|
HC PERIDARDIOCENTESIS WITH GUIDANCE
|
Facility
|
IP
|
$2,596.18
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
36100582
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,635.59 |
| Max. Negotiated Rate |
$2,336.56 |
| Rate for Payer: Aetna Commercial |
$2,206.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,687.52
|
| Rate for Payer: Cash Price |
$2,076.94
|
| Rate for Payer: Cofinity Advantage |
$1,817.33
|
| Rate for Payer: Cofinity Commercial |
$2,232.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,076.94
|
| Rate for Payer: Healthscope Commercial |
$2,336.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,206.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,947.13
|
| Rate for Payer: PHP Commercial |
$2,206.75
|
| Rate for Payer: Priority Health SBD |
$1,635.59
|
|
|
HC PERIDARDIOCENTESIS WITH GUIDANCE
|
Facility
|
OP
|
$2,596.18
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
36100582
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$737.61 |
| Max. Negotiated Rate |
$5,072.36 |
| Rate for Payer: Aetna Commercial |
$2,206.75
|
| Rate for Payer: Aetna Medicare |
$1,631.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,687.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.61
|
| Rate for Payer: BCBS Complete |
$861.41
|
| Rate for Payer: BCBS MAPPO |
$1,568.49
|
| Rate for Payer: BCBS Trust/PPO |
$737.61
|
| Rate for Payer: BCN Commercial |
$737.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.49
|
| Rate for Payer: Cash Price |
$2,076.94
|
| Rate for Payer: Cash Price |
$2,076.94
|
| Rate for Payer: Cash Price |
$2,076.94
|
| Rate for Payer: Cofinity Advantage |
$1,817.33
|
| Rate for Payer: Cofinity Commercial |
$2,232.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,076.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.49
|
| Rate for Payer: Healthscope Commercial |
$2,336.56
|
| Rate for Payer: Mclaren Medicaid |
$820.32
|
| Rate for Payer: Mclaren Medicare |
$1,568.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.91
|
| Rate for Payer: Meridian Medicaid |
$1,646.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,725.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,206.75
|
| Rate for Payer: Nomi Health Commercial |
$4,705.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,947.13
|
| Rate for Payer: PACE Medicare |
$1,490.07
|
| Rate for Payer: PACE SWMI |
$1,568.49
|
| Rate for Payer: PHP Commercial |
$2,206.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$820.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,072.36
|
| Rate for Payer: Priority Health Medicare |
$1,568.49
|
| Rate for Payer: Priority Health SBD |
$1,635.59
|
| Rate for Payer: Priority Health Tiered Network |
$4,057.89
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,568.49
|
| Rate for Payer: UHC Medicaid |
$820.32
|
| Rate for Payer: UHCCP Medicaid |
$820.32
|
| Rate for Payer: VA VA |
$1,568.49
|
|
|
HC PERIPH ARTERY DISEASE REHAB
|
Facility
|
OP
|
$105.30
|
|
|
Service Code
|
CPT 93668
|
| Hospital Charge Code |
94000006
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$19.99 |
| Max. Negotiated Rate |
$190.09 |
| Rate for Payer: Aetna Commercial |
$89.50
|
| Rate for Payer: Aetna Medicare |
$61.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$19.99
|
| Rate for Payer: BCN Commercial |
$19.99
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Cash Price |
$84.24
|
| Rate for Payer: Cash Price |
$84.24
|
| Rate for Payer: Cofinity Advantage |
$73.71
|
| Rate for Payer: Cofinity Commercial |
$90.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$94.77
|
| Rate for Payer: Mclaren Medicaid |
$30.74
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$61.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.50
|
| Rate for Payer: Nomi Health Commercial |
$176.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.97
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Commercial |
$89.50
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$190.09
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health SBD |
$66.34
|
| Rate for Payer: Priority Health Tiered Network |
