|
HC RF ABLATION LIVER TUMOR
|
Facility
|
IP
|
$6,003.59
|
|
|
Service Code
|
CPT 47382
|
| Hospital Charge Code |
36100199
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,782.26 |
| Max. Negotiated Rate |
$5,403.23 |
| Rate for Payer: Aetna Commercial |
$5,103.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,902.33
|
| Rate for Payer: Cash Price |
$4,802.87
|
| Rate for Payer: Cofinity Advantage |
$4,202.51
|
| Rate for Payer: Cofinity Commercial |
$5,163.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,802.87
|
| Rate for Payer: Healthscope Commercial |
$5,403.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,103.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,502.69
|
| Rate for Payer: PHP Commercial |
$5,103.05
|
| Rate for Payer: Priority Health SBD |
$3,782.26
|
|
|
HC RF ABLATION LIVER TUMOR
|
Facility
|
OP
|
$6,003.59
|
|
|
Service Code
|
CPT 47382
|
| Hospital Charge Code |
36100199
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,150.44 |
| Max. Negotiated Rate |
$19,480.40 |
| Rate for Payer: Aetna Commercial |
$5,103.05
|
| Rate for Payer: Aetna Medicare |
$6,264.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,902.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,529.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,529.74
|
| Rate for Payer: BCBS Complete |
$3,308.27
|
| Rate for Payer: BCBS MAPPO |
$6,023.79
|
| Rate for Payer: BCBS Trust/PPO |
$4,433.06
|
| Rate for Payer: BCN Commercial |
$4,433.06
|
| Rate for Payer: BCN Medicare Advantage |
$6,023.79
|
| Rate for Payer: Cash Price |
$4,802.87
|
| Rate for Payer: Cash Price |
$4,802.87
|
| Rate for Payer: Cash Price |
$4,802.87
|
| Rate for Payer: Cofinity Advantage |
$4,202.51
|
| Rate for Payer: Cofinity Commercial |
$5,163.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,802.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,023.79
|
| Rate for Payer: Healthscope Commercial |
$5,403.23
|
| Rate for Payer: Mclaren Medicaid |
$3,150.44
|
| Rate for Payer: Mclaren Medicare |
$6,023.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,324.98
|
| Rate for Payer: Meridian Medicaid |
$6,324.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,927.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,626.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,103.05
|
| Rate for Payer: Nomi Health Commercial |
$18,071.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,502.69
|
| Rate for Payer: PACE Medicare |
$5,722.60
|
| Rate for Payer: PACE SWMI |
$6,023.79
|
| Rate for Payer: PHP Commercial |
$5,103.05
|
| Rate for Payer: PHP Medicare Advantage |
$6,023.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,150.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,480.40
|
| Rate for Payer: Priority Health Medicare |
$6,023.79
|
| Rate for Payer: Priority Health SBD |
$3,782.26
|
| Rate for Payer: Priority Health Tiered Network |
$15,584.32
|
| Rate for Payer: Railroad Medicare Medicare |
$6,023.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,023.79
|
| Rate for Payer: UHC Medicaid |
$3,150.44
|
| Rate for Payer: UHCCP Medicaid |
$3,150.44
|
| Rate for Payer: VA VA |
$6,023.79
|
|
|
HC RFABLATION NRV INNERVATING SI JT W IMAG
|
Facility
|
OP
|
$2,736.88
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
36100594
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,017.60 |
| Max. Negotiated Rate |
$6,292.24 |
| Rate for Payer: Aetna Commercial |
$2,326.35
|
| Rate for Payer: Aetna Medicare |
$2,023.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,778.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,432.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,432.12
|
| Rate for Payer: BCBS Complete |
$1,068.58
|
| Rate for Payer: BCBS MAPPO |
$1,945.70
|
| Rate for Payer: BCN Medicare Advantage |
$1,945.70
|
| Rate for Payer: Cash Price |
$2,189.50
|
| Rate for Payer: Cash Price |
$2,189.50
|
| Rate for Payer: Cofinity Advantage |
$1,915.82
|
| Rate for Payer: Cofinity Commercial |
$2,353.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,189.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,945.70
|
| Rate for Payer: Healthscope Commercial |
