|
HC PENTOBARBITOL NEMBUTAL LVL
|
Facility
|
IP
|
$182.07
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
30100572
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$114.70 |
| Max. Negotiated Rate |
$163.86 |
| Rate for Payer: Aetna Commercial |
$154.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.35
|
| Rate for Payer: Cash Price |
$145.66
|
| Rate for Payer: Cofinity Advantage |
$127.45
|
| Rate for Payer: Cofinity Commercial |
$156.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.66
|
| Rate for Payer: Healthscope Commercial |
$163.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.55
|
| Rate for Payer: PHP Commercial |
$154.76
|
| Rate for Payer: Priority Health SBD |
$114.70
|
|
|
HC PEP VALVE SUPPLY
|
Facility
|
IP
|
$55.67
|
|
| Hospital Charge Code |
27000134
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.07 |
| Max. Negotiated Rate |
$50.10 |
| Rate for Payer: Aetna Commercial |
$47.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.19
|
| Rate for Payer: Cash Price |
$44.54
|
| Rate for Payer: Cofinity Advantage |
$38.97
|
| Rate for Payer: Cofinity Commercial |
$47.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.54
|
| Rate for Payer: Healthscope Commercial |
$50.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.75
|
| Rate for Payer: PHP Commercial |
$47.32
|
| Rate for Payer: Priority Health SBD |
$35.07
|
|
|
HC PEP VALVE SUPPLY
|
Facility
|
OP
|
$55.67
|
|
| Hospital Charge Code |
27000134
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.88 |
| Max. Negotiated Rate |
$50.10 |
| Rate for Payer: Aetna Commercial |
$47.32
|
| Rate for Payer: Aetna Medicare |
$27.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.19
|
| Rate for Payer: BCBS Complete |
$22.27
|
| Rate for Payer: Cash Price |
$44.54
|
| Rate for Payer: Cofinity Advantage |
$38.97
|
| Rate for Payer: Cofinity Commercial |
$47.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.54
|
| Rate for Payer: Healthscope Commercial |
$50.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.75
|
| Rate for Payer: PHP Commercial |
$47.32
|
| Rate for Payer: Priority Health SBD |
$35.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.19
|
| Rate for Payer: UHC Core |
$29.00
|
| Rate for Payer: UHC Exchange |
$21.88
|
|
|
HC PERC CHOLECYSTOSTOMY
|
Facility
|
IP
|
$5,268.14
|
|
|
Service Code
|
CPT 47490
|
| Hospital Charge Code |
36100200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,318.93 |
| Max. Negotiated Rate |
$4,741.33 |
| Rate for Payer: Aetna Commercial |
$4,477.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,424.29
|
| Rate for Payer: Cash Price |
$4,214.51
|
| Rate for Payer: Cofinity Advantage |
$3,687.70
|
| Rate for Payer: Cofinity Commercial |
$4,530.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,214.51
|
| Rate for Payer: Healthscope Commercial |
$4,741.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,477.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,951.11
|
| Rate for Payer: PHP Commercial |
$4,477.92
|
| Rate for Payer: Priority Health SBD |
$3,318.93
|
|
|
HC PERC CHOLECYSTOSTOMY
|
Facility
|
OP
|
$5,268.14
|
|
|
Service Code
|
CPT 47490
|
| Hospital Charge Code |
36100200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,865.82 |
| Max. Negotiated Rate |
$11,537.07 |
| Rate for Payer: Aetna Commercial |
$4,477.92
|
| Rate for Payer: Aetna Medicare |
$3,710.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,424.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,459.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,459.41
|
| Rate for Payer: BCBS Complete |
$1,959.29
|
| Rate for Payer: BCBS MAPPO |
$3,567.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,965.49
|
| Rate for Payer: BCN Commercial |
$1,965.49
|
| Rate for Payer: BCN Medicare Advantage |
$3,567.53
|
| Rate for Payer: Cash Price |
$4,214.51
|
| Rate for Payer: Cash Price |
$4,214.51
|
| Rate for Payer: Cash Price |
$4,214.51
|
| Rate for Payer: Cofinity Advantage |
$3,687.70
|
| Rate for Payer: Cofinity Commercial |