$152.07
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.44
|
| Rate for Payer: UHC Core |
$54.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Exchange |
$41.38
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: VA VA |
$58.78
|
|
|
HC PERIPH ARTERY DISEASE REHAB
|
Facility
|
IP
|
$105.30
|
|
|
Service Code
|
CPT 93668
|
| Hospital Charge Code |
94000006
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$66.34 |
| Max. Negotiated Rate |
$94.77 |
| Rate for Payer: Aetna Commercial |
$89.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.44
|
| Rate for Payer: Cash Price |
$84.24
|
| Rate for Payer: Cofinity Advantage |
$73.71
|
| Rate for Payer: Cofinity Commercial |
$90.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.24
|
| Rate for Payer: Healthscope Commercial |
$94.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.97
|
| Rate for Payer: PHP Commercial |
$89.50
|
| Rate for Payer: Priority Health SBD |
$66.34
|
|
|
HC PERIPHERAL DIAGNOSTIC CATHETER
|
Facility
|
OP
|
$289.51
|
|
| Hospital Charge Code |
27200145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.78 |
| Max. Negotiated Rate |
$260.56 |
| Rate for Payer: Aetna Commercial |
$246.08
|
| Rate for Payer: Aetna Medicare |
$144.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.18
|
| Rate for Payer: BCBS Complete |
$115.80
|
| Rate for Payer: Cash Price |
$231.61
|
| Rate for Payer: Cofinity Advantage |
$202.66
|
| Rate for Payer: Cofinity Commercial |
$248.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.61
|
| Rate for Payer: Healthscope Commercial |
$260.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.13
|
| Rate for Payer: PHP Commercial |
$246.08
|
| Rate for Payer: Priority Health SBD |
$182.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.18
|
| Rate for Payer: UHC Core |
$150.83
|
| Rate for Payer: UHC Exchange |
$113.78
|
|
|
HC PERIPHERAL DIAGNOSTIC CATHETER
|
Facility
|
IP
|
$289.51
|
|
| Hospital Charge Code |
27200145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$182.39 |
| Max. Negotiated Rate |
$260.56 |
| Rate for Payer: Aetna Commercial |
$246.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.18
|
| Rate for Payer: Cash Price |
$231.61
|
| Rate for Payer: Cofinity Advantage |
$202.66
|
| Rate for Payer: Cofinity Commercial |
$248.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.61
|
| Rate for Payer: Healthscope Commercial |
$260.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.13
|
| Rate for Payer: PHP Commercial |
$246.08
|
| Rate for Payer: Priority Health SBD |
$182.39
|
|
|
HC PERIPHERAL INTRODUCER
|
Facility
|
IP
|
$697.98
|
|
| Hospital Charge Code |
27200146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$439.73 |
| Max. Negotiated Rate |
$628.18 |
| Rate for Payer: Aetna Commercial |
$593.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$453.69
|
| Rate for Payer: Cash Price |
$558.38
|
| Rate for Payer: Cofinity Advantage |
$488.59
|
| Rate for Payer: Cofinity Commercial |
$600.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$558.38
|
| Rate for Payer: Healthscope Commercial |
$628.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$593.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$523.49
|
| Rate for Payer: PHP Commercial |
$593.28
|
| Rate for Payer: Priority Health SBD |
$439.73
|
|
|
HC PERIPHERAL INTRODUCER
|
Facility
|
OP
|
$697.98
|
|
| Hospital Charge Code |
27200146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$274.31 |
| Max. Negotiated Rate |
$628.18 |
| Rate for Payer: Aetna Commercial |
$593.28
|
| Rate for Payer: Aetna Medicare |
$348.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$453.69
|
| Rate for Payer: BCBS Complete |
$279.19
|
| Rate for Payer: Cash Price |
$558.38
|
| Rate for Payer: Cofinity Advantage |
$488.59
|
| Rate for Payer: Cofinity Commercial |
$600.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$558.38
|
| Rate for Payer: Healthscope Commercial |
$628.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$558.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$593.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$523.49