$2,463.19
|
| Rate for Payer: Mclaren Medicaid |
$1,017.60
|
| Rate for Payer: Mclaren Medicare |
$1,945.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,042.98
|
| Rate for Payer: Meridian Medicaid |
$2,042.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,237.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,140.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,326.35
|
| Rate for Payer: Nomi Health Commercial |
$5,837.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,052.66
|
| Rate for Payer: PACE Medicare |
$1,848.41
|
| Rate for Payer: PACE SWMI |
$1,945.70
|
| Rate for Payer: PHP Commercial |
$2,326.35
|
| Rate for Payer: PHP Medicare Advantage |
$1,945.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,017.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,292.24
|
| Rate for Payer: Priority Health Medicare |
$1,945.70
|
| Rate for Payer: Priority Health SBD |
$1,724.23
|
| Rate for Payer: Priority Health Tiered Network |
$5,033.79
|
| Rate for Payer: Railroad Medicare Medicare |
$1,945.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,945.70
|
| Rate for Payer: UHC Medicaid |
$1,017.60
|
| Rate for Payer: UHCCP Medicaid |
$1,017.60
|
| Rate for Payer: VA VA |
$1,945.70
|
|
|
HC RFABLATION NRV INNERVATING SI JT W IMAG
|
Facility
|
IP
|
$2,736.88
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
36100594
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,724.23 |
| Max. Negotiated Rate |
$2,463.19 |
| Rate for Payer: Aetna Commercial |
$2,326.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,778.97
|
| Rate for Payer: Cash Price |
$2,189.50
|
| Rate for Payer: Cofinity Advantage |
$1,915.82
|
| Rate for Payer: Cofinity Commercial |
$2,353.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,189.50
|
| Rate for Payer: Healthscope Commercial |
$2,463.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,326.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,052.66
|
| Rate for Payer: PHP Commercial |
$2,326.35
|
| Rate for Payer: Priority Health SBD |
$1,724.23
|
|
|
HC RF TRANSSEPTAL NEEDLE
|
Facility
|
OP
|
$1,824.29
|
|
| Hospital Charge Code |
27200285
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$716.95 |
| Max. Negotiated Rate |
$1,641.86 |
| Rate for Payer: Aetna Commercial |
$1,550.65
|
| Rate for Payer: Aetna Medicare |
$912.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,185.79
|
| Rate for Payer: BCBS Complete |
$729.72
|
| Rate for Payer: Cash Price |
$1,459.43
|
| Rate for Payer: Cofinity Advantage |
$1,277.00
|
| Rate for Payer: Cofinity Commercial |
$1,568.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,459.43
|
| Rate for Payer: Healthscope Commercial |
$1,641.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,459.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,550.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,368.22
|
| Rate for Payer: PHP Commercial |
$1,550.65
|
| Rate for Payer: Priority Health SBD |
$1,149.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,185.79
|
| Rate for Payer: UHC Core |
$950.46
|
| Rate for Payer: UHC Exchange |
$716.95
|
|
|
HC RF TRANSSEPTAL NEEDLE
|
Facility
|
IP
|
$1,824.29
|
|
| Hospital Charge Code |
27200285
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,149.30 |
| Max. Negotiated Rate |
$1,641.86 |
| Rate for Payer: Aetna Commercial |
$1,550.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,185.79
|
| Rate for Payer: Cash Price |
$1,459.43
|
| Rate for Payer: Cofinity Advantage |
$1,277.00
|
| Rate for Payer: Cofinity Commercial |
$1,568.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,459.43
|
| Rate for Payer: Healthscope Commercial |
$1,641.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,550.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,368.22
|
| Rate for Payer: PHP Commercial |
$1,550.65
|
| Rate for Payer: Priority Health SBD |
$1,149.30
|
|
|
HC RHEUMATOID FACTOR
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
30200211
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna Medicare |
$5.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.09
|
| Rate for Payer: BCBS Complete |
