|
HC US PELVIS TRANSVAG ONLY
|
Facility
|
IP
|
$370.48
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
40200031
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$233.40 |
| Max. Negotiated Rate |
$333.43 |
| Rate for Payer: Aetna Commercial |
$314.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.81
|
| Rate for Payer: Cash Price |
$296.38
|
| Rate for Payer: Cofinity Commercial |
$259.34
|
| Rate for Payer: Cofinity Commercial |
$318.61
|
| Rate for Payer: Healthscope Commercial |
$333.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$314.91
|
| Rate for Payer: PHP Commercial |
$314.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.34
|
| Rate for Payer: Priority Health SBD |
$233.40
|
|
|
HC US PROSTATE TRANSRECTAL
|
Facility
|
OP
|
$1,064.75
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
40200036
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$958.28 |
| Rate for Payer: Aetna Commercial |
$905.04
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$692.09
|
| 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 |
$280.22
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$851.80
|
| Rate for Payer: Cash Price |
$851.80
|
| Rate for Payer: Cofinity Commercial |
$915.68
|
| Rate for Payer: Cofinity Commercial |
$745.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$958.28
|
| 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 |
$905.04
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$905.04
|
| 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 |
$745.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.98
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$271.18
|
| Rate for Payer: Priority Health SBD |
$670.79
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$197.77
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC US PROSTATE TRANSRECTAL
|
Facility
|
IP
|
$1,064.75
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
40200036
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$670.79 |
| Max. Negotiated Rate |
$958.28 |
| Rate for Payer: Aetna Commercial |
$905.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$692.09
|
| Rate for Payer: Cash Price |
$851.80
|
| Rate for Payer: Cofinity Commercial |
$745.32
|
| Rate for Payer: Cofinity Commercial |
$915.68
|
| Rate for Payer: Healthscope Commercial |
$958.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$905.04
|
| Rate for Payer: PHP Commercial |
$905.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$745.32
|
| Rate for Payer: Priority Health SBD |
$670.79
|
|
|
HC US PROSTATE TRANSRECT TX PLAN SEP PROC
|
Facility
|
OP
|
$285.60
|
|
|
Service Code
|
CPT 76873
|
| Hospital Charge Code |
40200081
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$338.98 |
| Rate for Payer: Aetna Commercial |
$242.76
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.64
|
| 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 |
$163.83
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$228.48
|
| Rate for Payer: Cash Price |
$228.48
|
| Rate for Payer: Cofinity Commercial |
$245.62
|
| Rate for Payer: Cofinity Commercial |
$199.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$257.04
|
| 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 |
$242.76
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$242.76
|
| 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 |
$199.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.98
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$271.18
|
| Rate for Payer: Priority Health SBD |
$179.93
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$172.56
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC US PROSTATE TRANSRECT TX PLAN SEP PROC
|
Facility
|
IP
|
$285.60
|
|
|
Service Code
|
CPT 76873
|
| Hospital Charge Code |
40200081
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$179.93 |
| Max. Negotiated Rate |
$257.04 |
| Rate for Payer: Aetna Commercial |
$242.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.64
|
| Rate for Payer: Cash Price |
$228.48
|
| Rate for Payer: Cofinity Commercial |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$245.62
|
| Rate for Payer: Healthscope Commercial |
$257.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$242.76
|
| Rate for Payer: PHP Commercial |
$242.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.92
|
| Rate for Payer: Priority Health SBD |
$179.93
|
|
|
HC US RETROPERITONEAL COMPLETE
|
Facility
|
IP
|
$750.70
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
40200011
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$472.94 |
| Max. Negotiated Rate |
$675.63 |
| Rate for Payer: Aetna Commercial |
$638.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$487.96
|
| Rate for Payer: Cash Price |
$600.56
|
| Rate for Payer: Cofinity Commercial |
$525.49
|
| Rate for Payer: Cofinity Commercial |
$645.60
|
| Rate for Payer: Healthscope Commercial |
$675.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$638.10
|
| Rate for Payer: PHP Commercial |
$638.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.49
|
| Rate for Payer: Priority Health SBD |
$472.94
|
|
|
HC US RETROPERITONEAL COMPLETE
|
Facility
|
OP
|
$750.70
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
40200011
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$675.63 |
| Rate for Payer: Aetna Commercial |
$638.10
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$487.96
|
| 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 |
$123.01