|
| Rate for Payer: PHP Commercial |
$593.28
|
| Rate for Payer: Priority Health SBD |
$439.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$453.69
|
| Rate for Payer: UHC Core |
$363.65
|
| Rate for Payer: UHC Exchange |
$274.31
|
|
|
HC PERITONEAL DIALYSIS
|
Facility
|
OP
|
$976.17
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
83000001
|
|
Hospital Revenue Code
|
881
|
| Min. Negotiated Rate |
$217.44 |
| Max. Negotiated Rate |
$1,344.55 |
| Rate for Payer: Aetna Commercial |
$829.74
|
| Rate for Payer: Aetna Medicare |
$432.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$634.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$519.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$519.70
|
| Rate for Payer: BCBS Complete |
$228.34
|
| Rate for Payer: BCBS MAPPO |
$415.76
|
| Rate for Payer: BCN Medicare Advantage |
$415.76
|
| Rate for Payer: Cash Price |
$780.94
|
| Rate for Payer: Cash Price |
$780.94
|
| Rate for Payer: Cofinity Advantage |
$683.32
|
| Rate for Payer: Cofinity Commercial |
$839.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$780.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$415.76
|
| Rate for Payer: Healthscope Commercial |
$878.55
|
| Rate for Payer: Mclaren Medicaid |
$217.44
|
| Rate for Payer: Mclaren Medicare |
$415.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$436.55
|
| Rate for Payer: Meridian Medicaid |
$436.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$478.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$457.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$829.74
|
| Rate for Payer: Nomi Health Commercial |
$1,247.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$732.13
|
| Rate for Payer: PACE Medicare |
$394.97
|
| Rate for Payer: PACE SWMI |
$415.76
|
| Rate for Payer: PHP Commercial |
$829.74
|
| Rate for Payer: PHP Medicare Advantage |
$415.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$217.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,344.55
|
| Rate for Payer: Priority Health Medicare |
$415.76
|
| Rate for Payer: Priority Health SBD |
$614.99
|
| Rate for Payer: Priority Health Tiered Network |
$1,075.64
|
| Rate for Payer: Railroad Medicare Medicare |
$415.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$634.51
|
| Rate for Payer: UHC Core |
$508.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$415.76
|
| Rate for Payer: UHC Exchange |
$383.63
|
| Rate for Payer: UHC Medicaid |
$217.44
|
| Rate for Payer: UHCCP Medicaid |
$217.44
|
| Rate for Payer: VA VA |
$415.76
|
|
|
HC PERITONEAL DIALYSIS
|
Facility
|
IP
|
$976.17
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
83000001
|
|
Hospital Revenue Code
|
881
|
| Min. Negotiated Rate |
$614.99 |
| Max. Negotiated Rate |
$878.55 |
| Rate for Payer: Aetna Commercial |
$829.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$634.51
|
| Rate for Payer: Cash Price |
$780.94
|
| Rate for Payer: Cofinity Advantage |
$683.32
|
| Rate for Payer: Cofinity Commercial |
$839.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$780.94
|
| Rate for Payer: Healthscope Commercial |
$878.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$829.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$732.13
|
| Rate for Payer: PHP Commercial |
$829.74
|
| Rate for Payer: Priority Health SBD |
$614.99
|
|
|
HC PERITONEAL LVG TRAY
|
Facility
|
IP
|
$721.55
|
|
| Hospital Charge Code |
27000135
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$454.58 |
| Max. Negotiated Rate |
$649.39 |
| Rate for Payer: Aetna Commercial |
$613.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$469.01
|
| Rate for Payer: Cash Price |
$577.24
|
| Rate for Payer: Cofinity Advantage |
$505.08
|
| Rate for Payer: Cofinity Commercial |
$620.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$577.24
|
| Rate for Payer: Healthscope Commercial |
$649.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$613.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$541.16
|
| Rate for Payer: PHP Commercial |
$613.32
|