$4,530.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,214.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,567.53
|
| Rate for Payer: Healthscope Commercial |
$4,741.33
|
| Rate for Payer: Mclaren Medicaid |
$1,865.82
|
| Rate for Payer: Mclaren Medicare |
$3,567.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,745.91
|
| Rate for Payer: Meridian Medicaid |
$3,745.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,102.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,924.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,477.92
|
| Rate for Payer: Nomi Health Commercial |
$10,702.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,951.11
|
| Rate for Payer: PACE Medicare |
$3,389.15
|
| Rate for Payer: PACE SWMI |
$3,567.53
|
| Rate for Payer: PHP Commercial |
$4,477.92
|
| Rate for Payer: PHP Medicare Advantage |
$3,567.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,865.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,537.07
|
| Rate for Payer: Priority Health Medicare |
$3,567.53
|
| Rate for Payer: Priority Health SBD |
$3,318.93
|
| Rate for Payer: Priority Health Tiered Network |
$9,229.66
|
| Rate for Payer: Railroad Medicare Medicare |
$3,567.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,567.53
|
| Rate for Payer: UHC Medicaid |
$1,865.82
|
| Rate for Payer: UHCCP Medicaid |
$1,865.82
|
| Rate for Payer: VA VA |
$3,567.53
|
|
|
HC PERCH OCEAN IGE
|
Facility
|
OP
|
$74.29
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200481
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$66.86 |
| Rate for Payer: Aetna Commercial |
$63.15
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$59.43
|
| Rate for Payer: Cash Price |
$59.43
|
| Rate for Payer: Cofinity Advantage |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$63.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$66.86
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.15
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.72
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$63.15
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$46.80
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC PERCH OCEAN IGE
|
Facility
|
IP
|
$74.29
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200481
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$66.86 |
| Rate for Payer: Aetna Commercial |
$63.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.29
|
| Rate for Payer: Cash Price |
$59.43
|
| Rate for Payer: Cofinity Advantage |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$63.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.43
|
| Rate for Payer: Healthscope Commercial |
$66.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.72
|
| Rate for Payer: PHP Commercial |
$63.15
|
| Rate for Payer: Priority Health SBD |
$46.80
|
|
|
HC PERC IMPLANT OF NEUROSTIM EPIDURAL
|
Facility
|
IP
|
$14,383.08
|
|
|
Service Code
|
CPT 63650
|
| Hospital Charge Code |
36100610
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,061.34 |
| Max. Negotiated Rate |
$12,944.77 |
| Rate for Payer: Aetna Commercial |
$12,225.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,349.00
|
| Rate for Payer: Cash Price |
$11,506.46
|
| Rate for Payer: Cofinity Advantage |
$10,068.16
|
| Rate for Payer: Cofinity Commercial |
$12,369.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,506.46
|
| Rate for Payer: Healthscope Commercial |
$12,944.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,225.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,787.31
|
| Rate for Payer: PHP Commercial |
$12,225.62
|
| Rate for Payer: Priority Health SBD |
$9,061.34
|
|
|
HC PERC IMPLANT OF NEUROSTIM EPIDURAL
|
Facility
|
OP
|
$14,383.08
|
|
|
Service Code
|
CPT 63650
|
| Hospital Charge Code |
36100610
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,321.09 |
| Max. Negotiated Rate |
$20,535.59 |
| Rate for Payer: Aetna Commercial |
$12,225.62
|
| Rate for Payer: Aetna Medicare |
$6,604.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,349.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,937.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,937.60
