 |
| Rate for Payer: Aetna Commercial |
$552.50
|
| Rate for Payer: Aetna Medicare |
$226.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$422.50
|
| 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 |
$92.18
|
| Rate for Payer: BCN Medicare Advantage |
$217.34
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cofinity Commercial |
$559.00
|
| Rate for Payer: Cofinity Commercial |
$455.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.34
|
| Rate for Payer: Healthscope Commercial |
$585.00
|
| 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 |
$552.50
|
| Rate for Payer: PACE Medicare |
$206.47
|
| Rate for Payer: PACE SWMI |
$217.34
|
| Rate for Payer: PHP Commercial |
$552.50
|
| 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 |
$455.00
|
| 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 |
$409.50
|
| Rate for Payer: Railroad Medicare Medicare |
$217.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$217.34
|
| Rate for Payer: UHC Medicare Advantage |
$223.86
|
| Rate for Payer: VA VA |
$217.34
|
|
|
HC UNLISTED PROCEDURE SPINE
|
Facility
|
IP
|
$2,847.42
|
|
|
Service Code
|
CPT 22899
|
| Hospital Charge Code |
36100036
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,793.87 |
| Max. Negotiated Rate |
$2,562.68 |
| Rate for Payer: Aetna Commercial |
$2,420.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,850.82
|
| Rate for Payer: Cash Price |
$2,277.94
|
| Rate for Payer: Cofinity Commercial |
$1,993.19
|
| Rate for Payer: Cofinity Commercial |
$2,448.78
|
| Rate for Payer: Healthscope Commercial |
$2,562.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,420.31
|
| Rate for Payer: PHP Commercial |
$2,420.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,993.19
|
| Rate for Payer: Priority Health SBD |
$1,793.87
|
|
|
HC UNLISTED PROCEDURE SPINE
|
Facility
|
OP
|
$2,847.42
|
|
|
Service Code
|
CPT 22899
|
| Hospital Charge Code |
36100036
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$104.02 |
| Max. Negotiated Rate |
$2,562.68 |
| Rate for Payer: Aetna Commercial |
$2,420.31
|
| Rate for Payer: Aetna Medicare |
$218.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,850.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.29
|
| Rate for Payer: BCBS Complete |
$120.53
|
| Rate for Payer: BCBS MAPPO |
$209.83
|
| Rate for Payer: BCBS Trust/PPO |
$104.02
|
| Rate for Payer: BCN Medicare Advantage |
$209.83
|
| Rate for Payer: Cash Price |
$2,277.94
|
| Rate for Payer: Cash Price |
$2,277.94
|
| Rate for Payer: Cofinity Commercial |
$1,993.19
|
| Rate for Payer: Cofinity Commercial |
$2,448.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.83
|
| Rate for Payer: Healthscope Commercial |
$2,562.68
|
| Rate for Payer: Mclaren Medicaid |
$114.78
|
| Rate for Payer: Mclaren Medicare |
$209.83
|
| Rate for Payer: Meridian Medicaid |
$120.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$220.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,420.31
|
| Rate for Payer: PACE Medicare |
$199.34
|
| Rate for Payer: PACE SWMI |
$209.83
|
| Rate for Payer: PHP Commercial |
$2,420.31
|
| Rate for Payer: PHP Medicare Advantage |
$209.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,993.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$620.74
|
| Rate for Payer: Priority Health Medicare |
$209.83
|
| Rate for Payer: Priority Health Narrow Network |
$496.59
|
| Rate for Payer: Priority Health SBD |
$1,793.87
|
| Rate for Payer: Railroad Medicare Medicare |
$209.83
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.83
|
| Rate for Payer: UHC Medicare Advantage |
$216.12
|
| Rate for Payer: VA VA |
$209.83
|
|
|
HC UNLISTED PROC HAND OR FINGER
|
Facility
|
IP
|
$448.01
|
|
|
Service Code
|
CPT 26989
|
| Hospital Charge Code |
36100518
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$282.25 |
| Max. Negotiated Rate |
$403.21 |
| Rate for Payer: Aetna Commercial |
$380.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.21
|
| Rate for Payer: Cash Price |
$358.41
|
| Rate for Payer: Cofinity Commercial |
$313.61
|
| Rate for Payer: Cofinity Commercial |
$385.29
|
| Rate for Payer: Healthscope Commercial |
$403.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$380.81
|
| Rate for Payer: PHP Commercial |
$380.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.61
|
| Rate for Payer: Priority Health SBD |
$282.25
|
|
|
HC UNLISTED PROC HAND OR FINGER
|
Facility
|
OP
|
$448.01
|
|
|
Service Code
|
CPT 26989
|
| Hospital Charge Code |
36100518
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$104.02 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$380.81