| Rate for Payer: Priority Health SBD |
$454.58
|
|
|
HC PERITONEAL LVG TRAY
|
Facility
|
OP
|
$721.55
|
|
| Hospital Charge Code |
27000135
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$283.57 |
| Max. Negotiated Rate |
$649.39 |
| Rate for Payer: Aetna Commercial |
$613.32
|
| Rate for Payer: Aetna Medicare |
$360.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$469.01
|
| Rate for Payer: BCBS Complete |
$288.62
|
| Rate for Payer: Cash Price |
$577.24
|
| Rate for Payer: Cofinity Advantage |
$505.08
|
| Rate for Payer: Cofinity Commercial |
$620.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$577.24
|
| Rate for Payer: Healthscope Commercial |
$649.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$577.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$613.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$541.16
|
| Rate for Payer: PHP Commercial |
$613.32
|
| Rate for Payer: Priority Health SBD |
$454.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$469.01
|
| Rate for Payer: UHC Core |
$375.93
|
| Rate for Payer: UHC Exchange |
$283.57
|
|
|
HC PERITONEOGRAM
|
Facility
|
OP
|
$580.04
|
|
|
Service Code
|
CPT 74190
|
| Hospital Charge Code |
32000294
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$227.96 |
| Max. Negotiated Rate |
$1,760.71 |
| Rate for Payer: Aetna Commercial |
$493.03
|
| Rate for Payer: Aetna Medicare |
$566.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$377.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$680.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$680.56
|
| Rate for Payer: BCBS Complete |
$299.01
|
| Rate for Payer: BCBS MAPPO |
$544.45
|
| Rate for Payer: BCBS Trust/PPO |
$779.46
|
| Rate for Payer: BCN Commercial |
$779.46
|
| Rate for Payer: BCN Medicare Advantage |
$544.45
|
| Rate for Payer: Cash Price |
$464.03
|
| Rate for Payer: Cash Price |
$464.03
|
| Rate for Payer: Cofinity Advantage |
$406.03
|
| Rate for Payer: Cofinity Commercial |
$498.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$464.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$544.45
|
| Rate for Payer: Healthscope Commercial |
$522.04
|
| Rate for Payer: Mclaren Medicaid |
$284.75
|
| Rate for Payer: Mclaren Medicare |
$544.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$571.67
|
| Rate for Payer: Meridian Medicaid |
$571.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$626.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$598.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$493.03
|
| Rate for Payer: Nomi Health Commercial |
$1,633.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$435.03
|
| Rate for Payer: PACE Medicare |
$517.23
|
| Rate for Payer: PACE SWMI |
$544.45
|
| Rate for Payer: PHP Commercial |
$493.03
|
| Rate for Payer: PHP Medicare Advantage |
$544.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$284.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,760.71
|
| Rate for Payer: Priority Health Medicare |
$544.45
|
| Rate for Payer: Priority Health SBD |
$365.43
|
| Rate for Payer: Priority Health Tiered Network |
$1,408.57
|
| Rate for Payer: Railroad Medicare Medicare |
$544.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$377.03
|
| Rate for Payer: UHC Core |
$302.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$544.45
|
| Rate for Payer: UHC Exchange |
$227.96
|
| Rate for Payer: UHC Medicaid |
$284.75
|
| Rate for Payer: UHCCP Medicaid |
$284.75
|
| Rate for Payer: VA VA |
$544.45
|
|
|
HC PERITONEOGRAM
|
Facility
|
IP
|
$580.04
|
|
|
Service Code
|
CPT 74190
|
| Hospital Charge Code |
32000294
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$365.43 |
| Max. Negotiated Rate |
$522.04 |
| Rate for Payer: Aetna Commercial |
$493.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$377.03
|
| Rate for Payer: Cash Price |
$464.03
|
| Rate for Payer: Cofinity Advantage |
$406.03
|
| Rate for Payer: Cofinity Commercial |
$498.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$464.03
|
| Rate for Payer: Healthscope Commercial |
$522.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$493.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$435.03
