|
HC RECOVERY 3 ADD'L 15 MIN
|
Facility
|
IP
|
$104.21
|
|
| Hospital Charge Code |
71000024
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$65.65 |
| Max. Negotiated Rate |
$93.79 |
| Rate for Payer: Aetna Commercial |
$88.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.74
|
| Rate for Payer: Cash Price |
$83.37
|
| Rate for Payer: Cofinity Advantage |
$72.95
|
| Rate for Payer: Cofinity Commercial |
$89.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.37
|
| Rate for Payer: Healthscope Commercial |
$93.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.16
|
| Rate for Payer: PHP Commercial |
$88.58
|
| Rate for Payer: Priority Health SBD |
$65.65
|
|
|
HC RECOVERY 3 ADD'L 15 MIN
|
Facility
|
OP
|
$104.21
|
|
| Hospital Charge Code |
71000024
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$93.79 |
| Rate for Payer: Aetna Commercial |
$88.58
|
| Rate for Payer: Aetna Medicare |
$52.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.74
|
| Rate for Payer: BCBS Complete |
$41.68
|
| Rate for Payer: Cash Price |
$83.37
|
| Rate for Payer: Cofinity Advantage |
$72.95
|
| Rate for Payer: Cofinity Commercial |
$89.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.37
|
| Rate for Payer: Healthscope Commercial |
$93.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.16
|
| Rate for Payer: PHP Commercial |
$88.58
|
| Rate for Payer: Priority Health SBD |
$65.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.74
|
| Rate for Payer: UHC Core |
$54.29
|
| Rate for Payer: UHC Exchange |
$40.95
|
|
|
HC RECOVERY 3 BASE CHARGE
|
Facility
|
IP
|
$63.00
|
|
| Hospital Charge Code |
71000040
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$39.69 |
| Max. Negotiated Rate |
$56.70 |
| Rate for Payer: Aetna Commercial |
$53.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.95
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cofinity Advantage |
$44.10
|
| Rate for Payer: Cofinity Commercial |
$54.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.40
|
| Rate for Payer: Healthscope Commercial |
$56.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.25
|
| Rate for Payer: PHP Commercial |
$53.55
|
| Rate for Payer: Priority Health SBD |
$39.69
|
|
|
HC RECOVERY 3 BASE CHARGE
|
Facility
|
OP
|
$63.00
|
|
| Hospital Charge Code |
71000040
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$24.76 |
| Max. Negotiated Rate |
$56.70 |
| Rate for Payer: Aetna Commercial |
$53.55
|
| Rate for Payer: Aetna Medicare |
$31.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.95
|
| Rate for Payer: BCBS Complete |
$25.20
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cofinity Advantage |
$44.10
|
| Rate for Payer: Cofinity Commercial |
$54.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.40
|
| Rate for Payer: Healthscope Commercial |
$56.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.25
|
| Rate for Payer: PHP Commercial |
$53.55
|
| Rate for Payer: Priority Health SBD |
$39.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.95
|
| Rate for Payer: UHC Core |
$32.82
|
| Rate for Payer: UHC Exchange |
$24.76
|
|
|
HC RECOVERY 3 EA MIN
|
Facility
|
OP
|
$9.18
|
|
| Hospital Charge Code |
71000037
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$8.26 |
| Rate for Payer: Aetna Commercial |
$7.80
|
| Rate for Payer: Aetna Medicare |
$4.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.97
|
| Rate for Payer: BCBS Complete |
$3.67
|
| Rate for Payer: Cash Price |
$7.34
|
| Rate for Payer: Cofinity Advantage |
$6.43
|
| Rate for Payer: Cofinity Commercial |
$7.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.34
|
| Rate for Payer: Healthscope Commercial |
$8.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.88
|
| Rate for Payer: PHP Commercial |
$7.80
|
| Rate for Payer: Priority Health SBD |
$5.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.97
|
| Rate for Payer: UHC Core |
$4.78
|
| Rate for Payer: UHC Exchange |
$3.61
|
|
|
HC RECOVERY 3 EA MIN
|
Facility
|
IP
|
$9.18
|
|
| Hospital Charge Code |
71000037
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$8.26 |
| Rate for Payer: Aetna Commercial |
$7.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.97
|
| Rate for Payer: Cash Price |
$7.34
|
