|
HC POLYPECTOMY
|
Facility
|
OP
|
$545.16
|
|
| Hospital Charge Code |
36000080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$218.06 |
| Max. Negotiated Rate |
$490.64 |
| Rate for Payer: Aetna Commercial |
$463.39
|
| Rate for Payer: Aetna Medicare |
$272.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$354.35
|
| Rate for Payer: BCBS Complete |
$218.06
|
| Rate for Payer: Cash Price |
$436.13
|
| Rate for Payer: Cofinity Advantage |
$381.61
|
| Rate for Payer: Cofinity Commercial |
$468.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.13
|
| Rate for Payer: Healthscope Commercial |
$490.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$436.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$408.87
|
| Rate for Payer: PHP Commercial |
$463.39
|
| Rate for Payer: Priority Health SBD |
$343.45
|
|
|
HC POLYPECTOMY
|
Facility
|
IP
|
$545.16
|
|
| Hospital Charge Code |
36000080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$343.45 |
| Max. Negotiated Rate |
$490.64 |
| Rate for Payer: Aetna Commercial |
$463.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$354.35
|
| Rate for Payer: Cash Price |
$436.13
|
| Rate for Payer: Cofinity Advantage |
$381.61
|
| Rate for Payer: Cofinity Commercial |
$468.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.13
|
| Rate for Payer: Healthscope Commercial |
$490.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$408.87
|
| Rate for Payer: PHP Commercial |
$463.39
|
| Rate for Payer: Priority Health SBD |
$343.45
|
|
|
HC POLYPECTOMY ADDL 45 MIN OR MORE
|
Facility
|
OP
|
$186.38
|
|
| Hospital Charge Code |
36000004
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$74.55 |
| Max. Negotiated Rate |
$167.74 |
| Rate for Payer: Aetna Commercial |
$158.42
|
| Rate for Payer: Aetna Medicare |
$93.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.15
|
| Rate for Payer: BCBS Complete |
$74.55
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cofinity Advantage |
$130.47
|
| Rate for Payer: Cofinity Commercial |
$160.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.10
|
| Rate for Payer: Healthscope Commercial |
$167.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.78
|
| Rate for Payer: PHP Commercial |
$158.42
|
| Rate for Payer: Priority Health SBD |
$117.42
|
|
|
HC POLYPECTOMY ADDL 45 MIN OR MORE
|
Facility
|
IP
|
$186.38
|
|
| Hospital Charge Code |
36000004
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$117.42 |
| Max. Negotiated Rate |
$167.74 |
| Rate for Payer: Aetna Commercial |
$158.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.15
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cofinity Advantage |
$130.47
|
| Rate for Payer: Cofinity Commercial |
$160.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.10
|
| Rate for Payer: Healthscope Commercial |
$167.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.78
|
| Rate for Payer: PHP Commercial |
$158.42
|
| Rate for Payer: Priority Health SBD |
$117.42
|
|
|
HC PORPHYRIN URINE QUANTITATIVE
|
Facility
|
OP
|
$33.96
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
30100395
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.69 |
| Max. Negotiated Rate |
$30.56 |
| Rate for Payer: Aetna Commercial |
$28.87
|
| Rate for Payer: Aetna Medicare |
$15.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.39
|
| Rate for Payer: BCBS Complete |
$8.08
|
| Rate for Payer: BCBS MAPPO |
$14.71
|
| Rate for Payer: BCBS Trust/PPO |
$15.68
|
| Rate for Payer: BCN Commercial |
$15.68
|
| Rate for Payer: BCN Medicare Advantage |
$14.71
|
| Rate for Payer: Cash Price |
$27.17
|
| Rate for Payer: Cash Price |
$27.17
|
| Rate for Payer: Cofinity Advantage |
$23.77
|
| Rate for Payer: Cofinity Commercial |
$29.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.71
|
| Rate for Payer: Healthscope Commercial |
$30.56
|
| Rate for Payer: Mclaren Medicaid |
$7.69
|
| Rate for Payer: Mclaren Medicare |
$14.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.45
|
| Rate for Payer: Meridian Medicaid |
$15.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.87
|
| Rate for Payer: Nomi Health Commercial |
$22.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.47
|
| Rate for Payer: PACE Medicare |
$13.97
|
| Rate for Payer: PACE SWMI |
$14.71
|