|
| Rate for Payer: PHP Commercial |
$493.03
|
| Rate for Payer: Priority Health SBD |
$365.43
|
|
|
HC PERMANENT PACEMAKER INTRODUCER
|
Facility
|
IP
|
$252.01
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27200062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$158.77 |
| Max. Negotiated Rate |
$226.81 |
| Rate for Payer: Aetna Commercial |
$214.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.81
|
| Rate for Payer: Cash Price |
$201.61
|
| Rate for Payer: Cofinity Advantage |
$176.41
|
| Rate for Payer: Cofinity Commercial |
$216.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.61
|
| Rate for Payer: Healthscope Commercial |
$226.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$189.01
|
| Rate for Payer: PHP Commercial |
$214.21
|
| Rate for Payer: Priority Health SBD |
$158.77
|
|
|
HC PERMANENT PACEMAKER INTRODUCER
|
Facility
|
OP
|
$252.01
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27200062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.04 |
| Max. Negotiated Rate |
$226.81 |
| Rate for Payer: Aetna Commercial |
$214.21
|
| Rate for Payer: Aetna Medicare |
$126.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.81
|
| Rate for Payer: BCBS Complete |
$100.80
|
| Rate for Payer: Cash Price |
$201.61
|
| Rate for Payer: Cofinity Advantage |
$176.41
|
| Rate for Payer: Cofinity Commercial |
$216.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.61
|
| Rate for Payer: Healthscope Commercial |
$226.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$201.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$189.01
|
| Rate for Payer: PHP Commercial |
$214.21
|
| Rate for Payer: Priority Health SBD |
$158.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.81
|
| Rate for Payer: UHC Core |
$131.30
|
| Rate for Payer: UHC Exchange |
$99.04
|
|
|
HC PERMANENT PACEMAKER PACK
|
Facility
|
IP
|
$343.45
|
|
| Hospital Charge Code |
62200010
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$216.37 |
| Max. Negotiated Rate |
$309.11 |
| Rate for Payer: Aetna Commercial |
$291.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.24
|
| Rate for Payer: Cash Price |
$274.76
|
| Rate for Payer: Cofinity Advantage |
$240.41
|
| Rate for Payer: Cofinity Commercial |
$295.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.76
|
| Rate for Payer: Healthscope Commercial |
$309.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.59
|
| Rate for Payer: PHP Commercial |
$291.93
|
| Rate for Payer: Priority Health SBD |
$216.37
|
|
|
HC PERMANENT PACEMAKER PACK
|
Facility
|
OP
|
$343.45
|
|
| Hospital Charge Code |
62200010
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$134.98 |
| Max. Negotiated Rate |
$309.11 |
| Rate for Payer: Aetna Commercial |
$291.93
|
| Rate for Payer: Aetna Medicare |
$171.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.24
|
| Rate for Payer: BCBS Complete |
$137.38
|
| Rate for Payer: Cash Price |
$274.76
|
| Rate for Payer: Cofinity Advantage |
$240.41
|
| Rate for Payer: Cofinity Commercial |
$295.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.76
|
| Rate for Payer: Healthscope Commercial |
$309.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.59
|
| Rate for Payer: PHP Commercial |
$291.93
|
| Rate for Payer: Priority Health SBD |
$216.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.24
|
| Rate for Payer: UHC Core |
$178.94
|
| Rate for Payer: UHC Exchange |
$134.98
|
|
|
HC PERNICIOUS ANEMIA EVALUATION
|
Facility
|
OP
|
$47.76
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
30100186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.89 |
| Max. Negotiated Rate |
$42.98 |
| Rate for Payer: Aetna Commercial |
$40.60
|
| Rate for Payer: Aetna Medicare |
$15.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.85
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: BCBS MAPPO |
$15.08
|
| Rate for Payer: BCBS Trust/PPO |
$16.08
|
| Rate for Payer: BCN Commercial |
$16.08
|
| Rate for Payer: BCN Medicare Advantage |
$15.08
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cofinity Advantage |