|
| Rate for Payer: BCBS Complete |
$3,487.46
|
| Rate for Payer: BCBS MAPPO |
$6,350.08
|
| Rate for Payer: BCBS Trust/PPO |
$5,027.48
|
| Rate for Payer: BCN Commercial |
$5,027.48
|
| Rate for Payer: BCN Medicare Advantage |
$6,350.08
|
| Rate for Payer: Cash Price |
$11,506.46
|
| Rate for Payer: Cash Price |
$11,506.46
|
| Rate for Payer: Cash Price |
$11,506.46
|
| Rate for Payer: Cofinity Advantage |
$10,068.16
|
| Rate for Payer: Cofinity Commercial |
$12,369.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,506.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,350.08
|
| Rate for Payer: Healthscope Commercial |
$12,944.77
|
| Rate for Payer: Mclaren Medicaid |
$3,321.09
|
| Rate for Payer: Mclaren Medicare |
$6,350.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,667.58
|
| Rate for Payer: Meridian Medicaid |
$6,667.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,302.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,985.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,225.62
|
| Rate for Payer: Nomi Health Commercial |
$19,050.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,787.31
|
| Rate for Payer: PACE Medicare |
$6,032.58
|
| Rate for Payer: PACE SWMI |
$6,350.08
|
| Rate for Payer: PHP Commercial |
$12,225.62
|
| Rate for Payer: PHP Medicare Advantage |
$6,350.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,321.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20,535.59
|
| Rate for Payer: Priority Health Medicare |
$6,350.08
|
| Rate for Payer: Priority Health SBD |
$9,061.34
|
| Rate for Payer: Priority Health Tiered Network |
$16,428.47
|
| Rate for Payer: Railroad Medicare Medicare |
$6,350.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,350.08
|
| Rate for Payer: UHC Medicaid |
$3,321.09
|
| Rate for Payer: UHCCP Medicaid |
$3,321.09
|
| Rate for Payer: VA VA |
$6,350.08
|
|
|
HC PERCLOSE
|
Facility
|
IP
|
$1,073.27
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27200060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$676.16 |
| Max. Negotiated Rate |
$965.94 |
| Rate for Payer: Aetna Commercial |
$912.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$697.63
|
| Rate for Payer: Cash Price |
$858.62
|
| Rate for Payer: Cofinity Advantage |
$751.29
|
| Rate for Payer: Cofinity Commercial |
$923.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$858.62
|
| Rate for Payer: Healthscope Commercial |
$965.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$912.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$804.95
|
| Rate for Payer: PHP Commercial |
$912.28
|
| Rate for Payer: Priority Health SBD |
$676.16
|
|
|
HC PERCLOSE
|
Facility
|
OP
|
$1,073.27
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27200060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$421.80 |
| Max. Negotiated Rate |
$965.94 |
| Rate for Payer: Aetna Commercial |
$912.28
|
| Rate for Payer: Aetna Medicare |
$536.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$697.63
|
| Rate for Payer: BCBS Complete |
$429.31
|
| Rate for Payer: Cash Price |
$858.62
|
| Rate for Payer: Cofinity Advantage |
$751.29
|
| Rate for Payer: Cofinity Commercial |
$923.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$858.62
|
| Rate for Payer: Healthscope Commercial |
$965.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$858.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$912.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$804.95
|
| Rate for Payer: PHP Commercial |
$912.28
|
| Rate for Payer: Priority Health SBD |
$676.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$697.63
|
| Rate for Payer: UHC Core |
$559.17
|
| Rate for Payer: UHC Exchange |
$421.80
|
|
|
HC PERC THROMBECTOMY OR INFUSION DIALYSIS CIRCUIT W IMAGING
|
Facility
|
OP
|
$6,639.53
|
|
|
Service Code
|
CPT 36904
|
| Hospital Charge Code |
36100528
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,965.99 |
| Max. Negotiated Rate |
$18,339.80 |
| Rate for Payer: Aetna Commercial |
$5,643.60
|
| Rate for Payer: Aetna Medicare |
