|
HC PULSERIDER
|
Facility
|
IP
|
$17,410.45
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800119
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,968.58 |
| Max. Negotiated Rate |
$15,669.41 |
| Rate for Payer: Aetna Commercial |
$14,798.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,316.79
|
| Rate for Payer: Cash Price |
$13,928.36
|
| Rate for Payer: Cofinity Advantage |
$12,187.32
|
| Rate for Payer: Cofinity Commercial |
$14,972.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,928.36
|
| Rate for Payer: Healthscope Commercial |
$15,669.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,798.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,057.84
|
| Rate for Payer: PHP Commercial |
$14,798.88
|
| Rate for Payer: Priority Health SBD |
$10,968.58
|
|
|
HC PULSERIDER
|
Facility
|
OP
|
$17,410.45
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800119
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,842.31 |
| Max. Negotiated Rate |
$15,669.41 |
| Rate for Payer: Aetna Commercial |
$14,798.88
|
| Rate for Payer: Aetna Medicare |
$8,705.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,316.79
|
| Rate for Payer: BCBS Complete |
$6,964.18
|
| Rate for Payer: Cash Price |
$13,928.36
|
| Rate for Payer: Cofinity Advantage |
$12,187.32
|
| Rate for Payer: Cofinity Commercial |
$14,972.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,928.36
|
| Rate for Payer: Healthscope Commercial |
$15,669.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,928.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,798.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,057.84
|
| Rate for Payer: PHP Commercial |
$14,798.88
|
| Rate for Payer: Priority Health SBD |
$10,968.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,316.79
|
| Rate for Payer: UHC Core |
$9,070.84
|
| Rate for Payer: UHC Exchange |
$6,842.31
|
|
|
HC PUMP CENTRFUGAL
|
Facility
|
IP
|
$466.40
|
|
| Hospital Charge Code |
27000382
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$293.83 |
| Max. Negotiated Rate |
$419.76 |
| Rate for Payer: Aetna Commercial |
$396.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.16
|
| Rate for Payer: Cash Price |
$373.12
|
| Rate for Payer: Cofinity Advantage |
$326.48
|
| Rate for Payer: Cofinity Commercial |
$401.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$373.12
|
| Rate for Payer: Healthscope Commercial |
$419.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$396.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.80
|
| Rate for Payer: PHP Commercial |
$396.44
|
| Rate for Payer: Priority Health SBD |
$293.83
|
|
|
HC PUMP CENTRFUGAL
|
Facility
|
OP
|
$466.40
|
|
| Hospital Charge Code |
27000382
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$183.30 |
| Max. Negotiated Rate |
$419.76 |
| Rate for Payer: Aetna Commercial |
$396.44
|
| Rate for Payer: Aetna Medicare |
$233.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.16
|
| Rate for Payer: BCBS Complete |
$186.56
|
| Rate for Payer: Cash Price |
$373.12
|
| Rate for Payer: Cofinity Advantage |
$326.48
|
| Rate for Payer: Cofinity Commercial |
$401.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$373.12
|
| Rate for Payer: Healthscope Commercial |
$419.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$373.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$396.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.80
|
| Rate for Payer: PHP Commercial |
$396.44
|
| Rate for Payer: Priority Health SBD |
$293.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$303.16
|
| Rate for Payer: UHC Core |
$242.99
|
| Rate for Payer: UHC Exchange |
$183.30
|
|
|
HC PUNCH BIOPSY SKIN ADDL LESION
|
Facility
|
OP
|
$85.22
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
76100151
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.49 |
| Max. Negotiated Rate |
$135.44 |
| Rate for Payer: Aetna Commercial |
$72.44
|
| Rate for Payer: Aetna Medicare |
$42.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.39
|
| Rate for Payer: BCBS Complete |
$34.09
|
| Rate for Payer: BCBS Trust/PPO |
$135.44
|
| Rate for Payer: BCN Commercial |
$135.44
|
| Rate for Payer: Cash Price |
$68.18
|
| Rate for Payer: Cash Price |
$68.18
|
| Rate for Payer: Cofinity Advantage |
$59.65
|
| Rate for Payer: Cofinity Commercial |
$73.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.18
|
| Rate for Payer: Healthscope Commercial |
$76.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.91
|
| Rate for Payer: PHP Commercial |
$72.44
|
| Rate for Payer: Priority Health SBD |
$53.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.39
|
| Rate for Payer: UHC Core |
$44.40
|
| Rate for Payer: UHC Exchange |
$33.49
|
|
|
HC PUNCH BIOPSY SKIN ADDL LESION