$3.11
|
| Rate for Payer: BCBS MAPPO |
$5.67
|
| Rate for Payer: BCBS Trust/PPO |
$6.04
|
| Rate for Payer: BCN Commercial |
$6.04
|
| Rate for Payer: BCN Medicare Advantage |
$5.67
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.67
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Mclaren Medicaid |
$2.97
|
| Rate for Payer: Mclaren Medicare |
$5.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.95
|
| Rate for Payer: Meridian Medicaid |
$5.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$8.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PACE Medicare |
$5.39
|
| Rate for Payer: PACE SWMI |
$5.67
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: PHP Medicare Advantage |
$5.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.67
|
| Rate for Payer: Priority Health Medicare |
$5.67
|
| Rate for Payer: Priority Health SBD |
$16.71
|
| Rate for Payer: Priority Health Tiered Network |
$4.54
|
| Rate for Payer: Railroad Medicare Medicare |
$5.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.51
|
| Rate for Payer: UHC Core |
$8.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.67
|
| Rate for Payer: UHC Exchange |
$8.51
|
| Rate for Payer: UHC Medicaid |
$2.97
|
| Rate for Payer: UHCCP Medicaid |
$2.97
|
| Rate for Payer: VA VA |
$5.67
|
|
|
HC RHEUMATOID FACTOR
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
30200211
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: Priority Health SBD |
$16.71
|
|
|
HC RHOGAM
|
Facility
|
OP
|
$289.66
|
|
|
Service Code
|
HCPCS J2790
|
| Hospital Charge Code |
63600006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$115.86 |
| Max. Negotiated Rate |
$260.69 |
| Rate for Payer: Aetna Commercial |
$246.21
|
| Rate for Payer: Aetna Medicare |
$144.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.28
|
| Rate for Payer: BCBS Complete |
$115.86
|
| Rate for Payer: BCBS Trust/PPO |
$210.07
|
| Rate for Payer: BCN Commercial |
$210.07
|
| Rate for Payer: Cash Price |
$231.73
|
| Rate for Payer: Cash Price |
$231.73
|
| Rate for Payer: Cofinity Advantage |
$202.76
|
| Rate for Payer: Cofinity Commercial |
$249.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.73
|
| Rate for Payer: Healthscope Commercial |
$260.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.25
|
| Rate for Payer: PHP Commercial |
$246.21
|
| Rate for Payer: Priority Health SBD |
$182.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.87
|
| Rate for Payer: UHC Core |
$132.87
|
| Rate for Payer: UHC Exchange |
$132.87
|
|
|
HC RHOGAM
|
Facility
|
IP
|
$289.66
|
|
|
Service Code
|
HCPCS J2790
|
| Hospital Charge Code |
63600006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$182.49 |
| Max. Negotiated Rate |
$260.69 |
| Rate for Payer: Aetna Commercial |
$246.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.28
|
| Rate for Payer: Cash Price |
$231.73
|
| Rate for Payer: Cofinity Advantage |
$202.76
|
| Rate for Payer: Cofinity Commercial |
$249.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.73
|
| Rate for Payer: Healthscope Commercial |
$260.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.25
|
| Rate for Payer: PHP Commercial |
$246.21
|
| Rate for Payer: Priority Health SBD |
$182.49
|
|
|
HC RIBOSOME P AB, IGG
|
Facility
|
OP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200433
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$32.28 |
| Rate for Payer: Aetna Commercial |
$30.49
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$9.85
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$19.12
|
| Rate for Payer: BCN Commercial |
$19.12
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Advantage |
$25.11
|
| Rate for Payer: Cofinity Commercial |
$30.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$32.28
|
| Rate for Payer: Mclaren Medicaid |
$9.38
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Nomi Health Commercial |
$26.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$30.49
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.93
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$22.60
|
| Rate for Payer: Priority Health Tiered Network |