| Rate for Payer: PHP Commercial |
$28.87
|
| Rate for Payer: PHP Medicare Advantage |
$14.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.71
|
| Rate for Payer: Priority Health Medicare |
$14.71
|
| Rate for Payer: Priority Health SBD |
$21.39
|
| Rate for Payer: Priority Health Tiered Network |
$11.77
|
| Rate for Payer: Railroad Medicare Medicare |
$14.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.07
|
| Rate for Payer: UHC Core |
$22.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.71
|
| Rate for Payer: UHC Exchange |
$22.07
|
| Rate for Payer: UHC Medicaid |
$7.69
|
| Rate for Payer: UHCCP Medicaid |
$7.69
|
| Rate for Payer: VA VA |
$14.71
|
|
|
HC PORPHYRIN URINE QUANTITATIVE
|
Facility
|
IP
|
$33.96
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
30100395
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.39 |
| Max. Negotiated Rate |
$30.56 |
| Rate for Payer: Aetna Commercial |
$28.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.07
|
| Rate for Payer: Cash Price |
$27.17
|
| Rate for Payer: Cofinity Advantage |
$23.77
|
| Rate for Payer: Cofinity Commercial |
$29.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.17
|
| Rate for Payer: Healthscope Commercial |
$30.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.47
|
| Rate for Payer: PHP Commercial |
$28.87
|
| Rate for Payer: Priority Health SBD |
$21.39
|
|
|
HC PORPHYRIN URINE QUANTITATIVE C
|
Facility
|
IP
|
$32.25
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
30100394
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.32 |
| Max. Negotiated Rate |
$29.02 |
| Rate for Payer: Aetna Commercial |
$27.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.96
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cofinity Advantage |
$22.57
|
| Rate for Payer: Cofinity Commercial |
$27.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.80
|
| Rate for Payer: Healthscope Commercial |
$29.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.19
|
| Rate for Payer: PHP Commercial |
$27.41
|
| Rate for Payer: Priority Health SBD |
$20.32
|
|
|
HC PORPHYRIN URINE QUANTITATIVE C
|
Facility
|
OP
|
$32.25
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
30100394
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$29.02 |
| Rate for Payer: Aetna Commercial |
$27.41
|
| Rate for Payer: Aetna Medicare |
$8.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.55
|
| Rate for Payer: BCBS Complete |
$4.64
|
| Rate for Payer: BCBS MAPPO |
$8.44
|
| Rate for Payer: BCBS Trust/PPO |
$9.00
|
| Rate for Payer: BCN Commercial |
$9.00
|
| Rate for Payer: BCN Medicare Advantage |
$8.44
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cofinity Advantage |
$22.57
|
| Rate for Payer: Cofinity Commercial |
$27.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.44
|
| Rate for Payer: Healthscope Commercial |
$29.02
|
| Rate for Payer: Mclaren Medicaid |
$4.41
|
| Rate for Payer: Mclaren Medicare |
$8.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.86
|
| Rate for Payer: Meridian Medicaid |
$8.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.41
|
| Rate for Payer: Nomi Health Commercial |
$12.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.19
|
| Rate for Payer: PACE Medicare |
$8.02
|
| Rate for Payer: PACE SWMI |
$8.44
|
| Rate for Payer: PHP Commercial |
$27.41
|
| Rate for Payer: PHP Medicare Advantage |
$8.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8.44
|
| Rate for Payer: Priority Health Medicare |
$8.44
|
| Rate for Payer: Priority Health SBD |
$20.32
|
| Rate for Payer: Priority Health Tiered Network |
$6.75
|
| Rate for Payer: Railroad Medicare Medicare |
$8.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.66
|
| Rate for Payer: UHC Core |
$12.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.44
|
| Rate for Payer: UHC Exchange |
$12.66
|
| Rate for Payer: UHC Medicaid |
$4.41
|
| Rate for Payer: UHCCP Medicaid |
$4.41
|
| Rate for Payer: VA VA |
$8.44
|
|
|
HC PORTAL FILMS
|
Facility
|
OP
|
$272.73
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
33300023
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$37.10 |
| Max. Negotiated Rate |
$245.46 |
| Rate for Payer: Aetna Commercial |
$231.82
|
| Rate for Payer: Aetna Medicare |
$136.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.27
