|
HC VASCULAR GRAFT
|
Facility
|
IP
|
$2,269.02
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27800033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,429.48 |
| Max. Negotiated Rate |
$2,042.12 |
| Rate for Payer: Aetna Commercial |
$1,928.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,474.86
|
| Rate for Payer: Cash Price |
$1,815.22
|
| Rate for Payer: Cofinity Commercial |
$1,588.31
|
| Rate for Payer: Cofinity Commercial |
$1,951.36
|
| Rate for Payer: Healthscope Commercial |
$2,042.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,928.67
|
| Rate for Payer: PHP Commercial |
$1,928.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,588.31
|
| Rate for Payer: Priority Health SBD |
$1,429.48
|
|
|
HC VASCULAR GRAFT
|
Facility
|
OP
|
$2,269.02
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27800033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$907.61 |
| Max. Negotiated Rate |
$2,042.12 |
| Rate for Payer: Aetna Commercial |
$1,928.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,474.86
|
| Rate for Payer: BCBS Complete |
$907.61
|
| Rate for Payer: Cash Price |
$1,815.22
|
| Rate for Payer: Cofinity Commercial |
$1,588.31
|
| Rate for Payer: Cofinity Commercial |
$1,951.36
|
| Rate for Payer: Healthscope Commercial |
$2,042.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,928.67
|
| Rate for Payer: PHP Commercial |
$1,928.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,588.31
|
| Rate for Payer: Priority Health SBD |
$1,429.48
|
|
|
HC VASOACTIVE INTESTINAL PEPTIDE/VIP
|
Facility
|
IP
|
$82.62
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
30100456
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.05 |
| Max. Negotiated Rate |
$74.36 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.70
|
| Rate for Payer: Cash Price |
$66.10
|
| Rate for Payer: Cofinity Commercial |
$57.83
|
| Rate for Payer: Cofinity Commercial |
$71.05
|
| Rate for Payer: Healthscope Commercial |
$74.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.23
|
| Rate for Payer: PHP Commercial |
$70.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.83
|
| Rate for Payer: Priority Health SBD |
$52.05
|
|
|
HC VASOACTIVE INTESTINAL PEPTIDE/VIP
|
Facility
|
OP
|
$82.62
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
30100456
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.33 |
| Max. Negotiated Rate |
$74.36 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: Aetna Medicare |
$36.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.16
|
| Rate for Payer: BCBS Complete |
$20.29
|
| Rate for Payer: BCBS MAPPO |
$35.33
|
| Rate for Payer: BCBS Trust/PPO |
$27.67
|
| Rate for Payer: BCN Medicare Advantage |
$35.33
|
| Rate for Payer: Cash Price |
$66.10
|
| Rate for Payer: Cash Price |
$66.10
|
| Rate for Payer: Cofinity Commercial |
$71.05
|
| Rate for Payer: Cofinity Commercial |
$57.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.33
|
| Rate for Payer: Healthscope Commercial |
$74.36
|
| Rate for Payer: Mclaren Medicaid |
$19.33
|
| Rate for Payer: Mclaren Medicare |
$35.33
|
| Rate for Payer: Meridian Medicaid |
$20.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.23
|
| Rate for Payer: PACE Medicare |
$33.56
|
| Rate for Payer: PACE SWMI |
$35.33
|
| Rate for Payer: PHP Commercial |
$70.23
|
| Rate for Payer: PHP Medicare Advantage |
$35.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.83
|
| Rate for Payer: Priority Health Medicare |
$35.33
|
| Rate for Payer: Priority Health SBD |
$52.05
|
| Rate for Payer: Railroad Medicare Medicare |
$35.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.40
|
| Rate for Payer: UHC Core |
$60.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.33
|
| Rate for Payer: UHC Exchange |
$35.33
|
| Rate for Payer: UHC Medicare Advantage |
$36.39
|
| Rate for Payer: VA VA |
$35.33
|
|
|
HC VASOPNEUMATIC TREATMENT
|
Facility
|
OP
|
$73.44
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
43000017
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.74
|
| Rate for Payer: BCBS Complete |
$29.38
|
| Rate for Payer: BCBS Trust/PPO |
$7.81
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Cofinity Commercial |
$51.41
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.42
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.41
|
| Rate for Payer: Priority Health SBD |
$46.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.61
|
| Rate for Payer: UHC Exchange |
$11.46
|
|
|
HC VASOPNEUMATIC TREATMENT
|
Facility
|
IP
|
$73.44
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
43000017
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$46.27 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.74
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$51.41