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$600.56
|
| Rate for Payer: Cash Price |
$600.56
|
| Rate for Payer: Cofinity Commercial |
$525.49
|
| Rate for Payer: Cofinity Commercial |
$645.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$675.63
|
| 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 |
$638.10
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$638.10
|
| 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 |
$525.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.98
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$271.18
|
| Rate for Payer: Priority Health SBD |
$472.94
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$106.42
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC US RETROPERITONEAL LTD
|
Facility
|
OP
|
$750.70
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
40200012
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$675.63 |
| Rate for Payer: Aetna Commercial |
$638.10
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$487.96
|
| 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 |
$52.40
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$600.56
|
| Rate for Payer: Cash Price |
$600.56
|
| Rate for Payer: Cofinity Commercial |
$645.60
|
| Rate for Payer: Cofinity Commercial |
$525.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$675.63
|
| 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 |
$638.10
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$638.10
|
| 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 |
$525.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.98
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$271.18
|
| Rate for Payer: Priority Health SBD |
$472.94
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$58.61
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC US RETROPERITONEAL LTD
|
Facility
|
IP
|
$750.70
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
40200012
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$472.94 |
| Max. Negotiated Rate |
$675.63 |
| Rate for Payer: Aetna Commercial |
$638.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$487.96
|
| Rate for Payer: Cash Price |
$600.56
|
| Rate for Payer: Cofinity Commercial |
$525.49
|
| Rate for Payer: Cofinity Commercial |
$645.60
|
| Rate for Payer: Healthscope Commercial |
$675.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$638.10
|
| Rate for Payer: PHP Commercial |
$638.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.49
|
| Rate for Payer: Priority Health SBD |
$472.94
|
|
|
HC US SCROTUM AND CONTENTS
|
Facility
|
IP
|
$700.61
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
40200035
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$441.38 |
| Max. Negotiated Rate |
$630.55 |
| Rate for Payer: Aetna Commercial |
$595.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.40
|
| Rate for Payer: Cash Price |
$560.49
|
| Rate for Payer: Cofinity Commercial |
$490.43
|
| Rate for Payer: Cofinity Commercial |
$602.52
|
| Rate for Payer: Healthscope Commercial |
$630.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$595.52
|
| Rate for Payer: PHP Commercial |
$595.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.43
|
| Rate for Payer: Priority Health SBD |
$441.38
|
|
|
HC US SCROTUM AND CONTENTS
|
Facility
|
OP
|
$700.61
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
40200035
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$630.55 |
| Rate for Payer: Aetna Commercial |
$595.52
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.40
|
| 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 |
$117.49
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$560.49
|
| Rate for Payer: Cash Price |
$560.49
|
| Rate for Payer: Cofinity Commercial |
$602.52
|
| Rate for Payer: Cofinity Commercial |
$490.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$630.55
|
| 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 |
$595.52
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$595.52
|
| 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 |
$490.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.98
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$271.18
|
| Rate for Payer: Priority Health SBD |
$441.38
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$98.23
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC U.S. SKIN PREP PACK
|
Facility
|
OP
|
$16.56
|
|
| Hospital Charge Code |
27000163
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.62 |
| Max. Negotiated Rate |
$14.90 |
| Rate for Payer: Aetna Commercial |
$14.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.76
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: Cash Price |
$13.25
|
| Rate for Payer: Cofinity Commercial |
$11.59
|
| Rate for Payer: Cofinity Commercial |
$14.24
|
| Rate for Payer: Healthscope Commercial |
$14.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.08
|
| Rate for Payer: PHP Commercial |
$14.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.59
|
| Rate for Payer: Priority Health SBD |
$10.43
|
|
|
HC U.S. SKIN PREP PACK
|
Facility
|
IP
|
$16.56
|
|
| Hospital Charge Code |
27000163
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$14.90 |
| Rate for Payer: Aetna Commercial |
$14.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.76
|
| Rate for Payer: Cash Price |
$13.25
|
| Rate for Payer: Cofinity Commercial |
$11.59
|
| Rate for Payer: Cofinity Commercial |
$14.24
|
| Rate for Payer: Healthscope Commercial |
