|
HC ROTAVIRUS ANTIGEN
|
Facility
|
OP
|
$111.95
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
30600145
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.27 |
| Max. Negotiated Rate |
$100.75 |
| Rate for Payer: Aetna Commercial |
$95.16
|
| Rate for Payer: Aetna Medicare |
$12.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.97
|
| Rate for Payer: BCBS Complete |
$6.58
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$12.78
|
| Rate for Payer: BCN Commercial |
$12.78
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$89.56
|
| Rate for Payer: Cash Price |
$89.56
|
| Rate for Payer: Cofinity Advantage |
$78.36
|
| Rate for Payer: Cofinity Commercial |
$96.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$100.75
|
| Rate for Payer: Mclaren Medicaid |
$6.27
|
| Rate for Payer: Mclaren Medicare |
$11.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.58
|
| Rate for Payer: Meridian Medicaid |
$12.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.16
|
| Rate for Payer: Nomi Health Commercial |
$17.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.96
|
| Rate for Payer: PACE Medicare |
$11.38
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$95.16
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11.98
|
| Rate for Payer: Priority Health Medicare |
$11.98
|
| Rate for Payer: Priority Health SBD |
$70.53
|
| Rate for Payer: Priority Health Tiered Network |
$9.58
|
| Rate for Payer: Railroad Medicare Medicare |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.97
|
| Rate for Payer: UHC Core |
$17.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.98
|
| Rate for Payer: UHC Exchange |
$17.97
|
| Rate for Payer: UHC Medicaid |
$6.27
|
| Rate for Payer: UHCCP Medicaid |
$6.27
|
| Rate for Payer: VA VA |
$11.98
|
|
|
HC ROTAVIRUS ANTIGEN
|
Facility
|
IP
|
$111.95
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
30600145
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$70.53 |
| Max. Negotiated Rate |
$100.75 |
| Rate for Payer: Aetna Commercial |
$95.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.77
|
| Rate for Payer: Cash Price |
$89.56
|
| Rate for Payer: Cofinity Advantage |
$78.36
|
| Rate for Payer: Cofinity Commercial |
$96.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.56
|
| Rate for Payer: Healthscope Commercial |
$100.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.96
|
| Rate for Payer: PHP Commercial |
$95.16
|
| Rate for Payer: Priority Health SBD |
$70.53
|
|
|
HC ROTAVIRUS ATTEN 2 DOSE SCHED LIVE ORAL
|
Facility
|
IP
|
$182.10
|
|
|
Service Code
|
CPT 90681
|
| Hospital Charge Code |
63600121
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$114.72 |
| Max. Negotiated Rate |
$163.89 |
| Rate for Payer: Aetna Commercial |
$154.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.36
|
| Rate for Payer: Cash Price |
$145.68
|
| Rate for Payer: Cofinity Advantage |
$127.47
|
| Rate for Payer: Cofinity Commercial |
$156.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.68
|
| Rate for Payer: Healthscope Commercial |
$163.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.57
|
| Rate for Payer: PHP Commercial |
$154.78
|
| Rate for Payer: Priority Health SBD |
$114.72
|
|
|
HC ROTAVIRUS ATTEN 2 DOSE SCHED LIVE ORAL
|
Facility
|
OP
|
$182.10
|
|
|
Service Code
|
CPT 90681
|
| Hospital Charge Code |
63600121
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.84 |
| Max. Negotiated Rate |
$362.02 |
| Rate for Payer: Aetna Commercial |
$154.78
|
| Rate for Payer: Aetna Medicare |
$91.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.36
|
| Rate for Payer: BCBS Complete |
$72.84
|
| Rate for Payer: BCBS Trust/PPO |
$362.02
|
| Rate for Payer: BCN Commercial |
$362.02
|
| Rate for Payer: Cash Price |
$145.68
|
| Rate for Payer: Cash Price |
$145.68
|
| Rate for Payer: Cofinity Advantage |
$127.47
|
| Rate for Payer: Cofinity Commercial |
$156.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.68
|
| Rate for Payer: Healthscope Commercial |
$163.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.57
|
| Rate for Payer: PHP Commercial |
$154.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$167.46
|
| Rate for Payer: Priority Health SBD |
$114.72
|
| Rate for Payer: Priority Health Tiered Network |
$133.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.24
|
| Rate for Payer: UHC Core |
$308.24
|
| Rate for Payer: UHC Exchange |
$308.24
|
|
|
HC ROTAVIRUS VACCINE, PENTAVALENT (RV5), 3 DOSE SCHEDULE, LIVE ORAL