$14.34
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.90
|
| Rate for Payer: UHC Core |
$26.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.93
|
| Rate for Payer: UHC Exchange |
$26.90
|
| Rate for Payer: UHC Medicaid |
$9.38
|
| Rate for Payer: UHCCP Medicaid |
$9.38
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC RIBOSOME P AB, IGG
|
Facility
|
IP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200433
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.60 |
| Max. Negotiated Rate |
$32.28 |
| Rate for Payer: Aetna Commercial |
$30.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.32
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Advantage |
$25.11
|
| Rate for Payer: Cofinity Commercial |
$30.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Healthscope Commercial |
$32.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: PHP Commercial |
$30.49
|
| Rate for Payer: Priority Health SBD |
$22.60
|
|
|
HC RIGHT VENTRICULAR RECORDING
|
Facility
|
IP
|
$3,842.58
|
|
|
Service Code
|
CPT 93603
|
| Hospital Charge Code |
48100031
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,420.83 |
| Max. Negotiated Rate |
$3,458.32 |
| Rate for Payer: Aetna Commercial |
$3,266.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,497.68
|
| Rate for Payer: Cash Price |
$3,074.06
|
| Rate for Payer: Cofinity Advantage |
$2,689.81
|
| Rate for Payer: Cofinity Commercial |
$3,304.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,074.06
|
| Rate for Payer: Healthscope Commercial |
$3,458.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,266.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,881.93
|
| Rate for Payer: PHP Commercial |
$3,266.19
|
| Rate for Payer: Priority Health SBD |
$2,420.83
|
|
|
HC RIGHT VENTRICULAR RECORDING
|
Facility
|
OP
|
$3,842.58
|
|
|
Service Code
|
CPT 93603
|
| Hospital Charge Code |
48100031
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$634.48 |
| Max. Negotiated Rate |
$3,923.26 |
| Rate for Payer: Aetna Commercial |
$3,266.19
|
| Rate for Payer: Aetna Medicare |
$1,261.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,497.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,516.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,516.45
|
| Rate for Payer: BCBS Complete |
$666.27
|
| Rate for Payer: BCBS MAPPO |
$1,213.16
|
| Rate for Payer: BCBS Trust/PPO |
$3,374.53
|
| Rate for Payer: BCN Commercial |
$3,374.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,213.16
|
| Rate for Payer: Cash Price |
$3,074.06
|
| Rate for Payer: Cash Price |
$3,074.06
|
| Rate for Payer: Cofinity Advantage |
$2,689.81
|
| Rate for Payer: Cofinity Commercial |
$3,304.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,074.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,213.16
|
| Rate for Payer: Healthscope Commercial |
$3,458.32
|
| Rate for Payer: Mclaren Medicaid |
$634.48
|
| Rate for Payer: Mclaren Medicare |
$1,213.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,273.82
|
| Rate for Payer: Meridian Medicaid |
$1,273.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,395.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,334.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,266.19
|
| Rate for Payer: Nomi Health Commercial |
$3,639.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,881.93
|
| Rate for Payer: PACE Medicare |
$1,152.50
|
| Rate for Payer: PACE SWMI |
$1,213.16
|
| Rate for Payer: PHP Commercial |
$3,266.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,213.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$634.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,923.26
|
| Rate for Payer: Priority Health Medicare |
$1,213.16
|
| Rate for Payer: Priority Health SBD |
$2,420.83
|
| Rate for Payer: Priority Health Tiered Network |
$3,138.61
|
| Rate for Payer: Railroad Medicare Medicare |
$1,213.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,213.16
|
| Rate for Payer: UHC Medicaid |
$634.48
|
| Rate for Payer: UHCCP Medicaid |
$634.48
|
| Rate for Payer: VA VA |
$1,213.16
|
|
|
HC RISK ASCVD TEST ONCE PER 12 MO