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.42
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.41
|
| Rate for Payer: Priority Health SBD |
$46.27
|
|
|
HC VDRL SPINAL FLUID
|
Facility
|
IP
|
$34.68
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
30200216
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.85 |
| Max. Negotiated Rate |
$31.21 |
| Rate for Payer: Aetna Commercial |
$29.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.54
|
| Rate for Payer: Cash Price |
$27.74
|
| Rate for Payer: Cofinity Commercial |
$24.28
|
| Rate for Payer: Cofinity Commercial |
$29.82
|
| Rate for Payer: Healthscope Commercial |
$31.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.48
|
| Rate for Payer: PHP Commercial |
$29.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.28
|
| Rate for Payer: Priority Health SBD |
$21.85
|
|
|
HC VDRL SPINAL FLUID
|
Facility
|
OP
|
$34.68
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
30200216
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$31.21 |
| Rate for Payer: Aetna Commercial |
$29.48
|
| Rate for Payer: Aetna Medicare |
$4.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.34
|
| Rate for Payer: BCBS Complete |
$2.45
|
| Rate for Payer: BCBS MAPPO |
$4.27
|
| Rate for Payer: BCBS Trust/PPO |
$3.34
|
| Rate for Payer: BCN Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$27.74
|
| Rate for Payer: Cash Price |
$27.74
|
| Rate for Payer: Cofinity Commercial |
$24.28
|
| Rate for Payer: Cofinity Commercial |
$29.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.27
|
| Rate for Payer: Healthscope Commercial |
$31.21
|
| Rate for Payer: Mclaren Medicaid |
$2.34
|
| Rate for Payer: Mclaren Medicare |
$4.27
|
| Rate for Payer: Meridian Medicaid |
$2.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.48
|
| Rate for Payer: PACE Medicare |
$4.06
|
| Rate for Payer: PACE SWMI |
$4.27
|
| Rate for Payer: PHP Commercial |
$29.48
|
| Rate for Payer: PHP Medicare Advantage |
$4.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.28
|
| Rate for Payer: Priority Health Medicare |
$4.27
|
| Rate for Payer: Priority Health SBD |
$21.85
|
| Rate for Payer: Railroad Medicare Medicare |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.12
|
| Rate for Payer: UHC Core |
$7.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.27
|
| Rate for Payer: UHC Exchange |
$4.27
|
| Rate for Payer: UHC Medicare Advantage |
$4.40
|
| Rate for Payer: VA VA |
$4.27
|
|
|
HC VDRL TITER CSF
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
30200397
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.62 |
| Max. Negotiated Rate |
$66.60 |
| Rate for Payer: Aetna Commercial |
$62.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.10
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cofinity Commercial |
$63.64
|
| Rate for Payer: Cofinity Commercial |
$51.80
|
| Rate for Payer: Healthscope Commercial |
$66.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.90
|
| Rate for Payer: PHP Commercial |
$62.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.80
|
| Rate for Payer: Priority Health SBD |
$46.62
|
|
|
HC VDRL TITER CSF
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
30200397
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$66.60 |
| Rate for Payer: Aetna Commercial |
$62.90
|
| Rate for Payer: Aetna Medicare |
$4.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.50
|
| Rate for Payer: BCBS Complete |
$2.53
|
| Rate for Payer: BCBS MAPPO |
$4.40
|
| Rate for Payer: BCBS Trust/PPO |
$3.45
|
| Rate for Payer: BCN Medicare Advantage |
$4.40
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cofinity Commercial |
$63.64
|
| Rate for Payer: Cofinity Commercial |
$51.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.40
|
| Rate for Payer: Healthscope Commercial |
$66.60
|
| Rate for Payer: Mclaren Medicaid |
$2.41
|
| Rate for Payer: Mclaren Medicare |
$4.40
|
| Rate for Payer: Meridian Medicaid |
$2.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.90
|
| Rate for Payer: PACE Medicare |
$4.18
|
| Rate for Payer: PACE SWMI |
$4.40
|
| Rate for Payer: PHP Commercial |
$62.90
|
| Rate for Payer: PHP Medicare Advantage |
$4.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.80
|
| Rate for Payer: Priority Health Medicare |
$4.40
|
| Rate for Payer: Priority Health SBD |
$46.62
|
| Rate for Payer: Railroad Medicare Medicare |
$4.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.28
|
| Rate for Payer: UHC Core |
$7.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.40
|
| Rate for Payer: UHC Exchange |
$4.40
|
| Rate for Payer: UHC Medicare Advantage |
$4.53
|
| Rate for Payer: VA VA |
$4.40
|
|
|
HC VEDOLIZUMAB