|
Facility
|
IP
|
$78.96
|
|
|
Service Code
|
CPT 90680
|
| Hospital Charge Code |
63600076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.74 |
| Max. Negotiated Rate |
$71.06 |
| Rate for Payer: Aetna Commercial |
$67.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.32
|
| Rate for Payer: Cash Price |
$63.17
|
| Rate for Payer: Cofinity Advantage |
$55.27
|
| Rate for Payer: Cofinity Commercial |
$67.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.17
|
| Rate for Payer: Healthscope Commercial |
$71.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.22
|
| Rate for Payer: PHP Commercial |
$67.12
|
| Rate for Payer: Priority Health SBD |
$49.74
|
|
|
HC ROTAVIRUS VACCINE, PENTAVALENT (RV5), 3 DOSE SCHEDULE, LIVE ORAL
|
Facility
|
OP
|
$78.96
|
|
|
Service Code
|
CPT 90680
|
| Hospital Charge Code |
63600076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.58 |
| Max. Negotiated Rate |
$252.99 |
| Rate for Payer: Aetna Commercial |
$67.12
|
| Rate for Payer: Aetna Medicare |
$39.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.32
|
| Rate for Payer: BCBS Complete |
$31.58
|
| Rate for Payer: BCBS Trust/PPO |
$252.99
|
| Rate for Payer: BCN Commercial |
$252.99
|
| Rate for Payer: Cash Price |
$63.17
|
| Rate for Payer: Cash Price |
$63.17
|
| Rate for Payer: Cofinity Advantage |
$55.27
|
| Rate for Payer: Cofinity Commercial |
$67.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.17
|
| Rate for Payer: Healthscope Commercial |
$71.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.22
|
| Rate for Payer: PHP Commercial |
$67.12
|
| Rate for Payer: Priority Health SBD |
$49.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.18
|
| Rate for Payer: UHC Core |
$203.18
|
| Rate for Payer: UHC Exchange |
$203.18
|
|
|
HC RO TREATMENT DEVICE INTERMED
|
Facility
|
OP
|
$531.66
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
33300037
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$20.97 |
| Max. Negotiated Rate |
$478.49 |
| Rate for Payer: Aetna Commercial |
$451.91
|
| Rate for Payer: Aetna Medicare |
$139.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$167.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$167.41
|
| Rate for Payer: BCBS Complete |
$73.55
|
| Rate for Payer: BCBS MAPPO |
$133.93
|
| Rate for Payer: BCBS Trust/PPO |
$20.97
|
| Rate for Payer: BCN Commercial |
$20.97
|
| Rate for Payer: BCN Medicare Advantage |
$133.93
|
| Rate for Payer: Cash Price |
$425.33
|
| Rate for Payer: Cash Price |
$425.33
|
| Rate for Payer: Cofinity Advantage |
$372.16
|
| Rate for Payer: Cofinity Commercial |
$457.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.93
|
| Rate for Payer: Healthscope Commercial |
$478.49
|
| Rate for Payer: Mclaren Medicaid |
$70.05
|
| Rate for Payer: Mclaren Medicare |
$133.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.63
|
| Rate for Payer: Meridian Medicaid |
$140.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$147.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$451.91
|
| Rate for Payer: Nomi Health Commercial |
$401.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$398.75
|
| Rate for Payer: PACE Medicare |
$127.23
|
| Rate for Payer: PACE SWMI |
$133.93
|
| Rate for Payer: PHP Commercial |
$451.91
|
| Rate for Payer: PHP Medicare Advantage |
$133.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$433.11
|
| Rate for Payer: Priority Health Medicare |
$133.93
|
| Rate for Payer: Priority Health SBD |
$334.95
|
| Rate for Payer: Priority Health Tiered Network |
$346.49
|
| Rate for Payer: Railroad Medicare Medicare |
$133.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$345.58
|
| Rate for Payer: UHC Core |
$276.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$133.93
|
| Rate for Payer: UHC Exchange |
$208.94
|
| Rate for Payer: UHC Medicaid |
$70.05
|
| Rate for Payer: UHCCP Medicaid |
$70.05
|
| Rate for Payer: VA VA |
$133.93
|
|
|
HC RO TREATMENT DEVICE INTERMED
|
Facility
|
IP
|
$531.66
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
33300037
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$334.95 |
| Max. Negotiated Rate |
$478.49 |
| Rate for Payer: Aetna Commercial |
$451.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.58
|
| Rate for Payer: Cash Price |
$425.33
|
| Rate for Payer: Cofinity Advantage |
$372.16
|
| Rate for Payer: Cofinity Commercial |
$457.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.33
|