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS G0537
|
| Hospital Charge Code |
51000135
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.52 |
| Max. Negotiated Rate |
$120.72 |
| Rate for Payer: Aetna Commercial |
$80.75
|
| Rate for Payer: Aetna Medicare |
$38.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.66
|
| Rate for Payer: BCBS Complete |
$20.50
|
| Rate for Payer: BCBS MAPPO |
$37.33
|
| Rate for Payer: BCN Medicare Advantage |
$37.33
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cofinity Advantage |
$66.50
|
| Rate for Payer: Cofinity Commercial |
$81.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.33
|
| Rate for Payer: Healthscope Commercial |
$85.50
|
| Rate for Payer: Mclaren Medicaid |
$19.52
|
| Rate for Payer: Mclaren Medicare |
$37.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.20
|
| Rate for Payer: Meridian Medicaid |
$39.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$41.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.75
|
| Rate for Payer: Nomi Health Commercial |
$111.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.25
|
| Rate for Payer: PACE Medicare |
$35.46
|
| Rate for Payer: PACE SWMI |
$37.33
|
| Rate for Payer: PHP Commercial |
$80.75
|
| Rate for Payer: PHP Medicare Advantage |
$37.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$120.72
|
| Rate for Payer: Priority Health Medicare |
$37.33
|
| Rate for Payer: Priority Health SBD |
$59.85
|
| Rate for Payer: Priority Health Tiered Network |
$96.58
|
| Rate for Payer: Railroad Medicare Medicare |
$37.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.75
|
| Rate for Payer: UHC Core |
$49.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.33
|
| Rate for Payer: UHC Exchange |
$37.34
|
| Rate for Payer: UHC Medicaid |
$19.52
|
| Rate for Payer: UHCCP Medicaid |
$19.52
|
| Rate for Payer: VA VA |
$37.33
|
|
|
HC RISK ASCVD TEST ONCE PER 12 MO
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS G0537
|
| Hospital Charge Code |
51000135
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.85 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna Commercial |
$80.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.75
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cofinity Advantage |
$66.50
|
| Rate for Payer: Cofinity Commercial |
$81.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.00
|
| Rate for Payer: Healthscope Commercial |
$85.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.25
|
| Rate for Payer: PHP Commercial |
$80.75
|
| Rate for Payer: Priority Health SBD |
$59.85
|
|
|
HC RISPERIDONE AND METABOLIT
|
Facility
|
IP
|
$115.48
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
30100691
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$72.75 |
| Max. Negotiated Rate |
$103.93 |
| Rate for Payer: Aetna Commercial |
$98.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.06
|
| Rate for Payer: Cash Price |
$92.38
|
| Rate for Payer: Cofinity Advantage |
$80.84
|
| Rate for Payer: Cofinity Commercial |
$99.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.38
|
| Rate for Payer: Healthscope Commercial |
$103.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.61
|
| Rate for Payer: PHP Commercial |
$98.16
|
| Rate for Payer: Priority Health SBD |
$72.75
|
|
|
HC RISPERIDONE AND METABOLIT
|
Facility
|
OP
|
$115.48
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
30100691
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.19 |
| Max. Negotiated Rate |
$103.93 |
| Rate for Payer: Aetna Commercial |
$98.16
|
| Rate for Payer: Aetna Medicare |
$57.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.06
|
| Rate for Payer: BCBS Complete |
$46.19
|
| Rate for Payer: Cash Price |
$92.38
|
| Rate for Payer: Cofinity Advantage |
$80.84
|
| Rate for Payer: Cofinity Commercial |
$99.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.38
|
| Rate for Payer: Healthscope Commercial |
$103.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.61
|
| Rate for Payer: PHP Commercial |
$98.16
|
| Rate for Payer: Priority Health SBD |
$72.75
|
|
|
HC RISTOCETIN COFACTOR
|
Facility
|
OP
|
$70.46