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100671
|
|
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 VEDOLIZUMAB
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100671
|
|
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 VEDOLIZUMAB, ANTIBODY
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
30100683
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Aetna Commercial |
$109.65
|
| Rate for Payer: Aetna Medicare |
$14.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.85
|
| 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 |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Cofinity Commercial |
$110.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.12
|
| Rate for Payer: Healthscope Commercial |
$116.10
|
| 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 |
$109.65
|
| Rate for Payer: PACE Medicare |
$13.41
|
| Rate for Payer: PACE SWMI |
$14.12
|
| Rate for Payer: PHP Commercial |
$109.65
|
| 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 |
$90.30
|
| Rate for Payer: Priority Health Medicare |
$14.12
|
| Rate for Payer: Priority Health SBD |
$81.27
|
| 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
|
|
|
HC VEDOLIZUMAB, ANTIBODY
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
30100683
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$81.27 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Aetna Commercial |
$109.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.85
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cofinity Commercial |
$110.94
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Healthscope Commercial |
$116.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.65
|
| Rate for Payer: PHP Commercial |
$109.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.30
|
| Rate for Payer: Priority Health SBD |
$81.27
|
|
|
HC VEDOLIZUMAB CMPT
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100672
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna Commercial |
$108.80
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.20
|
| 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 |
$102.40
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cofinity Commercial |
$89.60
|
| Rate for Payer: Cofinity Commercial |
$110.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$115.20
|
| 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 |
$108.80
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$108.80
|
| 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 |
$89.60
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health SBD |
$80.64
|
| 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 VEDOLIZUMAB CMPT
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100672
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$80.64 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna Commercial |
$108.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.20
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cofinity Commercial |
$110.08
|
| Rate for Payer: Cofinity Commercial |
$89.60
|
| Rate for Payer: Healthscope Commercial |
$115.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$108.80
|
| Rate for Payer: PHP Commercial |
$108.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.60
|
| Rate for Payer: Priority Health SBD |
$80.64
|
|
|
HC VEDOLIZUMAB, S
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 80280
|
| Hospital Charge Code |
30100706
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$153.72 |
| Max. Negotiated Rate |
$219.60 |
| Rate for Payer: Aetna Commercial |
$207.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.60
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Cofinity Commercial |
$170.80
|
| Rate for Payer: Cofinity Commercial |
$209.84
|
| Rate for Payer: Healthscope Commercial |
$219.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.40
|
| Rate for Payer: PHP Commercial |
$207.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.80
|
| Rate for Payer: Priority Health SBD |
$153.72
|
|
|
HC VEDOLIZUMAB, S
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT 80280
|
| Hospital Charge Code |
30100706
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.10 |
| Max. Negotiated Rate |
$219.60 |
| Rate for Payer: Aetna Commercial |
$207.40
|
| Rate for Payer: Aetna Medicare |
$40.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.21
|
| Rate for Payer: BCBS Complete |
$22.15
|
| Rate for Payer: BCBS MAPPO |
$38.57
|
| Rate for Payer: BCN Medicare Advantage |
$38.57
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Cofinity Commercial |
$170.80
|
| Rate for Payer: Cofinity Commercial |
$209.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.57
|
| Rate for Payer: Healthscope Commercial |
$219.60
|