| Rate for Payer: Healthscope Commercial |
$478.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$451.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$398.75
|
| Rate for Payer: PHP Commercial |
$451.91
|
| Rate for Payer: Priority Health SBD |
$334.95
|
|
|
HC RO TREATMENT DEVICE SIMPLE
|
Facility
|
OP
|
$422.36
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
33300038
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$70.05 |
| Max. Negotiated Rate |
$433.11 |
| Rate for Payer: Aetna Commercial |
$359.01
|
| Rate for Payer: Aetna Medicare |
$139.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$167.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$167.41
|
| Rate for Payer: BCBS Complete |
$73.55
|
| Rate for Payer: BCBS MAPPO |
$133.93
|
| Rate for Payer: BCBS Trust/PPO |
$119.61
|
| Rate for Payer: BCN Commercial |
$119.61
|
| Rate for Payer: BCN Medicare Advantage |
$133.93
|
| Rate for Payer: Cash Price |
$337.89
|
| Rate for Payer: Cash Price |
$337.89
|
| Rate for Payer: Cofinity Advantage |
$295.65
|
| Rate for Payer: Cofinity Commercial |
$363.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.93
|
| Rate for Payer: Healthscope Commercial |
$380.12
|
| Rate for Payer: Mclaren Medicaid |
$70.05
|
| Rate for Payer: Mclaren Medicare |
$133.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.63
|
| Rate for Payer: Meridian Medicaid |
$140.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$147.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.01
|
| Rate for Payer: Nomi Health Commercial |
$401.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.77
|
| Rate for Payer: PACE Medicare |
$127.23
|
| Rate for Payer: PACE SWMI |
$133.93
|
| Rate for Payer: PHP Commercial |
$359.01
|
| Rate for Payer: PHP Medicare Advantage |
$133.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$433.11
|
| Rate for Payer: Priority Health Medicare |
$133.93
|
| Rate for Payer: Priority Health SBD |
$266.09
|
| Rate for Payer: Priority Health Tiered Network |
$346.49
|
| Rate for Payer: Railroad Medicare Medicare |
$133.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.53
|
| Rate for Payer: UHC Core |
$220.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$133.93
|
| Rate for Payer: UHC Exchange |
$165.99
|
| Rate for Payer: UHC Medicaid |
$70.05
|
| Rate for Payer: UHCCP Medicaid |
$70.05
|
| Rate for Payer: VA VA |
$133.93
|
|
|
HC RO TREATMENT DEVICE SIMPLE
|
Facility
|
IP
|
$422.36
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
33300038
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$266.09 |
| Max. Negotiated Rate |
$380.12 |
| Rate for Payer: Aetna Commercial |
$359.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.53
|
| Rate for Payer: Cash Price |
$337.89
|
| Rate for Payer: Cofinity Advantage |
$295.65
|
| Rate for Payer: Cofinity Commercial |
$363.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.89
|
| Rate for Payer: Healthscope Commercial |
$380.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.77
|
| Rate for Payer: PHP Commercial |
$359.01
|
| Rate for Payer: Priority Health SBD |
$266.09
|
|
|
HC RO TRTMNT >1 MEV COMPLEX
|
Facility
|
IP
|
$715.25
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
33300049
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$450.61 |
| Max. Negotiated Rate |
$643.73 |
| Rate for Payer: Aetna Commercial |
$607.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.91
|
| Rate for Payer: Cash Price |
$572.20
|
| Rate for Payer: Cofinity Advantage |
$500.68
|
| Rate for Payer: Cofinity Commercial |
$615.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$572.20
|
| Rate for Payer: Healthscope Commercial |
$643.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$536.44
|
| Rate for Payer: PHP Commercial |
$607.96
|
| Rate for Payer: Priority Health SBD |
$450.61
|
|
|
HC RO TRTMNT >1 MEV COMPLEX
|
Facility
|
OP
|
$715.25
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
33300049
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$281.09 |
| Max. Negotiated Rate |
$1,780.43 |
| Rate for Payer: Aetna Commercial |
$607.96
|
| Rate for Payer: Aetna Medicare |
$572.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$688.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$688.20
|
| Rate for Payer: BCBS Complete |
$302.37
|
| Rate for Payer: BCBS MAPPO |
$550.56
|
| Rate for Payer: BCBS Trust/PPO |
$288.87
|
| Rate for Payer: BCN Commercial |
$288.87
|
| Rate for Payer: BCN Medicare Advantage |