$5,897.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,315.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,088.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,088.88
|
| Rate for Payer: BCBS Complete |
$3,114.57
|
| Rate for Payer: BCBS MAPPO |
$5,671.10
|
| Rate for Payer: BCBS Trust/PPO |
$3,982.87
|
| Rate for Payer: BCN Commercial |
$3,982.87
|
| Rate for Payer: BCN Medicare Advantage |
$5,671.10
|
| Rate for Payer: Cash Price |
$5,311.62
|
| Rate for Payer: Cash Price |
$5,311.62
|
| Rate for Payer: Cash Price |
$5,311.62
|
| Rate for Payer: Cofinity Advantage |
$4,647.67
|
| Rate for Payer: Cofinity Commercial |
$5,710.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,311.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,671.10
|
| Rate for Payer: Healthscope Commercial |
$5,975.58
|
| Rate for Payer: Mclaren Medicaid |
$2,965.99
|
| Rate for Payer: Mclaren Medicare |
$5,671.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,954.65
|
| Rate for Payer: Meridian Medicaid |
$5,954.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,521.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,238.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,643.60
|
| Rate for Payer: Nomi Health Commercial |
$17,013.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,979.65
|
| Rate for Payer: PACE Medicare |
$5,387.55
|
| Rate for Payer: PACE SWMI |
$5,671.10
|
| Rate for Payer: PHP Commercial |
$5,643.60
|
| Rate for Payer: PHP Medicare Advantage |
$5,671.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,965.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18,339.80
|
| Rate for Payer: Priority Health Medicare |
$5,671.10
|
| Rate for Payer: Priority Health SBD |
$4,182.90
|
| Rate for Payer: Priority Health Tiered Network |
$14,671.84
|
| Rate for Payer: Railroad Medicare Medicare |
$5,671.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,671.10
|
| Rate for Payer: UHC Medicaid |
$2,965.99
|
| Rate for Payer: UHCCP Medicaid |
$2,965.99
|
| Rate for Payer: VA VA |
$5,671.10
|
|
|
HC PERC THROMBECTOMY OR INFUSION DIALYSIS CIRCUIT W IMAGING
|
Facility
|
IP
|
$6,639.53
|
|
|
Service Code
|
CPT 36904
|
| Hospital Charge Code |
36100528
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,182.90 |
| Max. Negotiated Rate |
$5,975.58 |
| Rate for Payer: Aetna Commercial |
$5,643.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,315.69
|
| Rate for Payer: Cash Price |
$5,311.62
|
| Rate for Payer: Cofinity Advantage |
$4,647.67
|
| Rate for Payer: Cofinity Commercial |
$5,710.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,311.62
|
| Rate for Payer: Healthscope Commercial |
$5,975.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,643.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,979.65
|
| Rate for Payer: PHP Commercial |
$5,643.60
|
| Rate for Payer: Priority Health SBD |
$4,182.90
|
|
|
HC PERC THROMBECT OR INF W ANGIOPLASTY PERIPH DIALYSIS W IMAGING
|
Facility
|
OP
|
$18,046.39
|
|
|
Service Code
|
CPT 36905
|
| Hospital Charge Code |
36100529
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,015.90 |
| Max. Negotiated Rate |
$37,198.61 |
| Rate for Payer: Aetna Commercial |
$15,339.43
|
| Rate for Payer: Aetna Medicare |
$11,962.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,730.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,378.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,378.35
|
| Rate for Payer: BCBS Complete |
$6,317.27
|
| Rate for Payer: BCBS MAPPO |
$11,502.68
|
| Rate for Payer: BCBS Trust/PPO |
$7,546.95
|
| Rate for Payer: BCN Commercial |
$7,546.95
|
| Rate for Payer: BCN Medicare Advantage |
$11,502.68
|
| Rate for Payer: Cash Price |
$14,437.11
|
| Rate for Payer: Cash Price |
$14,437.11
|
| Rate for Payer: Cash Price |
$14,437.11
|
| Rate for Payer: Cofinity Advantage |
$12,632.47
|
| Rate for Payer: Cofinity Commercial |
$15,519.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,437.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,502.68
|
| Rate for Payer: Healthscope Commercial |