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
30500023
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$63.41 |
| Rate for Payer: Aetna Commercial |
$59.89
|
| Rate for Payer: Aetna Medicare |
$23.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.68
|
| Rate for Payer: BCBS Complete |
$12.60
|
| Rate for Payer: BCBS MAPPO |
$22.94
|
| Rate for Payer: BCBS Trust/PPO |
$24.47
|
| Rate for Payer: BCN Commercial |
$24.47
|
| Rate for Payer: BCN Medicare Advantage |
$22.94
|
| Rate for Payer: Cash Price |
$56.37
|
| Rate for Payer: Cash Price |
$56.37
|
| Rate for Payer: Cofinity Advantage |
$49.32
|
| Rate for Payer: Cofinity Commercial |
$60.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.94
|
| Rate for Payer: Healthscope Commercial |
$63.41
|
| Rate for Payer: Mclaren Medicaid |
$12.00
|
| Rate for Payer: Mclaren Medicare |
$22.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.09
|
| Rate for Payer: Meridian Medicaid |
$24.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.89
|
| Rate for Payer: Nomi Health Commercial |
$34.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.84
|
| Rate for Payer: PACE Medicare |
$21.79
|
| Rate for Payer: PACE SWMI |
$22.94
|
| Rate for Payer: PHP Commercial |
$59.89
|
| Rate for Payer: PHP Medicare Advantage |
$22.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22.94
|
| Rate for Payer: Priority Health Medicare |
$22.94
|
| Rate for Payer: Priority Health SBD |
$44.39
|
| Rate for Payer: Priority Health Tiered Network |
$18.35
|
| Rate for Payer: Railroad Medicare Medicare |
$22.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.41
|
| Rate for Payer: UHC Core |
$34.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22.94
|
| Rate for Payer: UHC Exchange |
$34.41
|
| Rate for Payer: UHC Medicaid |
$12.00
|
| Rate for Payer: UHCCP Medicaid |
$12.00
|
| Rate for Payer: VA VA |
$22.94
|
|
|
HC RISTOCETIN COFACTOR
|
Facility
|
IP
|
$70.46
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
30500023
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$44.39 |
| Max. Negotiated Rate |
$63.41 |
| Rate for Payer: Aetna Commercial |
$59.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.80
|
| Rate for Payer: Cash Price |
$56.37
|
| Rate for Payer: Cofinity Advantage |
$49.32
|
| Rate for Payer: Cofinity Commercial |
$60.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.37
|
| Rate for Payer: Healthscope Commercial |
$63.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.84
|
| Rate for Payer: PHP Commercial |
$59.89
|
| Rate for Payer: Priority Health SBD |
$44.39
|
|
|
HC RIV 4 VACC RECOMBINANT DNA PRSRV ABX FREE
|
Facility
|
OP
|
$97.07
|
|
|
Service Code
|
CPT 90682
|
| Hospital Charge Code |
63600171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.83 |
| Max. Negotiated Rate |
$158.85 |
| Rate for Payer: Aetna Commercial |
$82.51
|
| Rate for Payer: Aetna Medicare |
$48.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.10
|
| Rate for Payer: BCBS Complete |
$38.83
|
| Rate for Payer: BCBS Trust/PPO |
$158.85
|
| Rate for Payer: BCN Commercial |
$158.85
|
| Rate for Payer: Cash Price |
$77.66
|
| Rate for Payer: Cash Price |
$77.66
|
| Rate for Payer: Cofinity Advantage |
$67.95
|
| Rate for Payer: Cofinity Commercial |
$83.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.66
|
| Rate for Payer: Healthscope Commercial |
$87.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.80
|
| Rate for Payer: PHP Commercial |
$82.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$73.40
|
| Rate for Payer: Priority Health SBD |
$61.15
|
| Rate for Payer: Priority Health Tiered Network |
$58.72
|
|
|
HC RIV 4 VACC RECOMBINANT DNA PRSRV ABX FREE
|
Facility
|
IP
|
$97.07
|
|
|
Service Code
|
CPT 90682
|
| Hospital Charge Code |
63600171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.15 |
| Max. Negotiated Rate |
$87.36 |
| Rate for Payer: Aetna Commercial |
$82.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.10
|
| Rate for Payer: Cash Price |
$77.66
|
| Rate for Payer: Cofinity Advantage |
$67.95
|
| Rate for Payer: Cofinity Commercial |
$83.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.66