$33.43
|
| Rate for Payer: Cofinity Commercial |
$41.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.08
|
| Rate for Payer: Healthscope Commercial |
$42.98
|
| Rate for Payer: Mclaren Medicaid |
$7.89
|
| Rate for Payer: Mclaren Medicare |
$15.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.83
|
| Rate for Payer: Meridian Medicaid |
$15.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.60
|
| Rate for Payer: Nomi Health Commercial |
$22.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.82
|
| Rate for Payer: PACE Medicare |
$14.33
|
| Rate for Payer: PACE SWMI |
$15.08
|
| Rate for Payer: PHP Commercial |
$40.60
|
| Rate for Payer: PHP Medicare Advantage |
$15.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15.08
|
| Rate for Payer: Priority Health Medicare |
$15.08
|
| Rate for Payer: Priority Health SBD |
$30.09
|
| Rate for Payer: Priority Health Tiered Network |
$12.06
|
| Rate for Payer: Railroad Medicare Medicare |
$15.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.62
|
| Rate for Payer: UHC Core |
$22.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.08
|
| Rate for Payer: UHC Exchange |
$22.62
|
| Rate for Payer: UHC Medicaid |
$7.89
|
| Rate for Payer: UHCCP Medicaid |
$7.89
|
| Rate for Payer: VA VA |
$15.08
|
|
|
HC PERNICIOUS ANEMIA EVALUATION
|
Facility
|
IP
|
$47.76
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
30100186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.09 |
| Max. Negotiated Rate |
$42.98 |
| Rate for Payer: Aetna Commercial |
$40.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.04
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cofinity Advantage |
$33.43
|
| Rate for Payer: Cofinity Commercial |
$41.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.21
|
| Rate for Payer: Healthscope Commercial |
$42.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.82
|
| Rate for Payer: PHP Commercial |
$40.60
|
| Rate for Payer: Priority Health SBD |
$30.09
|
|
|
HC PERQ PRCRD DRG 6YR+ W/O CONGENITAL CAR ANOMALY
|
Facility
|
OP
|
$1,804.05
|
|
|
Service Code
|
CPT 33017
|
| Hospital Charge Code |
36100616
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$640.93 |
| Max. Negotiated Rate |
$1,623.64 |
| Rate for Payer: Aetna Commercial |
$1,533.44
|
| Rate for Payer: Aetna Medicare |
$902.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,172.63
|
| Rate for Payer: BCBS Complete |
$721.62
|
| Rate for Payer: BCBS Trust/PPO |
$640.93
|
| Rate for Payer: BCN Commercial |
$640.93
|
| Rate for Payer: Cash Price |
$1,443.24
|
| Rate for Payer: Cash Price |
$1,443.24
|
| Rate for Payer: Cofinity Advantage |
$1,262.84
|
| Rate for Payer: Cofinity Commercial |
$1,551.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,443.24
|
| Rate for Payer: Healthscope Commercial |
$1,623.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,443.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,533.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,353.04
|
| Rate for Payer: PHP Commercial |
$1,533.44
|
| Rate for Payer: Priority Health SBD |
$1,136.55
|
|
|
HC PERQ PRCRD DRG 6YR+ W/O CONGENITAL CAR ANOMALY
|
Facility
|
IP
|
$1,804.05
|
|
|
Service Code
|
CPT 33017
|
| Hospital Charge Code |
36100616
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,136.55 |
| Max. Negotiated Rate |
$1,623.64 |
| Rate for Payer: Aetna Commercial |
$1,533.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,172.63
|
| Rate for Payer: Cash Price |
$1,443.24
|
| Rate for Payer: Cofinity Advantage |
$1,262.84
|
| Rate for Payer: Cofinity Commercial |
$1,551.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,443.24
|
| Rate for Payer: Healthscope Commercial |
$1,623.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,533.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,353.04
|
| Rate for Payer: PHP Commercial |
$1,533.44
|
| Rate for Payer: Priority Health SBD |
$1,136.55
|
|
|
HC PERQ REPLACE GTUBE NOT REQ REV GSTRST TRACT
|
Facility
|
OP
|
$451.89
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
76100320
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$805.08 |