|
Facility
|
IP
|
$85.22
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
76100151
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.69 |
| Max. Negotiated Rate |
$76.70 |
| Rate for Payer: Aetna Commercial |
$72.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.39
|
| Rate for Payer: Cash Price |
$68.18
|
| Rate for Payer: Cofinity Advantage |
$59.65
|
| Rate for Payer: Cofinity Commercial |
$73.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.18
|
| Rate for Payer: Healthscope Commercial |
$76.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.91
|
| Rate for Payer: PHP Commercial |
$72.44
|
| Rate for Payer: Priority Health SBD |
$53.69
|
|
|
HC PUNCH BIOPSY SKIN SINGLE LESION
|
Facility
|
IP
|
$325.50
|
|
|
Service Code
|
CPT 11104
|
| Hospital Charge Code |
76100150
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$205.06 |
| Max. Negotiated Rate |
$292.95 |
| Rate for Payer: Aetna Commercial |
$276.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.57
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cofinity Advantage |
$227.85
|
| Rate for Payer: Cofinity Commercial |
$279.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.40
|
| Rate for Payer: Healthscope Commercial |
$292.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.12
|
| Rate for Payer: PHP Commercial |
$276.68
|
| Rate for Payer: Priority Health SBD |
$205.06
|
|
|
HC PUNCH BIOPSY SKIN SINGLE LESION
|
Facility
|
OP
|
$325.50
|
|
|
Service Code
|
CPT 11104
|
| Hospital Charge Code |
76100150
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.64 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Commercial |
$276.68
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$120.64
|
| Rate for Payer: BCN Commercial |
$120.64
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cofinity Advantage |
$227.85
|
| Rate for Payer: Cofinity Commercial |
$279.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$292.95
|
| Rate for Payer: Mclaren Medicaid |
$211.84
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.68
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.12
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$276.68
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health SBD |
$205.06
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.57
|
| Rate for Payer: UHC Core |
$169.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Exchange |
$127.92
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
HC PUNCTURE ASPIRATION, HYDROCELE
|
Facility
|
OP
|
$971.03
|
|
|
Service Code
|
CPT 55000
|
| Hospital Charge Code |
76100259
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.10 |
| Max. Negotiated Rate |
$2,281.79 |
| Rate for Payer: Aetna Commercial |
$825.38
|
| Rate for Payer: Aetna Medicare |
$733.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$631.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$881.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$881.99
|
| Rate for Payer: BCBS Complete |
$387.51
|
| Rate for Payer: BCBS MAPPO |
$705.59
|
| Rate for Payer: BCBS Trust/PPO |
$61.10
|
| Rate for Payer: BCN Commercial |
$61.10
|
| Rate for Payer: BCN Medicare Advantage |
$705.59
|
| Rate for Payer: Cash Price |
$776.82
|
| Rate for Payer: Cash Price |
$776.82
|
| Rate for Payer: Cash Price |
$776.82
|
| Rate for Payer: Cofinity Advantage |
$679.72
|
| Rate for Payer: Cofinity Commercial |
$835.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$776.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.59
|
| Rate for Payer: Healthscope Commercial |
$873.93
|
| Rate for Payer: Mclaren Medicaid |
$369.02
|
| Rate for Payer: Mclaren Medicare |
$705.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$740.87
|
| Rate for Payer: Meridian Medicaid |
$740.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$811.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$776.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$825.38
|
| Rate for Payer: Nomi Health Commercial |
$2,116.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$728.27
|
| Rate for Payer: PACE Medicare |
$670.31
|
| Rate for Payer: PACE SWMI |
$705.59
|
| Rate for Payer: PHP Commercial |
$825.38
|
| Rate for Payer: PHP Medicare Advantage |
$705.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,281.79
|
| Rate for Payer: Priority Health Medicare |
$705.59
|
| Rate for Payer: Priority Health SBD |
$611.75
|
| Rate for Payer: Priority Health Tiered Network |
$1,825.43
|
| Rate for Payer: Railroad Medicare Medicare |
$705.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$631.17
|
| Rate for Payer: UHC Core |
$505.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$705.59
|
| Rate for Payer: UHC Exchange |
$381.61
|
| Rate for Payer: UHC Medicaid |