|
| Rate for Payer: Healthscope Commercial |
$87.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.80
|
| Rate for Payer: PHP Commercial |
$82.51
|
| Rate for Payer: Priority Health SBD |
$61.15
|
|
|
HC RLC W INTERVENTION
|
Facility
|
OP
|
$11,423.48
|
|
|
Service Code
|
CPT 93460
|
| Hospital Charge Code |
48100020
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,689.43 |
| Max. Negotiated Rate |
$10,446.41 |
| Rate for Payer: Aetna Commercial |
$9,709.96
|
| Rate for Payer: Aetna Medicare |
$3,359.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,425.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,037.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,037.84
|
| Rate for Payer: BCBS Complete |
$1,774.06
|
| Rate for Payer: BCBS MAPPO |
$3,230.27
|
| Rate for Payer: BCBS Trust/PPO |
$3,649.36
|
| Rate for Payer: BCN Commercial |
$3,649.36
|
| Rate for Payer: BCN Medicare Advantage |
$3,230.27
|
| Rate for Payer: Cash Price |
$9,138.78
|
| Rate for Payer: Cash Price |
$9,138.78
|
| Rate for Payer: Cofinity Advantage |
$7,996.44
|
| Rate for Payer: Cofinity Commercial |
$9,824.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,138.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,230.27
|
| Rate for Payer: Healthscope Commercial |
$10,281.13
|
| Rate for Payer: Mclaren Medicaid |
$1,689.43
|
| Rate for Payer: Mclaren Medicare |
$3,230.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,391.78
|
| Rate for Payer: Meridian Medicaid |
$3,391.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,714.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,553.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,709.96
|
| Rate for Payer: Nomi Health Commercial |
$9,690.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,567.61
|
| Rate for Payer: PACE Medicare |
$3,068.76
|
| Rate for Payer: PACE SWMI |
$3,230.27
|
| Rate for Payer: PHP Commercial |
$9,709.96
|
| Rate for Payer: PHP Medicare Advantage |
$3,230.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,689.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,446.41
|
| Rate for Payer: Priority Health Medicare |
$3,230.27
|
| Rate for Payer: Priority Health SBD |
$7,196.79
|
| Rate for Payer: Priority Health Tiered Network |
$8,357.13
|
| Rate for Payer: Railroad Medicare Medicare |
$3,230.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,230.27
|
| Rate for Payer: UHC Medicaid |
$1,689.43
|
| Rate for Payer: UHCCP Medicaid |
$1,689.43
|
| Rate for Payer: VA VA |
$3,230.27
|
|
|
HC RLC W INTERVENTION
|
Facility
|
IP
|
$11,423.48
|
|
|
Service Code
|
CPT 93460
|
| Hospital Charge Code |
48100020
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,196.79 |
| Max. Negotiated Rate |
$10,281.13 |
| Rate for Payer: Aetna Commercial |
$9,709.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,425.26
|
| Rate for Payer: Cash Price |
$9,138.78
|
| Rate for Payer: Cofinity Advantage |
$7,996.44
|
| Rate for Payer: Cofinity Commercial |
$9,824.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,138.78
|
| Rate for Payer: Healthscope Commercial |
$10,281.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,709.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,567.61
|
| Rate for Payer: PHP Commercial |
$9,709.96
|
| Rate for Payer: Priority Health SBD |
$7,196.79
|
|
|
HC RMVL EMBEDDED FB VESTIBULE MOUTH SMPL
|
Facility
|
IP
|
$2,444.94
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
76100458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,540.31 |
| Max. Negotiated Rate |
$2,200.45 |
| Rate for Payer: Aetna Commercial |
$2,078.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,589.21
|
| Rate for Payer: Cash Price |
$1,955.95
|
| Rate for Payer: Cofinity Advantage |
$1,711.46
|
| Rate for Payer: Cofinity Commercial |
$2,102.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,955.95
|
| Rate for Payer: Healthscope Commercial |
$2,200.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,078.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,833.70
|
| Rate for Payer: PHP Commercial |
$2,078.20
|
| Rate for Payer: Priority Health SBD |
$1,540.31
|
|