| Rate for Payer: Mclaren Medicaid |
$21.10
|
| Rate for Payer: Mclaren Medicare |
$38.57
|
| Rate for Payer: Meridian Medicaid |
$22.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.40
|
| Rate for Payer: PACE Medicare |
$36.64
|
| Rate for Payer: PACE SWMI |
$38.57
|
| Rate for Payer: PHP Commercial |
$207.40
|
| Rate for Payer: PHP Medicare Advantage |
$38.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.80
|
| Rate for Payer: Priority Health Medicare |
$38.57
|
| Rate for Payer: Priority Health SBD |
$153.72
|
| Rate for Payer: Railroad Medicare Medicare |
$38.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.28
|
| Rate for Payer: UHC Core |
$46.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.57
|
| Rate for Payer: UHC Exchange |
$38.57
|
| Rate for Payer: UHC Medicare Advantage |
$39.73
|
| Rate for Payer: VA VA |
$38.57
|
|
|
HC VEEG 12-26 HR UNMONITORED
|
Facility
|
IP
|
$1,001.24
|
|
|
Service Code
|
CPT 95714
|
| Hospital Charge Code |
74000027
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$630.78 |
| Max. Negotiated Rate |
$901.12 |
| Rate for Payer: Aetna Commercial |
$851.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$650.81
|
| Rate for Payer: Cash Price |
$800.99
|
| Rate for Payer: Cofinity Commercial |
$700.87
|
| Rate for Payer: Cofinity Commercial |
$861.07
|
| Rate for Payer: Healthscope Commercial |
$901.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$851.05
|
| Rate for Payer: PHP Commercial |
$851.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.87
|
| Rate for Payer: Priority Health SBD |
$630.78
|
|
|
HC VEEG 12-26 HR UNMONITORED
|
Facility
|
OP
|
$1,001.24
|
|
|
Service Code
|
CPT 95714
|
| Hospital Charge Code |
74000027
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$260.87 |
| Max. Negotiated Rate |
$1,404.70 |
| Rate for Payer: Aetna Commercial |
$851.05
|
| Rate for Payer: Aetna Medicare |
$495.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$650.81
|
| 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 |
$1,404.70
|
| Rate for Payer: BCN Medicare Advantage |
$476.91
|
| Rate for Payer: Cash Price |
$800.99
|
| Rate for Payer: Cash Price |
$800.99
|
| Rate for Payer: Cofinity Commercial |
$861.07
|
| Rate for Payer: Cofinity Commercial |
$700.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.91
|
| Rate for Payer: Healthscope Commercial |
$901.12
|
| 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 |
$851.05
|
| Rate for Payer: PACE Medicare |
$453.06
|
| Rate for Payer: PACE SWMI |
$476.91
|
| Rate for Payer: PHP Commercial |
$851.05
|
| 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 |
$700.87
|
| Rate for Payer: Priority Health Medicare |
$476.91
|
| Rate for Payer: Priority Health SBD |
$630.78
|
| Rate for Payer: Railroad Medicare Medicare |
$476.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$476.91
|
| Rate for Payer: UHC Medicare Advantage |
$491.22
|
| Rate for Payer: VA VA |
$476.91
|
|
|
HC VEEG 2-12 HR CONT MNTR
|
Facility
|
IP
|
$2,394.08
|
|
|
Service Code
|
CPT 95713
|
| Hospital Charge Code |
74000023
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,508.27 |
| Max. Negotiated Rate |
$2,154.67 |
| Rate for Payer: Aetna Commercial |
$2,034.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,556.15
|
| Rate for Payer: Cash Price |
$1,915.26
|
| Rate for Payer: Cofinity Commercial |
$1,675.86
|
| Rate for Payer: Cofinity Commercial |
$2,058.91
|
| Rate for Payer: Healthscope Commercial |
$2,154.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,034.97
|
| Rate for Payer: PHP Commercial |
$2,034.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,675.86
|
| Rate for Payer: Priority Health SBD |
$1,508.27
|
|
|
HC VEEG 2-12 HR CONT MNTR
|
Facility
|
OP
|
$2,394.08
|
|
|
Service Code
|
CPT 95713
|
| Hospital Charge Code |
74000023
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$260.87 |
| Max. Negotiated Rate |
$2,154.67 |
| Rate for Payer: Aetna Commercial |
$2,034.97
|
| Rate for Payer: Aetna Medicare |
$495.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,556.15
|
| 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 |
$1,404.70
|
| Rate for Payer: BCN Medicare Advantage |
$476.91
|
| Rate for Payer: Cash Price |
$1,915.26
|
| Rate for Payer: Cash Price |
$1,915.26
|
| Rate for Payer: Cofinity Commercial |
$2,058.91
|
| Rate for Payer: Cofinity Commercial |
$1,675.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.91
|
| Rate for Payer: Healthscope Commercial |
$2,154.67
|
| 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 |
$2,034.97
|
| Rate for Payer: PACE Medicare |
$453.06
|
| Rate for Payer: PACE SWMI |
$476.91
|
| Rate for Payer: PHP Commercial |
$2,034.97
|
| 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 |