$14.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.08
|
| Rate for Payer: PHP Commercial |
$14.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.59
|
| Rate for Payer: Priority Health SBD |
$10.43
|
|
|
HC US SOFT TISSUE HEAD NECK
|
Facility
|
OP
|
$770.55
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
40200006
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$693.50 |
| Rate for Payer: Aetna Commercial |
$654.97
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$500.86
|
| 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 |
$140.11
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$616.44
|
| Rate for Payer: Cash Price |
$616.44
|
| Rate for Payer: Cofinity Commercial |
$539.38
|
| Rate for Payer: Cofinity Commercial |
$662.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$693.50
|
| 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 |
$654.97
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$654.97
|
| 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 |
$539.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.98
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$271.18
|
| Rate for Payer: Priority Health SBD |
$485.45
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$108.38
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC US SOFT TISSUE HEAD NECK
|
Facility
|
IP
|
$770.55
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
40200006
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$485.45 |
| Max. Negotiated Rate |
$693.50 |
| Rate for Payer: Aetna Commercial |
$654.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$500.86
|
| Rate for Payer: Cash Price |
$616.44
|
| Rate for Payer: Cofinity Commercial |
$539.38
|
| Rate for Payer: Cofinity Commercial |
$662.67
|
| Rate for Payer: Healthscope Commercial |
$693.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$654.97
|
| Rate for Payer: PHP Commercial |
$654.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$539.38
|
| Rate for Payer: Priority Health SBD |
$485.45
|
|
|
HC US SPINAL CANAL AND CONTENTS
|
Facility
|
IP
|
$476.47
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
40200014
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$300.18 |
| Max. Negotiated Rate |
$428.82 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$309.71
|
| Rate for Payer: Cash Price |
$381.18
|
| Rate for Payer: Cofinity Commercial |
$333.53
|
| Rate for Payer: Cofinity Commercial |
$409.76
|
| Rate for Payer: Healthscope Commercial |
$428.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$405.00
|
| Rate for Payer: PHP Commercial |
$405.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.53
|
| Rate for Payer: Priority Health SBD |
$300.18
|
|
|
HC US SPINAL CANAL AND CONTENTS
|
Facility
|
OP
|
$476.47
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
40200014
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$428.82 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$309.71
|
| 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 |
$159.97
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$381.18
|
| Rate for Payer: Cash Price |
$381.18
|
| Rate for Payer: Cofinity Commercial |
$409.76
|
| Rate for Payer: Cofinity Commercial |
$333.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$428.82
|
| 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 |
$405.00
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$405.00
|
| 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 |
$333.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.98
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$271.18
|
| Rate for Payer: Priority Health SBD |
$300.18
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$169.94
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC US SURGERY INTRAOPERATIVE
|
Facility
|
OP
|
$667.08
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
40200050
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$200.78 |
| Max. Negotiated Rate |
$600.37 |
| Rate for Payer: Aetna Commercial |
$567.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$433.60
|
| Rate for Payer: BCBS Complete |
$266.83
|
| Rate for Payer: BCBS Trust/PPO |
$200.78
|
| Rate for Payer: Cash Price |
$533.66
|
| Rate for Payer: Cash Price |
$533.66
|
| Rate for Payer: Cofinity Commercial |
$466.96
|
| Rate for Payer: Cofinity Commercial |
$573.69
|
| Rate for Payer: Healthscope Commercial |
$600.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$567.02
|
| Rate for Payer: PHP Commercial |
$567.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$466.96
|
| Rate for Payer: Priority Health SBD |
$420.26
|
|
|
HC US SURGERY INTRAOPERATIVE
|
Facility
|
IP
|
$667.08
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
40200050
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$420.26 |
| Max. Negotiated Rate |
$600.37 |
| Rate for Payer: Aetna Commercial |
$567.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$433.60
|
| Rate for Payer: Cash Price |
$533.66
|
| Rate for Payer: Cofinity Commercial |
$466.96
|
| Rate for Payer: Cofinity Commercial |
$573.69
|
| Rate for Payer: Healthscope Commercial |
$600.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$567.02
|
| Rate for Payer: PHP Commercial |
$567.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$466.96
|
| Rate for Payer: Priority Health SBD |
$420.26
|
|
|
HC USTEKINUMAB AND AB
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100673