| Rate for Payer: Cofinity Advantage |
$6.43
|
| Rate for Payer: Cofinity Commercial |
$7.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.34
|
| Rate for Payer: Healthscope Commercial |
$8.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.88
|
| Rate for Payer: PHP Commercial |
$7.80
|
| Rate for Payer: Priority Health SBD |
$5.78
|
|
|
HC RECOVERY 3 INIT 30 MIN
|
Facility
|
IP
|
$210.56
|
|
| Hospital Charge Code |
71000025
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$132.65 |
| Max. Negotiated Rate |
$189.50 |
| Rate for Payer: Aetna Commercial |
$178.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.86
|
| Rate for Payer: Cash Price |
$168.45
|
| Rate for Payer: Cofinity Advantage |
$147.39
|
| Rate for Payer: Cofinity Commercial |
$181.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.45
|
| Rate for Payer: Healthscope Commercial |
$189.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.92
|
| Rate for Payer: PHP Commercial |
$178.98
|
| Rate for Payer: Priority Health SBD |
$132.65
|
|
|
HC RECOVERY 3 INIT 30 MIN
|
Facility
|
OP
|
$210.56
|
|
| Hospital Charge Code |
71000025
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$82.75 |
| Max. Negotiated Rate |
$189.50 |
| Rate for Payer: Aetna Commercial |
$178.98
|
| Rate for Payer: Aetna Medicare |
$105.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.86
|
| Rate for Payer: BCBS Complete |
$84.22
|
| Rate for Payer: Cash Price |
$168.45
|
| Rate for Payer: Cofinity Advantage |
$147.39
|
| Rate for Payer: Cofinity Commercial |
$181.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.45
|
| Rate for Payer: Healthscope Commercial |
$189.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$168.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.92
|
| Rate for Payer: PHP Commercial |
$178.98
|
| Rate for Payer: Priority Health SBD |
$132.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.86
|
| Rate for Payer: UHC Core |
$109.70
|
| Rate for Payer: UHC Exchange |
$82.75
|
|
|
HC RED CEDAR IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200099
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
|
|
HC RED CEDAR IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200099
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC RED CELL GENO MI BLD
|
Facility
|
IP
|
$331.53
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
31000135
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$208.86 |
| Max. Negotiated Rate |
$298.38 |
| Rate for Payer: Aetna Commercial |
$281.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.49
|
| Rate for Payer: Cash Price |
$265.22
|
| Rate for Payer: Cofinity Advantage |
$232.07
|
| Rate for Payer: Cofinity Commercial |
$285.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.22
|
| Rate for Payer: Healthscope Commercial |
$298.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$248.65
|
| Rate for Payer: PHP Commercial |
$281.80
|
| Rate for Payer: Priority Health SBD |
$208.86
|
|
|
HC RED CELL GENO MI BLD
|
Facility
|
OP
|
$331.53
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
31000135
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$96.86 |
| Max. Negotiated Rate |
$555.60 |
| Rate for Payer: Aetna Commercial |
$281.80
|
| Rate for Payer: Aetna Medicare |
$192.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$231.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$231.50
|
| Rate for Payer: BCBS Complete |
$101.71
|
| Rate for Payer: BCBS MAPPO |
$185.20
|
| Rate for Payer: BCBS Trust/PPO |
$197.46
|
| Rate for Payer: BCN Commercial |
$197.46
|
| Rate for Payer: BCN Medicare Advantage |
$185.20
|
| Rate for Payer: Cash Price |
$265.22
|
| Rate for Payer: Cash Price |
$265.22
|
| Rate for Payer: Cofinity Advantage |
$232.07
|
| Rate for Payer: Cofinity Commercial |
$285.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.20
|
| Rate for Payer: Healthscope Commercial |
$298.38
|
| Rate for Payer: Mclaren Medicaid |
$96.86
|
| Rate for Payer: Mclaren Medicare |
$185.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$194.46
|
| Rate for Payer: Meridian Medicaid |
$194.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$203.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.80
|
| Rate for Payer: Nomi Health Commercial |