$369.02
|
| Rate for Payer: UHCCP Medicaid |
$369.02
|
| Rate for Payer: VA VA |
$705.59
|
|
|
HC PUNCTURE ASPIRATION, HYDROCELE
|
Facility
|
IP
|
$971.03
|
|
|
Service Code
|
CPT 55000
|
| Hospital Charge Code |
76100259
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$611.75 |
| Max. Negotiated Rate |
$873.93 |
| Rate for Payer: Aetna Commercial |
$825.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$631.17
|
| Rate for Payer: Cash Price |
$776.82
|
| Rate for Payer: Cofinity Advantage |
$679.72
|
| Rate for Payer: Cofinity Commercial |
$835.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$776.82
|
| Rate for Payer: Healthscope Commercial |
$873.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$825.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$728.27
|
| Rate for Payer: PHP Commercial |
$825.38
|
| Rate for Payer: Priority Health SBD |
$611.75
|
|
|
HC PUNCTURE ASPIRATION OF ABSCESS
|
Facility
|
IP
|
$280.80
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
36100004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$176.90 |
| Max. Negotiated Rate |
$252.72 |
| Rate for Payer: Aetna Commercial |
$238.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.52
|
| Rate for Payer: Cash Price |
$224.64
|
| Rate for Payer: Cofinity Advantage |
$196.56
|
| Rate for Payer: Cofinity Commercial |
$241.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.64
|
| Rate for Payer: Healthscope Commercial |
$252.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.60
|
| Rate for Payer: PHP Commercial |
$238.68
|
| Rate for Payer: Priority Health SBD |
$176.90
|
|
|
HC PUNCTURE ASPIRATION OF ABSCESS
|
Facility
|
OP
|
$280.80
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
36100004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.35 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Commercial |
$238.68
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$214.05
|
| Rate for Payer: BCN Commercial |
$214.05
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$224.64
|
| Rate for Payer: Cash Price |
$224.64
|
| Rate for Payer: Cash Price |
$224.64
|
| Rate for Payer: Cofinity Advantage |
$196.56
|
| Rate for Payer: Cofinity Commercial |
$241.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$252.72
|
| Rate for Payer: Mclaren Medicaid |
$211.84
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.68
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.60
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$238.68
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health SBD |
$176.90
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.52
|
| Rate for Payer: UHC Core |
$146.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Exchange |
$110.35
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
HC PUNCTURE CERVICAL
|
Facility
|
IP
|
$793.26
|
|
|
Service Code
|
CPT 61050
|
| Hospital Charge Code |
36100268
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$499.75 |
| Max. Negotiated Rate |
$713.93 |
| Rate for Payer: Aetna Commercial |
$674.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.62
|
| Rate for Payer: Cash Price |
$634.61
|
| Rate for Payer: Cofinity Advantage |
$555.28
|
| Rate for Payer: Cofinity Commercial |
$682.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.61
|
| Rate for Payer: Healthscope Commercial |
$713.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.95
|
| Rate for Payer: PHP Commercial |
$674.27
|
| Rate for Payer: Priority Health SBD |
$499.75
|
|
|
HC PUNCTURE CERVICAL
|
Facility
|
OP
|
$793.26
|
|
|
Service Code
|
CPT 61050
|
| Hospital Charge Code |
36100268
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$159.96 |
| Max. Negotiated Rate |
$989.08 |
| Rate for Payer: Aetna Commercial |
$674.27
|
| Rate for Payer: Aetna Medicare |
$318.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.62
|
| 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 |
$505.48
|
| Rate for Payer: BCN Commercial |
$505.48
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Cash Price |
$634.61
|
| Rate for Payer: Cash Price |
$634.61
|
| Rate for Payer: Cash Price |
$634.61
|
| Rate for Payer: Cofinity Advantage |
$555.28
|
| Rate for Payer: Cofinity Commercial |
$682.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Healthscope Commercial |
$713.93
|
| 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 |
$674.27
|
| Rate for Payer: Nomi Health Commercial |
$917.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.95
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Commercial |
$674.27
|
| 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 |
$499.75
|
| Rate for Payer: Priority Health Tiered Network |
$791.26
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
|