|
| Rate for Payer: BCBS Complete |
$109.09
|
| Rate for Payer: BCBS Trust/PPO |
$37.10
|
| Rate for Payer: BCN Commercial |
$37.10
|
| Rate for Payer: Cash Price |
$218.18
|
| Rate for Payer: Cash Price |
$218.18
|
| Rate for Payer: Cofinity Advantage |
$190.91
|
| Rate for Payer: Cofinity Commercial |
$234.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.18
|
| Rate for Payer: Healthscope Commercial |
$245.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.55
|
| Rate for Payer: PHP Commercial |
$231.82
|
| Rate for Payer: Priority Health SBD |
$171.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.27
|
| Rate for Payer: UHC Core |
$142.09
|
| Rate for Payer: UHC Exchange |
$107.18
|
|
|
HC PORTAL FILMS
|
Facility
|
IP
|
$272.73
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
33300023
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$171.82 |
| Max. Negotiated Rate |
$245.46 |
| Rate for Payer: Aetna Commercial |
$231.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.27
|
| Rate for Payer: Cash Price |
$218.18
|
| Rate for Payer: Cofinity Advantage |
$190.91
|
| Rate for Payer: Cofinity Commercial |
$234.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.18
|
| Rate for Payer: Healthscope Commercial |
$245.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.55
|
| Rate for Payer: PHP Commercial |
$231.82
|
| Rate for Payer: Priority Health SBD |
$171.82
|
|
|
HC PORT PLAN, TOTAL BODY
|
Facility
|
IP
|
$564.56
|
|
|
Service Code
|
CPT 77321
|
| Hospital Charge Code |
33300031
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$355.67 |
| Max. Negotiated Rate |
$508.10 |
| Rate for Payer: Aetna Commercial |
$479.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$366.96
|
| Rate for Payer: Cash Price |
$451.65
|
| Rate for Payer: Cofinity Advantage |
$395.19
|
| Rate for Payer: Cofinity Commercial |
$485.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$451.65
|
| Rate for Payer: Healthscope Commercial |
$508.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$479.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$423.42
|
| Rate for Payer: PHP Commercial |
$479.88
|
| Rate for Payer: Priority Health SBD |
$355.67
|
|
|
HC PORT PLAN, TOTAL BODY
|
Facility
|
OP
|
$564.56
|
|
|
Service Code
|
CPT 77321
|
| Hospital Charge Code |
33300031
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$102.21 |
| Max. Negotiated Rate |
$1,206.50 |
| Rate for Payer: Aetna Commercial |
$479.88
|
| Rate for Payer: Aetna Medicare |
$388.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$366.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$466.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$466.35
|
| Rate for Payer: BCBS Complete |
$204.90
|
| Rate for Payer: BCBS MAPPO |
$373.08
|
| Rate for Payer: BCBS Trust/PPO |
$102.21
|
| Rate for Payer: BCN Commercial |
$102.21
|
| Rate for Payer: BCN Medicare Advantage |
$373.08
|
| Rate for Payer: Cash Price |
$451.65
|
| Rate for Payer: Cash Price |
$451.65
|
| Rate for Payer: Cofinity Advantage |
$395.19
|
| Rate for Payer: Cofinity Commercial |
$485.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$451.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$373.08
|
| Rate for Payer: Healthscope Commercial |
$508.10
|
| Rate for Payer: Mclaren Medicaid |
$195.12
|
| Rate for Payer: Mclaren Medicare |
$373.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$391.73
|
| Rate for Payer: Meridian Medicaid |
$391.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$429.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$410.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$479.88
|
| Rate for Payer: Nomi Health Commercial |
$1,119.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$423.42
|
| Rate for Payer: PACE Medicare |
$354.43
|
| Rate for Payer: PACE SWMI |
$373.08
|
| Rate for Payer: PHP Commercial |
$479.88
|
| Rate for Payer: PHP Medicare Advantage |
$373.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$195.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,206.50
|
| Rate for Payer: Priority Health Medicare |
$373.08
|
| Rate for Payer: Priority Health SBD |
$355.67
|
| Rate for Payer: Priority Health Tiered Network |
$965.20
|
| Rate for Payer: Railroad Medicare Medicare |