$555.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$248.65
|
| Rate for Payer: PACE Medicare |
$175.94
|
| Rate for Payer: PACE SWMI |
$185.20
|
| Rate for Payer: PHP Commercial |
$281.80
|
| Rate for Payer: PHP Medicare Advantage |
$185.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$185.20
|
| Rate for Payer: Priority Health Medicare |
$185.20
|
| Rate for Payer: Priority Health SBD |
$208.86
|
| Rate for Payer: Priority Health Tiered Network |
$148.16
|
| Rate for Payer: Railroad Medicare Medicare |
$185.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$277.80
|
| Rate for Payer: UHC Core |
$277.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$185.20
|
| Rate for Payer: UHC Exchange |
$277.80
|
| Rate for Payer: UHC Medicaid |
$96.86
|
| Rate for Payer: UHCCP Medicaid |
$96.86
|
| Rate for Payer: VA VA |
$185.20
|
|
|
HC RED CELL GENO MI BLD CMPT
|
Facility
|
OP
|
$238.68
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
31000136
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$95.47 |
| Max. Negotiated Rate |
$214.81 |
| Rate for Payer: Aetna Commercial |
$202.88
|
| Rate for Payer: Aetna Medicare |
$119.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.14
|
| Rate for Payer: BCBS Complete |
$95.47
|
| Rate for Payer: BCBS Trust/PPO |
$142.16
|
| Rate for Payer: BCN Commercial |
$142.16
|
| Rate for Payer: Cash Price |
$190.94
|
| Rate for Payer: Cash Price |
$190.94
|
| Rate for Payer: Cofinity Advantage |
$167.08
|
| Rate for Payer: Cofinity Commercial |
$205.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.94
|
| Rate for Payer: Healthscope Commercial |
$214.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$190.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.01
|
| Rate for Payer: PHP Commercial |
$202.88
|
| Rate for Payer: Priority Health SBD |
$150.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.34
|
| Rate for Payer: UHC Core |
$119.34
|
| Rate for Payer: UHC Exchange |
$119.34
|
|
|
HC RED CELL GENO MI BLD CMPT
|
Facility
|
IP
|
$238.68
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
31000136
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$150.37 |
| Max. Negotiated Rate |
$214.81 |
| Rate for Payer: Aetna Commercial |
$202.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.14
|
| Rate for Payer: Cash Price |
$190.94
|
| Rate for Payer: Cofinity Advantage |
$167.08
|
| Rate for Payer: Cofinity Commercial |
$205.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.94
|
| Rate for Payer: Healthscope Commercial |
$214.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.01
|
| Rate for Payer: PHP Commercial |
$202.88
|
| Rate for Payer: Priority Health SBD |
$150.37
|
|
|
HC RED CELLS, DIRECTED, LEUKO RED
|
Facility
|
IP
|
$1,128.42
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
39000061
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$710.90 |
| Max. Negotiated Rate |
$1,015.58 |
| Rate for Payer: Aetna Commercial |
$959.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$733.47
|
| Rate for Payer: Cash Price |
$902.74
|
| Rate for Payer: Cofinity Advantage |
$789.89
|
| Rate for Payer: Cofinity Commercial |
$970.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$902.74
|
| Rate for Payer: Healthscope Commercial |
$1,015.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$959.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$846.32
|
| Rate for Payer: PHP Commercial |
$959.16
|
| Rate for Payer: Priority Health SBD |
$710.90
|
|
|
HC RED CELLS, DIRECTED, LEUKO RED
|
Facility
|
OP
|
$1,128.42
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
39000061
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$94.32 |
| Max. Negotiated Rate |
$1,015.58 |
| Rate for Payer: Aetna Commercial |
$959.16
|
| Rate for Payer: Aetna Medicare |
$187.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$733.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$225.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$225.43
|
| Rate for Payer: BCBS Complete |
$99.04
|
| Rate for Payer: BCBS MAPPO |
$180.34
|
| Rate for Payer: BCBS Trust/PPO |
$505.91
|
| Rate for Payer: BCN Commercial |
$505.91
|
| Rate for Payer: BCN Medicare Advantage |
$180.34
|
| Rate for Payer: Cash Price |
$902.74