|
HC PUNCTURE WITH INJECTION CERVICAL
|
Facility
|
IP
|
$793.26
|
|
|
Service Code
|
CPT 61055
|
| Hospital Charge Code |
36100269
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$499.75 |
| Max. Negotiated Rate |
$713.93 |
| Rate for Payer: Aetna Commercial |
$674.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.62
|
| Rate for Payer: Cash Price |
$634.61
|
| Rate for Payer: Cofinity Advantage |
$555.28
|
| Rate for Payer: Cofinity Commercial |
$682.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.61
|
| Rate for Payer: Healthscope Commercial |
$713.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.95
|
| Rate for Payer: PHP Commercial |
$674.27
|
| Rate for Payer: Priority Health SBD |
$499.75
|
|
|
HC PUNCTURE WITH INJECTION CERVICAL
|
Facility
|
OP
|
$793.26
|
|
|
Service Code
|
CPT 61055
|
| Hospital Charge Code |
36100269
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$159.96 |
| Max. Negotiated Rate |
$989.08 |
| Rate for Payer: Aetna Commercial |
$674.27
|
| Rate for Payer: Aetna Medicare |
$318.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.62
|
| 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 |
$365.07
|
| Rate for Payer: BCN Commercial |
$365.07
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Cash Price |
$634.61
|
| Rate for Payer: Cash Price |
$634.61
|
| Rate for Payer: Cash Price |
$634.61
|
| Rate for Payer: Cofinity Advantage |
$555.28
|
| Rate for Payer: Cofinity Commercial |
$682.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Healthscope Commercial |
$713.93
|
| 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 |
$674.27
|
| Rate for Payer: Nomi Health Commercial |
$917.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.95
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Commercial |
$674.27
|
| 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 |
$499.75
|
| Rate for Payer: Priority Health Tiered Network |
$791.26
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
|
|
HC PURAPLY AM (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
IP
|
$752.14
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$473.85 |
| Max. Negotiated Rate |
$676.93 |
| Rate for Payer: Aetna Commercial |
$639.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$488.89
|
| Rate for Payer: Cash Price |
$601.71
|
| Rate for Payer: Cofinity Advantage |
$526.50
|
| Rate for Payer: Cofinity Commercial |
$646.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$601.71
|
| Rate for Payer: Healthscope Commercial |
$676.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$639.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$564.11
|
| Rate for Payer: PHP Commercial |
$639.32
|
| Rate for Payer: Priority Health SBD |
$473.85
|
|
|
HC PURAPLY AM (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
OP
|
$752.14
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$676.93 |
| Rate for Payer: Aetna Commercial |
$639.32
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$488.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$81.21
|
| Rate for Payer: BCN Commercial |
$242.55
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$601.71
|
| Rate for Payer: Cash Price |
$601.71
|
| Rate for Payer: Cash Price |
$601.71
|
| Rate for Payer: Cofinity Advantage |
$526.50
|
| Rate for Payer: Cofinity Commercial |
$646.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$601.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$676.93
|
| Rate for Payer: Mclaren Medicaid |
$64.85
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$639.32
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$564.11
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$639.32
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$473.85
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC PURAPLY AM 2X2 PER SQ CM
|
Facility
|
OP
|
$522.31
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$470.08 |
| Rate for Payer: Aetna Commercial |
$443.96
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$339.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$81.21
|
| Rate for Payer: BCN Commercial |
$242.55
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$417.85
|
| Rate for Payer: Cash Price |
$417.85
|
| Rate for Payer: Cash Price |
$417.85
|
| Rate for Payer: Cofinity Advantage |
$365.62
|
| Rate for Payer: Cofinity Commercial |
$449.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$417.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$470.08
|
| Rate for Payer: Mclaren Medicaid |
$64.85
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$443.96
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$391.73
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$443.96
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$329.06