$16,241.75
|
| Rate for Payer: Mclaren Medicaid |
$6,015.90
|
| Rate for Payer: Mclaren Medicare |
$11,502.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,077.81
|
| Rate for Payer: Meridian Medicaid |
$12,077.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,228.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,652.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,339.43
|
| Rate for Payer: Nomi Health Commercial |
$34,508.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,534.79
|
| Rate for Payer: PACE Medicare |
$10,927.55
|
| Rate for Payer: PACE SWMI |
$11,502.68
|
| Rate for Payer: PHP Commercial |
$15,339.43
|
| Rate for Payer: PHP Medicare Advantage |
$11,502.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,015.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$37,198.61
|
| Rate for Payer: Priority Health Medicare |
$11,502.68
|
| Rate for Payer: Priority Health SBD |
$11,369.23
|
| Rate for Payer: Priority Health Tiered Network |
$29,758.89
|
| Rate for Payer: Railroad Medicare Medicare |
$11,502.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,502.68
|
| Rate for Payer: UHC Medicaid |
$6,015.90
|
| Rate for Payer: UHCCP Medicaid |
$6,015.90
|
| Rate for Payer: VA VA |
$11,502.68
|
|
|
HC PERC THROMBECT OR INF W ANGIOPLASTY PERIPH DIALYSIS W IMAGING
|
Facility
|
IP
|
$18,046.39
|
|
|
Service Code
|
CPT 36905
|
| Hospital Charge Code |
36100529
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,369.23 |
| Max. Negotiated Rate |
$16,241.75 |
| Rate for Payer: Aetna Commercial |
$15,339.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,730.15
|
| Rate for Payer: Cash Price |
$14,437.11
|
| Rate for Payer: Cofinity Advantage |
$12,632.47
|
| Rate for Payer: Cofinity Commercial |
$15,519.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,437.11
|
| Rate for Payer: Healthscope Commercial |
$16,241.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,339.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,534.79
|
| Rate for Payer: PHP Commercial |
$15,339.43
|
| Rate for Payer: Priority Health SBD |
$11,369.23
|
|
|
HC PERC THROMBECT OR INF W STENT PERIPH DIALYSIS W IMAGING
|
Facility
|
OP
|
$28,657.20
|
|
|
Service Code
|
CPT 36906
|
| Hospital Charge Code |
36100530
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,552.97 |
| Max. Negotiated Rate |
$59,069.70 |
| Rate for Payer: Aetna Commercial |
$24,358.62
|
| Rate for Payer: Aetna Medicare |
$18,996.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,627.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,832.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,832.15
|
| Rate for Payer: BCBS Complete |
$10,031.53
|
| Rate for Payer: BCBS MAPPO |
$18,265.72
|
| Rate for Payer: BCBS Trust/PPO |
$11,815.28
|
| Rate for Payer: BCN Commercial |
$11,815.28
|
| Rate for Payer: BCN Medicare Advantage |
$18,265.72
|
| Rate for Payer: Cash Price |
$22,925.76
|
| Rate for Payer: Cash Price |
$22,925.76
|
| Rate for Payer: Cash Price |
$22,925.76
|
| Rate for Payer: Cofinity Advantage |
$20,060.04
|
| Rate for Payer: Cofinity Commercial |
$24,645.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,925.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,265.72
|
| Rate for Payer: Healthscope Commercial |
$25,791.48
|
| Rate for Payer: Mclaren Medicaid |
$9,552.97
|
| Rate for Payer: Mclaren Medicare |
$18,265.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,179.01
|
| Rate for Payer: Meridian Medicaid |
$19,179.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,005.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,092.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,358.62
|
| Rate for Payer: Nomi Health Commercial |
$54,797.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,492.90
|
| Rate for Payer: PACE Medicare |
$17,352.43
|
| Rate for Payer: PACE SWMI |
$18,265.72
|
| Rate for Payer: PHP Commercial |
$24,358.62
|
| Rate for Payer: PHP Medicare Advantage |
$18,265.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,552.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$59,069.70