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$146.70 |
| Rate for Payer: Aetna Commercial |
$138.55
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$13.52
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$114.10
|
| Rate for Payer: Cofinity Commercial |
$140.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$146.70
|
| Rate for Payer: Mclaren Medicaid |
$9.45
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Medicaid |
$9.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.55
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$138.55
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.10
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health SBD |
$102.69
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.72
|
| Rate for Payer: UHC Core |
$22.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Exchange |
$17.27
|
| Rate for Payer: UHC Medicare Advantage |
$17.79
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC USTEKINUMAB AND AB
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100673
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$102.69 |
| Max. Negotiated Rate |
$146.70 |
| Rate for Payer: Aetna Commercial |
$138.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.95
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$114.10
|
| Rate for Payer: Cofinity Commercial |
$140.18
|
| Rate for Payer: Healthscope Commercial |
$146.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.55
|
| Rate for Payer: PHP Commercial |
$138.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.10
|
| Rate for Payer: Priority Health SBD |
$102.69
|
|
|
HC USTEKINUMAB AND AB CMPT
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100674
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$102.06 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.30
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cofinity Commercial |
$113.40
|
| Rate for Payer: Cofinity Commercial |
$139.32
|
| Rate for Payer: Healthscope Commercial |
$145.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$137.70
|
| Rate for Payer: PHP Commercial |
$137.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.40
|
| Rate for Payer: Priority Health SBD |
$102.06
|
|
|
HC USTEKINUMAB AND AB CMPT
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100674
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: BCBS Complete |
$10.71
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$14.60
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cofinity Commercial |
$113.40
|
| Rate for Payer: Cofinity Commercial |
$139.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$145.80
|
| Rate for Payer: Mclaren Medicaid |
$10.20
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Medicaid |
$10.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$137.70
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$137.70
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.40
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health SBD |
$102.06
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.37
|
| Rate for Payer: UHC Core |
$23.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Exchange |
$18.64
|
| Rate for Payer: UHC Medicare Advantage |
$19.20
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC USTEKINUMAB AND ANTI-USTEK AB
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
30100708
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$93.24 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna Commercial |
$125.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.20
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Commercial |
$103.60
|
| Rate for Payer: Cofinity Commercial |
$127.28
|
| Rate for Payer: Healthscope Commercial |
$133.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.80
|
| Rate for Payer: PHP Commercial |
$125.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.60
|
| Rate for Payer: Priority Health SBD |
$93.24
|
|
|
HC USTEKINUMAB AND ANTI-USTEK AB
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
30100708
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna Commercial |
$125.80
|
| Rate for Payer: Aetna Medicare |
$14.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.65
|
| Rate for Payer: BCBS Complete |
$8.11
|
| Rate for Payer: BCBS MAPPO |
$14.12
|
| Rate for Payer: BCBS Trust/PPO |
$11.06
|
| Rate for Payer: BCN Medicare Advantage |
$14.12
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Commercial |
$127.28
|
| Rate for Payer: Cofinity Commercial |
$103.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.12
|
| Rate for Payer: Healthscope Commercial |
$133.20
|
| Rate for Payer: Mclaren Medicaid |
$7.72
|
| Rate for Payer: Mclaren Medicare |
$14.12
|
| Rate for Payer: Meridian Medicaid |
$8.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.80
|
| Rate for Payer: PACE Medicare |
$13.41
|
| Rate for Payer: PACE SWMI |
$14.12
|
| Rate for Payer: PHP Commercial |
$125.80
|
| Rate for Payer: PHP Medicare Advantage |
$14.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.60
|
| Rate for Payer: Priority Health Medicare |
$14.12
|
| Rate for Payer: Priority Health SBD |
$93.24
|
| Rate for Payer: Railroad Medicare Medicare |
$14.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.94
|
| Rate for Payer: UHC Core |
$24.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.12
|
| Rate for Payer: UHC Exchange |
$14.12
|
| Rate for Payer: UHC Medicare Advantage |
$14.54
|
| Rate for Payer: VA VA |
$14.12
|
|