$373.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$366.96
|
| Rate for Payer: UHC Core |
$294.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$373.08
|
| Rate for Payer: UHC Exchange |
$221.87
|
| Rate for Payer: UHC Medicaid |
$195.12
|
| Rate for Payer: UHCCP Medicaid |
$195.12
|
| Rate for Payer: VA VA |
$373.08
|
|
|
HC POSLUMA PER MCI
|
Facility
|
IP
|
$1,715.94
|
|
|
Service Code
|
HCPCS A9608
|
| Hospital Charge Code |
34300038
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,081.04 |
| Max. Negotiated Rate |
$1,544.35 |
| Rate for Payer: Aetna Commercial |
$1,458.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,115.36
|
| Rate for Payer: Cash Price |
$1,372.75
|
| Rate for Payer: Cofinity Advantage |
$1,201.16
|
| Rate for Payer: Cofinity Commercial |
$1,475.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,372.75
|
| Rate for Payer: Healthscope Commercial |
$1,544.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,458.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,286.95
|
| Rate for Payer: PHP Commercial |
$1,458.55
|
| Rate for Payer: Priority Health SBD |
$1,081.04
|
|
|
HC POSLUMA PER MCI
|
Facility
|
OP
|
$1,715.94
|
|
|
Service Code
|
HCPCS A9608
|
| Hospital Charge Code |
34300038
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$351.05 |
| Max. Negotiated Rate |
$2,116.99 |
| Rate for Payer: Aetna Commercial |
$1,458.55
|
| Rate for Payer: Aetna Medicare |
$698.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,115.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$839.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$839.02
|
| Rate for Payer: BCBS Complete |
$368.63
|
| Rate for Payer: BCBS MAPPO |
$671.22
|
| Rate for Payer: BCBS Trust/PPO |
$900.20
|
| Rate for Payer: BCN Commercial |
$900.20
|
| Rate for Payer: BCN Medicare Advantage |
$671.22
|
| Rate for Payer: Cash Price |
$1,372.75
|
| Rate for Payer: Cash Price |
$1,372.75
|
| Rate for Payer: Cofinity Advantage |
$1,201.16
|
| Rate for Payer: Cofinity Commercial |
$1,475.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,372.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$671.22
|
| Rate for Payer: Healthscope Commercial |
$1,544.35
|
| Rate for Payer: Mclaren Medicaid |
$351.05
|
| Rate for Payer: Mclaren Medicare |
$671.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$704.78
|
| Rate for Payer: Meridian Medicaid |
$704.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$771.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$738.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,458.55
|
| Rate for Payer: Nomi Health Commercial |
$2,013.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,286.95
|
| Rate for Payer: PACE Medicare |
$637.66
|
| Rate for Payer: PACE SWMI |
$671.22
|
| Rate for Payer: PHP Commercial |
$1,458.55
|
| Rate for Payer: PHP Medicare Advantage |
$671.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$351.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,116.99
|
| Rate for Payer: Priority Health Medicare |
$671.22
|
| Rate for Payer: Priority Health SBD |
$1,081.04
|
| Rate for Payer: Priority Health Tiered Network |
$1,693.59
|
| Rate for Payer: Railroad Medicare Medicare |
$671.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,107.51
|
| Rate for Payer: UHC Core |
$1,107.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$671.22
|
| Rate for Payer: UHC Exchange |
$1,107.51
|
| Rate for Payer: UHC Medicaid |
$351.05
|
| Rate for Payer: UHCCP Medicaid |
$351.05
|
| Rate for Payer: VA VA |
$671.22
|
|
|
HC POST MASTECTOMY SLEEVE A
|
Facility
|
OP
|
$70.75
|
|
| Hospital Charge Code |
96000049
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.80 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Aetna Commercial |
$60.14
|
| Rate for Payer: Aetna Medicare |
$35.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.99
|
| Rate for Payer: BCBS Complete |
$28.30
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Advantage |
$49.52
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Healthscope Commercial |
$63.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.06
|
| Rate for Payer: PHP Commercial |
$60.14
|
| Rate for Payer: Priority Health SBD |
$44.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.99
|
| Rate for Payer: UHC Core |