|
| Rate for Payer: Priority Health Medicare |
$18,265.72
|
| Rate for Payer: Priority Health SBD |
$18,054.04
|
| Rate for Payer: Priority Health Tiered Network |
$47,255.76
|
| Rate for Payer: Railroad Medicare Medicare |
$18,265.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,265.72
|
| Rate for Payer: UHC Medicaid |
$9,552.97
|
| Rate for Payer: UHCCP Medicaid |
$9,552.97
|
| Rate for Payer: VA VA |
$18,265.72
|
|
|
HC PERC THROMBECT OR INF W STENT PERIPH DIALYSIS W IMAGING
|
Facility
|
IP
|
$28,657.20
|
|
|
Service Code
|
CPT 36906
|
| Hospital Charge Code |
36100530
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$18,054.04 |
| Max. Negotiated Rate |
$25,791.48 |
| Rate for Payer: Aetna Commercial |
$24,358.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,627.18
|
| Rate for Payer: Cash Price |
$22,925.76
|
| Rate for Payer: Cofinity Advantage |
$20,060.04
|
| Rate for Payer: Cofinity Commercial |
$24,645.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,925.76
|
| Rate for Payer: Healthscope Commercial |
$25,791.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,358.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,492.90
|
| Rate for Payer: PHP Commercial |
$24,358.62
|
| Rate for Payer: Priority Health SBD |
$18,054.04
|
|
|
HC PERCUTANEOUS NEEDLE
|
Facility
|
OP
|
$13.96
|
|
| Hospital Charge Code |
27200144
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.49 |
| Max. Negotiated Rate |
$12.56 |
| Rate for Payer: Aetna Commercial |
$11.87
|
| Rate for Payer: Aetna Medicare |
$6.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.07
|
| Rate for Payer: BCBS Complete |
$5.58
|
| Rate for Payer: Cash Price |
$11.17
|
| Rate for Payer: Cofinity Advantage |
$9.77
|
| Rate for Payer: Cofinity Commercial |
$12.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.17
|
| Rate for Payer: Healthscope Commercial |
$12.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.47
|
| Rate for Payer: PHP Commercial |
$11.87
|
| Rate for Payer: Priority Health SBD |
$8.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.07
|
| Rate for Payer: UHC Core |
$7.27
|
| Rate for Payer: UHC Exchange |
$5.49
|
|
|
HC PERCUTANEOUS NEEDLE
|
Facility
|
IP
|
$13.96
|
|
| Hospital Charge Code |
27200144
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.79 |
| Max. Negotiated Rate |
$12.56 |
| Rate for Payer: Aetna Commercial |
$11.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.07
|
| Rate for Payer: Cash Price |
$11.17
|
| Rate for Payer: Cofinity Advantage |
$9.77
|
| Rate for Payer: Cofinity Commercial |
$12.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.17
|
| Rate for Payer: Healthscope Commercial |
$12.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.47
|
| Rate for Payer: PHP Commercial |
$11.87
|
| Rate for Payer: Priority Health SBD |
$8.79
|
|
|
HC PERCUTANEOUS TRACHEOSTOMY
|
Facility
|
OP
|
$4,628.79
|
|
|
Service Code
|
CPT 31600
|
| Hospital Charge Code |
36000001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,492.42 |
| Max. Negotiated Rate |
$10,683.35 |
| Rate for Payer: Aetna Commercial |
$3,934.47
|
| Rate for Payer: Aetna Medicare |
$3,435.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,008.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,129.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,129.43
|
| Rate for Payer: BCBS Complete |
$1,814.30
|
| Rate for Payer: BCBS MAPPO |
$3,303.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,492.42
|
| Rate for Payer: BCN Commercial |
$1,492.42
|
| Rate for Payer: BCN Medicare Advantage |
$3,303.54
|
| Rate for Payer: Cash Price |
$3,703.03
|
| Rate for Payer: Cash Price |
$3,703.03
|
| Rate for Payer: Cash Price |
$3,703.03
|
| Rate for Payer: Cofinity Advantage |
$3,240.15
|
| Rate for Payer: Cofinity Commercial |
$3,980.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,703.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,303.54
|
| Rate for Payer: Healthscope Commercial |
$4,165.91
|
| Rate for Payer: Mclaren Medicaid |
$1,727.75
|