$1,675.86
|
| Rate for Payer: Priority Health Medicare |
$476.91
|
| Rate for Payer: Priority Health SBD |
$1,508.27
|
| Rate for Payer: Railroad Medicare Medicare |
$476.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$476.91
|
| Rate for Payer: UHC Medicare Advantage |
$491.22
|
| Rate for Payer: VA VA |
$476.91
|
|
|
HC VEEG 2-12 HR INTMT MNTR
|
Facility
|
IP
|
$1,051.86
|
|
|
Service Code
|
CPT 95712
|
| Hospital Charge Code |
74000022
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$662.67 |
| Max. Negotiated Rate |
$946.67 |
| Rate for Payer: Aetna Commercial |
$894.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$683.71
|
| Rate for Payer: Cash Price |
$841.49
|
| Rate for Payer: Cofinity Commercial |
$736.30
|
| Rate for Payer: Cofinity Commercial |
$904.60
|
| Rate for Payer: Healthscope Commercial |
$946.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$894.08
|
| Rate for Payer: PHP Commercial |
$894.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$736.30
|
| Rate for Payer: Priority Health SBD |
$662.67
|
|
|
HC VEEG 2-12 HR INTMT MNTR
|
Facility
|
OP
|
$1,051.86
|
|
|
Service Code
|
CPT 95712
|
| Hospital Charge Code |
74000022
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$152.77 |
| Max. Negotiated Rate |
$946.67 |
| Rate for Payer: Aetna Commercial |
$894.08
|
| Rate for Payer: Aetna Medicare |
$290.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$683.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$349.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$349.11
|
| Rate for Payer: BCBS Complete |
$160.42
|
| Rate for Payer: BCBS MAPPO |
$279.29
|
| Rate for Payer: BCBS Trust/PPO |
$813.77
|
| Rate for Payer: BCN Medicare Advantage |
$279.29
|
| Rate for Payer: Cash Price |
$841.49
|
| Rate for Payer: Cash Price |
$841.49
|
| Rate for Payer: Cofinity Commercial |
$904.60
|
| Rate for Payer: Cofinity Commercial |
$736.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.29
|
| Rate for Payer: Healthscope Commercial |
$946.67
|
| Rate for Payer: Mclaren Medicaid |
$152.77
|
| Rate for Payer: Mclaren Medicare |
$279.29
|
| Rate for Payer: Meridian Medicaid |
$160.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$293.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$321.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$894.08
|
| Rate for Payer: PACE Medicare |
$265.33
|
| Rate for Payer: PACE SWMI |
$279.29
|
| Rate for Payer: PHP Commercial |
$894.08
|
| Rate for Payer: PHP Medicare Advantage |
$279.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$736.30
|
| Rate for Payer: Priority Health Medicare |
$279.29
|
| Rate for Payer: Priority Health SBD |
$662.67
|
| Rate for Payer: Railroad Medicare Medicare |
$279.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.29
|
| Rate for Payer: UHC Medicare Advantage |
$287.67
|
| Rate for Payer: VA VA |
$279.29
|
|
|
HC VEEG 2-12 HR UNMONITORED
|
Facility
|
OP
|
$1,921.04
|
|
|
Service Code
|
CPT 95711
|
| Hospital Charge Code |
74000026
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$152.77 |
| Max. Negotiated Rate |
$1,728.94 |
| Rate for Payer: Aetna Commercial |
$1,632.88
|
| Rate for Payer: Aetna Medicare |
$290.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,248.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$349.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$349.11
|
| Rate for Payer: BCBS Complete |
$160.42
|
| Rate for Payer: BCBS MAPPO |
$279.29
|
| Rate for Payer: BCBS Trust/PPO |
$813.77
|
| Rate for Payer: BCN Medicare Advantage |
$279.29
|
| Rate for Payer: Cash Price |
$1,536.83
|
| Rate for Payer: Cash Price |
$1,536.83
|
| Rate for Payer: Cofinity Commercial |
$1,652.09
|
| Rate for Payer: Cofinity Commercial |
$1,344.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.29
|
| Rate for Payer: Healthscope Commercial |
$1,728.94
|
| Rate for Payer: Mclaren Medicaid |
$152.77
|
| Rate for Payer: Mclaren Medicare |
$279.29
|
| Rate for Payer: Meridian Medicaid |
$160.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$293.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$321.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,632.88
|
| Rate for Payer: PACE Medicare |
$265.33
|
| Rate for Payer: PACE SWMI |
$279.29
|
| Rate for Payer: PHP Commercial |
$1,632.88
|
| Rate for Payer: PHP Medicare Advantage |
$279.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,344.73
|
| Rate for Payer: Priority Health Medicare |
$279.29
|
| Rate for Payer: Priority Health SBD |
$1,210.26
|
| Rate for Payer: Railroad Medicare Medicare |
$279.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.29
|
| Rate for Payer: UHC Medicare Advantage |
$287.67
|
| Rate for Payer: VA VA |
$279.29
|
|