$36.86
|
| Rate for Payer: UHC Exchange |
$27.80
|
|
|
HC POST MASTECTOMY SLEEVE A
|
Facility
|
IP
|
$70.75
|
|
| Hospital Charge Code |
96000049
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.57 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Aetna Commercial |
$60.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.99
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Advantage |
$49.52
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Healthscope Commercial |
$63.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.06
|
| Rate for Payer: PHP Commercial |
$60.14
|
| Rate for Payer: Priority Health SBD |
$44.57
|
|
|
HC POST MASTECTOMY SLEEVE B
|
Facility
|
OP
|
$83.23
|
|
| Hospital Charge Code |
96000050
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.71 |
| Max. Negotiated Rate |
$74.91 |
| Rate for Payer: Aetna Commercial |
$70.75
|
| Rate for Payer: Aetna Medicare |
$41.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.10
|
| Rate for Payer: BCBS Complete |
$33.29
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cofinity Advantage |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$71.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.58
|
| Rate for Payer: Healthscope Commercial |
$74.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.42
|
| Rate for Payer: PHP Commercial |
$70.75
|
| Rate for Payer: Priority Health SBD |
$52.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.10
|
| Rate for Payer: UHC Core |
$43.36
|
| Rate for Payer: UHC Exchange |
$32.71
|
|
|
HC POST MASTECTOMY SLEEVE B
|
Facility
|
IP
|
$83.23
|
|
| Hospital Charge Code |
96000050
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$52.43 |
| Max. Negotiated Rate |
$74.91 |
| Rate for Payer: Aetna Commercial |
$70.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.10
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cofinity Advantage |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$71.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.58
|
| Rate for Payer: Healthscope Commercial |
$74.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.42
|
| Rate for Payer: PHP Commercial |
$70.75
|
| Rate for Payer: Priority Health SBD |
$52.43
|
|
|
HC POST MASTECTOMY SLEEVE C
|
Facility
|
IP
|
$224.73
|
|
| Hospital Charge Code |
96000051
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$141.58 |
| Max. Negotiated Rate |
$202.26 |
| Rate for Payer: Aetna Commercial |
$191.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.07
|
| Rate for Payer: Cash Price |
$179.78
|
| Rate for Payer: Cofinity Advantage |
$157.31
|
| Rate for Payer: Cofinity Commercial |
$193.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.78
|
| Rate for Payer: Healthscope Commercial |
$202.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.55
|
| Rate for Payer: PHP Commercial |
$191.02
|
| Rate for Payer: Priority Health SBD |
$141.58
|
|
|
HC POST MASTECTOMY SLEEVE C
|
Facility
|
OP
|
$224.73
|
|
| Hospital Charge Code |
96000051
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$88.32 |
| Max. Negotiated Rate |
$202.26 |
| Rate for Payer: Aetna Commercial |
$191.02
|
| Rate for Payer: Aetna Medicare |
$112.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.07
|
| Rate for Payer: BCBS Complete |
$89.89
|
| Rate for Payer: Cash Price |
$179.78
|
| Rate for Payer: Cofinity Advantage |
$157.31
|
| Rate for Payer: Cofinity Commercial |
$193.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.78
|
| Rate for Payer: Healthscope Commercial |
$202.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$179.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.55
|
| Rate for Payer: PHP Commercial |
$191.02
|
| Rate for Payer: Priority Health SBD |
$141.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.07
|
| Rate for Payer: UHC Core |
$117.08
|
| Rate for Payer: UHC Exchange |
$88.32
|
|
|
HC POST MASTECTOMY SLEEVE D
|
Facility
|
IP
|
$255.94
|
|
| Hospital Charge Code |
96000052
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$161.24 |
| Max. Negotiated Rate |
$230.35 |
| Rate for Payer: Aetna Commercial |
$217.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.36
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cofinity Advantage |
$179.16
|
| Rate for Payer: Cofinity Commercial |