| Rate for Payer: Mclaren Medicare |
$3,303.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,468.72
|
| Rate for Payer: Meridian Medicaid |
$3,468.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,799.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,633.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,934.47
|
| Rate for Payer: Nomi Health Commercial |
$9,910.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,471.59
|
| Rate for Payer: PACE Medicare |
$3,138.36
|
| Rate for Payer: PACE SWMI |
$3,303.54
|
| Rate for Payer: PHP Commercial |
$3,934.47
|
| Rate for Payer: PHP Medicare Advantage |
$3,303.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,727.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,683.35
|
| Rate for Payer: Priority Health Medicare |
$3,303.54
|
| Rate for Payer: Priority Health SBD |
$2,916.14
|
| Rate for Payer: Priority Health Tiered Network |
$8,546.68
|
| Rate for Payer: Railroad Medicare Medicare |
$3,303.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,303.54
|
| Rate for Payer: UHC Medicaid |
$1,727.75
|
| Rate for Payer: UHCCP Medicaid |
$1,727.75
|
| Rate for Payer: VA VA |
$3,303.54
|
|
|
HC PERCUTANEOUS TRACHEOSTOMY
|
Facility
|
IP
|
$4,628.79
|
|
|
Service Code
|
CPT 31600
|
| Hospital Charge Code |
36000001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,916.14 |
| Max. Negotiated Rate |
$4,165.91 |
| Rate for Payer: Aetna Commercial |
$3,934.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,008.71
|
| Rate for Payer: Cash Price |
$3,703.03
|
| Rate for Payer: Cofinity Advantage |
$3,240.15
|
| Rate for Payer: Cofinity Commercial |
$3,980.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,703.03
|
| Rate for Payer: Healthscope Commercial |
$4,165.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,934.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,471.59
|
| Rate for Payer: PHP Commercial |
$3,934.47
|
| Rate for Payer: Priority Health SBD |
$2,916.14
|
|
|
HC PERENNIAL RYE IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200097
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC PERENNIAL RYE IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200097
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
|
|
HC PERFUSION OPEN HEART
|
Facility
|
IP
|
$6,656.19
|
|
| Hospital Charge Code |
27000107
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4,193.40 |
| Max. Negotiated Rate |
$5,990.57 |
| Rate for Payer: Aetna Commercial |
$5,657.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,326.52
|
| Rate for Payer: Cash Price |
$5,324.95
|
| Rate for Payer: Cofinity Advantage |
$4,659.33
|
| Rate for Payer: Cofinity Commercial |
$5,724.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,324.95
|
| Rate for Payer: Healthscope Commercial |
$5,990.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,657.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,992.14
|
| Rate for Payer: PHP Commercial |
$5,657.76
|
| Rate for Payer: Priority Health SBD |
$4,193.40
|
|
|
HC PERFUSION OPEN HEART
|
Facility
|
OP
|
$6,656.19
|
|
| Hospital Charge Code |
27000107
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,615.88 |
| Max. Negotiated Rate |
$5,990.57 |
| Rate for Payer: Aetna Commercial |
$5,657.76
|
| Rate for Payer: Aetna Medicare |
$3,328.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,326.52
|
| Rate for Payer: BCBS Complete |
$2,662.48
|
| Rate for Payer: Cash Price |
$5,324.95
|
| Rate for Payer: Cofinity Advantage |
$4,659.33
|
| Rate for Payer: Cofinity Commercial |
$5,724.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,324.95
|
| Rate for Payer: Healthscope Commercial |
$5,990.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,324.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,657.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,992.14
|
| Rate for Payer: PHP Commercial |
$5,657.76
|
| Rate for Payer: Priority Health SBD |
$4,193.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,326.52
|
| Rate for Payer: UHC Core |
$3,467.87
|
| Rate for Payer: UHC Exchange |
$2,615.88
|
|