|
| Rate for Payer: Aetna Medicare |
$218.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.29
|
| Rate for Payer: BCBS Complete |
$120.53
|
| Rate for Payer: BCBS MAPPO |
$209.83
|
| Rate for Payer: BCBS Trust/PPO |
$104.02
|
| Rate for Payer: BCN Medicare Advantage |
$209.83
|
| Rate for Payer: Cash Price |
$358.41
|
| Rate for Payer: Cash Price |
$358.41
|
| Rate for Payer: Cofinity Commercial |
$385.29
|
| Rate for Payer: Cofinity Commercial |
$313.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.83
|
| Rate for Payer: Healthscope Commercial |
$403.21
|
| Rate for Payer: Mclaren Medicaid |
$114.78
|
| Rate for Payer: Mclaren Medicare |
$209.83
|
| Rate for Payer: Meridian Medicaid |
$120.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$220.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$380.81
|
| Rate for Payer: PACE Medicare |
$199.34
|
| Rate for Payer: PACE SWMI |
$209.83
|
| Rate for Payer: PHP Commercial |
$380.81
|
| Rate for Payer: PHP Medicare Advantage |
$209.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.61
|
| Rate for Payer: Priority Health Medicare |
$209.83
|
| Rate for Payer: Priority Health SBD |
$282.25
|
| Rate for Payer: Railroad Medicare Medicare |
$209.83
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.83
|
| Rate for Payer: UHC Medicare Advantage |
$216.12
|
| Rate for Payer: VA VA |
$209.83
|
|
|
HC UNNA BOOT
|
Facility
|
OP
|
$360.06
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
42000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.54 |
| Max. Negotiated Rate |
$324.05 |
| Rate for Payer: Aetna Commercial |
$306.05
|
| Rate for Payer: Aetna Medicare |
$145.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$175.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$175.25
|
| Rate for Payer: BCBS Complete |
$80.53
|
| Rate for Payer: BCBS MAPPO |
$140.20
|
| Rate for Payer: BCBS Trust/PPO |
$91.11
|
| Rate for Payer: BCN Medicare Advantage |
$140.20
|
| Rate for Payer: Cash Price |
$288.05
|
| Rate for Payer: Cash Price |
$288.05
|
| Rate for Payer: Cofinity Commercial |
$309.65
|
| Rate for Payer: Cofinity Commercial |
$252.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.20
|
| Rate for Payer: Healthscope Commercial |
$324.05
|
| Rate for Payer: Mclaren Medicaid |
$76.69
|
| Rate for Payer: Mclaren Medicare |
$140.20
|
| Rate for Payer: Meridian Medicaid |
$80.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$147.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$161.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$306.05
|
| Rate for Payer: PACE Medicare |
$133.19
|
| Rate for Payer: PACE SWMI |
$140.20
|
| Rate for Payer: PHP Commercial |
$306.05
|
| Rate for Payer: PHP Medicare Advantage |
$140.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.04
|
| Rate for Payer: Priority Health Medicare |
$140.20
|
| Rate for Payer: Priority Health SBD |
$226.84
|
| Rate for Payer: Railroad Medicare Medicare |
$140.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.20
|
| Rate for Payer: UHC Exchange |
$25.54
|
| Rate for Payer: UHC Medicare Advantage |
$144.41
|
| Rate for Payer: VA VA |
$140.20
|
|
|
HC UNNA BOOT
|
Facility
|
IP
|
$360.06
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
42000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$226.84 |
| Max. Negotiated Rate |
$324.05 |
| Rate for Payer: Aetna Commercial |
$306.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.04
|
| Rate for Payer: Cash Price |
$288.05
|
| Rate for Payer: Cofinity Commercial |
$252.04
|
| Rate for Payer: Cofinity Commercial |
$309.65
|
| Rate for Payer: Healthscope Commercial |
$324.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$306.05
|
| Rate for Payer: PHP Commercial |
$306.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.04
|
| Rate for Payer: Priority Health SBD |
$226.84
|
|
|
HC UPGRADE PACEMAKER
|
Facility
|
IP
|
$8,845.22
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
36100063
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,572.49 |
| Max. Negotiated Rate |
$7,960.70 |
| Rate for Payer: Aetna Commercial |
$7,518.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,749.39
|
| Rate for Payer: Cash Price |
$7,076.18
|
| Rate for Payer: Cofinity Commercial |
$7,606.89
|
| Rate for Payer: Cofinity Commercial |
$6,191.65
|
| Rate for Payer: Healthscope Commercial |
$7,960.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,518.44
|
| Rate for Payer: PHP Commercial |
$7,518.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,191.65
|
| Rate for Payer: Priority Health SBD |
$5,572.49
|
|