| Rate for Payer: Aetna Commercial |
$384.11
|
| Rate for Payer: Aetna Medicare |
$258.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$311.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$311.19
|
| Rate for Payer: BCBS Complete |
$136.72
|
| Rate for Payer: BCBS MAPPO |
$248.95
|
| Rate for Payer: BCBS Trust/PPO |
$319.98
|
| Rate for Payer: BCN Commercial |
$319.98
|
| Rate for Payer: BCN Medicare Advantage |
$248.95
|
| Rate for Payer: Cash Price |
$361.51
|
| Rate for Payer: Cash Price |
$361.51
|
| Rate for Payer: Cash Price |
$361.51
|
| Rate for Payer: Cofinity Advantage |
$316.32
|
| Rate for Payer: Cofinity Commercial |
$388.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.95
|
| Rate for Payer: Healthscope Commercial |
$406.70
|
| Rate for Payer: Mclaren Medicaid |
$130.20
|
| Rate for Payer: Mclaren Medicare |
$248.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.40
|
| Rate for Payer: Meridian Medicaid |
$261.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$286.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$273.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.11
|
| Rate for Payer: Nomi Health Commercial |
$746.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$338.92
|
| Rate for Payer: PACE Medicare |
$236.50
|
| Rate for Payer: PACE SWMI |
$248.95
|
| Rate for Payer: PHP Commercial |
$384.11
|
| Rate for Payer: PHP Medicare Advantage |
$248.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$805.08
|
| Rate for Payer: Priority Health Medicare |
$248.95
|
| Rate for Payer: Priority Health SBD |
$284.69
|
| Rate for Payer: Priority Health Tiered Network |
$644.06
|
| Rate for Payer: Railroad Medicare Medicare |
$248.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.73
|
| Rate for Payer: UHC Core |
$235.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$248.95
|
| Rate for Payer: UHC Exchange |
$177.59
|
| Rate for Payer: UHC Medicaid |
$130.20
|
| Rate for Payer: UHCCP Medicaid |
$130.20
|
| Rate for Payer: VA VA |
$248.95
|
|
|
HC PERQ REPLACE GTUBE NOT REQ REV GSTRST TRACT
|
Facility
|
IP
|
$451.89
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
76100320
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$284.69 |
| Max. Negotiated Rate |
$406.70 |
| Rate for Payer: Aetna Commercial |
$384.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.73
|
| Rate for Payer: Cash Price |
$361.51
|
| Rate for Payer: Cofinity Advantage |
$316.32
|
| Rate for Payer: Cofinity Commercial |
$388.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.51
|
| Rate for Payer: Healthscope Commercial |
$406.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$338.92
|
| Rate for Payer: PHP Commercial |
$384.11
|
| Rate for Payer: Priority Health SBD |
$284.69
|
|
|
HC PERQ TRANSCATH DRUG DELIVERY BY BALLOON
|
Facility
|
OP
|
$29,485.58
|
|
|
Service Code
|
CPT 0913T
|
| Hospital Charge Code |
48100152
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,015.90 |
| Max. Negotiated Rate |
$37,198.61 |
| Rate for Payer: Aetna Commercial |
$25,062.74
|
| Rate for Payer: Aetna Medicare |
$11,962.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,165.63
|
| 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: BCN Medicare Advantage |
$11,502.68
|
| Rate for Payer: Cash Price |
$23,588.46
|
| Rate for Payer: Cash Price |
$23,588.46
|
| Rate for Payer: Cofinity Advantage |
$20,639.91
|
| Rate for Payer: Cofinity Commercial |
$25,357.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,588.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,502.68
|
| Rate for Payer: Healthscope Commercial |
$26,537.02
|
| 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 |
$25,062.74
|
| Rate for Payer: Nomi Health Commercial |
$34,508.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,114.19
|
| Rate for Payer: PACE Medicare |
$10,927.55
|
| Rate for Payer: PACE SWMI |
$11,502.68
|
| Rate for Payer: PHP Commercial |
$25,062.74
|
| 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 |
$18,575.92
|
| 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
|
|