|
| Rate for Payer: Cash Price |
$902.74
|
| Rate for Payer: Cofinity Advantage |
$789.89
|
| Rate for Payer: Cofinity Commercial |
$970.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$902.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$180.34
|
| Rate for Payer: Healthscope Commercial |
$1,015.58
|
| Rate for Payer: Mclaren Medicaid |
$94.32
|
| Rate for Payer: Mclaren Medicare |
$180.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$189.36
|
| Rate for Payer: Meridian Medicaid |
$189.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$207.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$198.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$959.16
|
| Rate for Payer: Nomi Health Commercial |
$541.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$846.32
|
| Rate for Payer: PACE Medicare |
$171.32
|
| Rate for Payer: PACE SWMI |
$180.34
|
| Rate for Payer: PHP Commercial |
$959.16
|
| Rate for Payer: PHP Medicare Advantage |
$180.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$583.21
|
| Rate for Payer: Priority Health Medicare |
$180.34
|
| Rate for Payer: Priority Health SBD |
$710.90
|
| Rate for Payer: Priority Health Tiered Network |
$466.57
|
| Rate for Payer: Railroad Medicare Medicare |
$180.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$733.47
|
| Rate for Payer: UHC Core |
$587.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$180.34
|
| Rate for Payer: UHC Exchange |
$443.47
|
| Rate for Payer: UHC Medicaid |
$94.32
|
| Rate for Payer: UHCCP Medicaid |
$94.32
|
| Rate for Payer: VA VA |
$180.34
|
|
|
HC REDTOP BENT GRASS IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200057
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC REDTOP BENT GRASS IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200057
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
|
|
HC REDUCER ASY 3/8 X 3/8 STRAIGHT
|
Facility
|
IP
|
$6.00
|
|
| Hospital Charge Code |
27000717
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Aetna Commercial |
$5.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.90
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cofinity Advantage |
$4.20
|
| Rate for Payer: Cofinity Commercial |
$5.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.80
|
| Rate for Payer: Healthscope Commercial |
$5.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.50
|
| Rate for Payer: PHP Commercial |
$5.10
|
| Rate for Payer: Priority Health SBD |
$3.78
|
|
|
HC REDUCER ASY 3/8 X 3/8 STRAIGHT
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
27000717
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Aetna Commercial |
$5.10
|
| Rate for Payer: Aetna Medicare |
$3.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.90
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cofinity Advantage |
$4.20
|
| Rate for Payer: Cofinity Commercial |
$5.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.80
|
| Rate for Payer: Healthscope Commercial |
$5.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.50
|
| Rate for Payer: PHP Commercial |
$5.10
|
| Rate for Payer: Priority Health SBD |
$3.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.90
|
| Rate for Payer: UHC Core |
$3.13
|
| Rate for Payer: UHC Exchange |
$2.36
|
|
|
HC REDUCER W/LL ASY 1/4 X 3/8
|
Facility
|
OP
|
$9.36
|
|
| Hospital Charge Code |
27000679
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Aetna Commercial |
$7.96
|
| Rate for Payer: Aetna Medicare |
$4.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.08
|
| Rate for Payer: BCBS Complete |
$3.74
|
| Rate for Payer: Cash Price |
$7.49
|
| Rate for Payer: Cofinity Advantage |
$6.55
|
| Rate for Payer: Cofinity Commercial |
$8.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.49
|
| Rate for Payer: Healthscope Commercial |
$8.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.02
|
| Rate for Payer: PHP Commercial |
$7.96
|
| Rate for Payer: Priority Health SBD |
$5.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.08
|
| Rate for Payer: UHC Core |
$4.88
|
| Rate for Payer: UHC Exchange |
$3.68
|
|
|
HC REDUCER W/LL ASY 1/4 X 3/8
|
Facility
|
IP
|
$9.36
|
|
| Hospital Charge Code |
27000679
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Aetna Commercial |