$220.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.75
|
| Rate for Payer: Healthscope Commercial |
$230.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.96
|
| Rate for Payer: PHP Commercial |
$217.55
|
| Rate for Payer: Priority Health SBD |
$161.24
|
|
|
HC POST MASTECTOMY SLEEVE D
|
Facility
|
OP
|
$255.94
|
|
| Hospital Charge Code |
96000052
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$100.58 |
| Max. Negotiated Rate |
$230.35 |
| Rate for Payer: Aetna Commercial |
$217.55
|
| Rate for Payer: Aetna Medicare |
$127.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.36
|
| Rate for Payer: BCBS Complete |
$102.38
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cofinity Advantage |
$179.16
|
| Rate for Payer: Cofinity Commercial |
$220.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.75
|
| Rate for Payer: Healthscope Commercial |
$230.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.96
|
| Rate for Payer: PHP Commercial |
$217.55
|
| Rate for Payer: Priority Health SBD |
$161.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.36
|
| Rate for Payer: UHC Core |
$133.34
|
| Rate for Payer: UHC Exchange |
$100.58
|
|
|
HC POST-OP
|
Facility
|
OP
|
$18.43
|
|
| Hospital Charge Code |
27000136
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$16.59 |
| Rate for Payer: Aetna Commercial |
$15.67
|
| Rate for Payer: Aetna Medicare |
$9.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.98
|
| Rate for Payer: BCBS Complete |
$7.37
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Advantage |
$12.90
|
| Rate for Payer: Cofinity Commercial |
$15.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Healthscope Commercial |
$16.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.82
|
| Rate for Payer: PHP Commercial |
$15.67
|
| Rate for Payer: Priority Health SBD |
$11.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.98
|
| Rate for Payer: UHC Core |
$9.60
|
| Rate for Payer: UHC Exchange |
$7.24
|
|
|
HC POST-OP
|
Facility
|
IP
|
$18.43
|
|
| Hospital Charge Code |
27000136
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.61 |
| Max. Negotiated Rate |
$16.59 |
| Rate for Payer: Aetna Commercial |
$15.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.98
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Advantage |
$12.90
|
| Rate for Payer: Cofinity Commercial |
$15.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Healthscope Commercial |
$16.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.82
|
| Rate for Payer: PHP Commercial |
$15.67
|
| Rate for Payer: Priority Health SBD |
$11.61
|
|
|
HC POST TIBIAL NEUROSTIMULATION PERC NEEDLE ELECTRODE
|
Facility
|
OP
|
$393.93
|
|
|
Service Code
|
CPT 64566
|
| Hospital Charge Code |
76100208
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.65 |
| Max. Negotiated Rate |
$989.08 |
| Rate for Payer: Aetna Commercial |
$334.84
|
| Rate for Payer: Aetna Medicare |
$318.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$108.65
|
| Rate for Payer: BCN Commercial |
$108.65
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Cash Price |
$315.14
|
| Rate for Payer: Cash Price |
$315.14
|
| Rate for Payer: Cash Price |
$315.14
|
| Rate for Payer: Cofinity Advantage |
$275.75
|
| Rate for Payer: Cofinity Commercial |
$338.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Healthscope Commercial |
$354.54
|
| Rate for Payer: Mclaren Medicaid |
$159.96
|
| Rate for Payer: Mclaren Medicare |
$305.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.14
|
| Rate for Payer: Meridian Medicaid |
$321.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.84
|
| Rate for Payer: Nomi Health Commercial |
$917.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.45
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Commercial |
$334.84
|
| Rate for Payer: PHP Medicare Advantage |
$305.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$989.08
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health SBD |
$248.18
|
| Rate for Payer: Priority Health Tiered Network |
$791.26
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.05
|
| Rate for Payer: UHC Core |
$205.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Exchange |
$154.81
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
|