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC PURAPLY AM 2X2 PER SQ CM
|
Facility
|
IP
|
$522.31
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$329.06 |
| Max. Negotiated Rate |
$470.08 |
| Rate for Payer: Aetna Commercial |
$443.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$339.50
|
| Rate for Payer: Cash Price |
$417.85
|
| Rate for Payer: Cofinity Advantage |
$365.62
|
| Rate for Payer: Cofinity Commercial |
$449.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$417.85
|
| Rate for Payer: Healthscope Commercial |
$470.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$443.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$391.73
|
| Rate for Payer: PHP Commercial |
$443.96
|
| Rate for Payer: Priority Health SBD |
$329.06
|
|
|
HC PURAPLY AM 2X4 PER SQ CM
|
Facility
|
IP
|
$330.80
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$208.40 |
| Max. Negotiated Rate |
$297.72 |
| Rate for Payer: Aetna Commercial |
$281.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.02
|
| Rate for Payer: Cash Price |
$264.64
|
| Rate for Payer: Cofinity Advantage |
$231.56
|
| Rate for Payer: Cofinity Commercial |
$284.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.64
|
| Rate for Payer: Healthscope Commercial |
$297.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$248.10
|
| Rate for Payer: PHP Commercial |
$281.18
|
| Rate for Payer: Priority Health SBD |
$208.40
|
|
|
HC PURAPLY AM 2X4 PER SQ CM
|
Facility
|
OP
|
$330.80
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: Aetna Commercial |
$281.18
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$81.21
|
| Rate for Payer: BCN Commercial |
$242.55
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$264.64
|
| Rate for Payer: Cash Price |
$264.64
|
| Rate for Payer: Cash Price |
$264.64
|
| Rate for Payer: Cofinity Advantage |
$231.56
|
| Rate for Payer: Cofinity Commercial |
$284.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$297.72
|
| Rate for Payer: Mclaren Medicaid |
$64.85
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.18
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$248.10
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$281.18
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$208.40
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC PURAPLY AM 3X4 PER SQ CM
|
Facility
|
OP
|
$276.36
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: Aetna Commercial |
$234.91
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$81.21
|
| Rate for Payer: BCN Commercial |
$242.55
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$221.09
|
| Rate for Payer: Cash Price |
$221.09
|
| Rate for Payer: Cash Price |
$221.09
|
| Rate for Payer: Cofinity Advantage |
$193.45
|
| Rate for Payer: Cofinity Commercial |
$237.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$248.72
|
| Rate for Payer: Mclaren Medicaid |
$64.85
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.91
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.27
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$234.91
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$174.11
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC PURAPLY AM 3X4 PER SQ CM
|
Facility
|
IP
|
$276.36
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$174.11 |
| Max. Negotiated Rate |
$248.72 |
| Rate for Payer: Aetna Commercial |
$234.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.63
|
| Rate for Payer: Cash Price |
$221.09
|
| Rate for Payer: Cofinity Advantage |
$193.45
|
| Rate for Payer: Cofinity Commercial |
$237.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.09
|
| Rate for Payer: Healthscope Commercial |
$248.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.27
|
| Rate for Payer: PHP Commercial |
$234.91
|
| Rate for Payer: Priority Health SBD |
$174.11
|
|
|
HC PURAPLY AM 4X3 PER SQ CM EXTRA FENESTRATED
|
Facility
|
OP
|
$291.83
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: Aetna Commercial |
$248.06
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$81.21
|
| Rate for Payer: BCN Commercial |
$242.55
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$233.46
|
| Rate for Payer: Cash Price |
$233.46
|
| Rate for Payer: Cash Price |
$233.46
|
| Rate for Payer: Cofinity Advantage |
$204.28
|
| Rate for Payer: Cofinity Commercial |
$250.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$262.65
|
| Rate for Payer: Mclaren Medicaid |
$64.85
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.06
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.87
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$248.06
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$183.85
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