$7.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.08
|
| Rate for Payer: Cash Price |
$7.49
|
| Rate for Payer: Cofinity Advantage |
$6.55
|
| Rate for Payer: Cofinity Commercial |
$8.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.49
|
| Rate for Payer: Healthscope Commercial |
$8.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.02
|
| Rate for Payer: PHP Commercial |
$7.96
|
| Rate for Payer: Priority Health SBD |
$5.90
|
|
|
HC REFILL AND MAINTENANCE OF IMPLANTED PUMP
|
Facility
|
IP
|
$447.42
|
|
|
Service Code
|
HCPCS 96522
|
| Hospital Charge Code |
33500009
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$281.87 |
| Max. Negotiated Rate |
$402.68 |
| Rate for Payer: Aetna Commercial |
$380.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.82
|
| Rate for Payer: Cash Price |
$357.94
|
| Rate for Payer: Cofinity Advantage |
$313.19
|
| Rate for Payer: Cofinity Commercial |
$384.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.94
|
| Rate for Payer: Healthscope Commercial |
$402.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.56
|
| Rate for Payer: PHP Commercial |
$380.31
|
| Rate for Payer: Priority Health SBD |
$281.87
|
|
|
HC REFILL AND MAINTENANCE OF IMPLANTED PUMP
|
Facility
|
OP
|
$447.42
|
|
|
Service Code
|
HCPCS 96522
|
| Hospital Charge Code |
33500009
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$110.84 |
| Max. Negotiated Rate |
$685.39 |
| Rate for Payer: Aetna Commercial |
$380.31
|
| Rate for Payer: Aetna Medicare |
$220.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$264.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$264.93
|
| Rate for Payer: BCBS Complete |
$116.40
|
| Rate for Payer: BCBS MAPPO |
$211.94
|
| Rate for Payer: BCBS Trust/PPO |
$147.11
|
| Rate for Payer: BCN Commercial |
$147.11
|
| Rate for Payer: BCN Medicare Advantage |
$211.94
|
| Rate for Payer: Cash Price |
$357.94
|
| Rate for Payer: Cash Price |
$357.94
|
| Rate for Payer: Cash Price |
$357.94
|
| Rate for Payer: Cofinity Advantage |
$313.19
|
| Rate for Payer: Cofinity Commercial |
$384.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.94
|
| Rate for Payer: Healthscope Commercial |
$402.68
|
| Rate for Payer: Mclaren Medicaid |
$110.84
|
| Rate for Payer: Mclaren Medicare |
$211.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$222.54
|
| Rate for Payer: Meridian Medicaid |
$222.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$243.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$233.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.31
|
| Rate for Payer: Nomi Health Commercial |
$635.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.56
|
| Rate for Payer: PACE Medicare |
$201.34
|
| Rate for Payer: PACE SWMI |
$211.94
|
| Rate for Payer: PHP Commercial |
$380.31
|
| Rate for Payer: PHP Medicare Advantage |
$211.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$685.39
|
| Rate for Payer: Priority Health Medicare |
$211.94
|
| Rate for Payer: Priority Health SBD |
$281.87
|
| Rate for Payer: Priority Health Tiered Network |
$548.31
|
| Rate for Payer: Railroad Medicare Medicare |
$211.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$290.82
|
| Rate for Payer: UHC Core |
$233.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$211.94
|
| Rate for Payer: UHC Exchange |
$175.84
|
| Rate for Payer: UHC Medicaid |
$110.84
|
| Rate for Payer: UHCCP Medicaid |
$110.84
|
| Rate for Payer: VA VA |
$211.94
|
|
|
HC REFILL AND MAINTENANCE OF PORT PUMP
|
Facility
|
IP
|
$899.63
|
|
|
Service Code
|
CPT 96521
|
| Hospital Charge Code |
33500008
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$566.77 |
| Max. Negotiated Rate |
$809.67 |
| Rate for Payer: Aetna Commercial |
$764.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$584.76
|
| Rate for Payer: Cash Price |
$719.70
|
| Rate for Payer: Cofinity Advantage |
$629.74
|
| Rate for Payer: Cofinity Commercial |
$773.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$719.70
|
| Rate for Payer: Healthscope Commercial |
$809.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$764.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$674.72
|
| Rate for Payer: PHP Commercial |
$764.69
|
| Rate for Payer: Priority Health SBD |
$566.77
|
|