$550.56
|
| Rate for Payer: Cash Price |
$572.20
|
| Rate for Payer: Cash Price |
$572.20
|
| Rate for Payer: Cofinity Advantage |
$500.68
|
| Rate for Payer: Cofinity Commercial |
$615.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$572.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$550.56
|
| Rate for Payer: Healthscope Commercial |
$643.73
|
| Rate for Payer: Mclaren Medicaid |
$287.94
|
| Rate for Payer: Mclaren Medicare |
$550.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$578.09
|
| Rate for Payer: Meridian Medicaid |
$578.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$633.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$605.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.96
|
| Rate for Payer: Nomi Health Commercial |
$1,651.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$536.44
|
| Rate for Payer: PACE Medicare |
$523.03
|
| Rate for Payer: PACE SWMI |
$550.56
|
| Rate for Payer: PHP Commercial |
$607.96
|
| Rate for Payer: PHP Medicare Advantage |
$550.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$287.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,780.43
|
| Rate for Payer: Priority Health Medicare |
$550.56
|
| Rate for Payer: Priority Health SBD |
$450.61
|
| Rate for Payer: Priority Health Tiered Network |
$1,424.34
|
| Rate for Payer: Railroad Medicare Medicare |
$550.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$464.91
|
| Rate for Payer: UHC Core |
$372.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$550.56
|
| Rate for Payer: UHC Exchange |
$281.09
|
| Rate for Payer: UHC Medicaid |
$287.94
|
| Rate for Payer: UHCCP Medicaid |
$287.94
|
| Rate for Payer: VA VA |
$550.56
|
|
|
HC RO TRTMNT > 1 MEV INTERMEDIATE
|
Facility
|
IP
|
$429.97
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
33300052
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$270.88 |
| Max. Negotiated Rate |
$386.97 |
| Rate for Payer: Aetna Commercial |
$365.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.48
|
| Rate for Payer: Cash Price |
$343.98
|
| Rate for Payer: Cofinity Advantage |
$300.98
|
| Rate for Payer: Cofinity Commercial |
$369.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.98
|
| Rate for Payer: Healthscope Commercial |
$386.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.48
|
| Rate for Payer: PHP Commercial |
$365.47
|
| Rate for Payer: Priority Health SBD |
$270.88
|
|
|
HC RO TRTMNT > 1 MEV INTERMEDIATE
|
Facility
|
OP
|
$429.97
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
33300052
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$164.00 |
| Max. Negotiated Rate |
$1,242.83 |
| Rate for Payer: Aetna Commercial |
$365.47
|
| Rate for Payer: Aetna Medicare |
$399.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$480.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$480.39
|
| Rate for Payer: BCBS Complete |
$211.06
|
| Rate for Payer: BCBS MAPPO |
$384.31
|
| Rate for Payer: BCBS Trust/PPO |
$164.00
|
| Rate for Payer: BCN Commercial |
$164.00
|
| Rate for Payer: BCN Medicare Advantage |
$384.31
|
| Rate for Payer: Cash Price |
$343.98
|
| Rate for Payer: Cash Price |
$343.98
|
| Rate for Payer: Cofinity Advantage |
$300.98
|
| Rate for Payer: Cofinity Commercial |
$369.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$384.31
|
| Rate for Payer: Healthscope Commercial |
$386.97
|
| Rate for Payer: Mclaren Medicaid |
$200.99
|
| Rate for Payer: Mclaren Medicare |
$384.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$403.53
|
| Rate for Payer: Meridian Medicaid |
$403.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$441.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$422.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.47
|
| Rate for Payer: Nomi Health Commercial |
$1,152.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.48
|
| Rate for Payer: PACE Medicare |
$365.09
|
| Rate for Payer: PACE SWMI |
$384.31
|
| Rate for Payer: PHP Commercial |
$365.47
|
| Rate for Payer: PHP Medicare Advantage |
$384.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,242.83
|
| Rate for Payer: Priority Health Medicare |
$384.31
|
| Rate for Payer: Priority Health SBD |
$270.88
|
| Rate for Payer: Priority Health Tiered Network |
$994.26
|
| Rate for Payer: Railroad Medicare Medicare |
$384.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$279.48
|
| Rate for Payer: UHC Core |
$224.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$384.31
|
| Rate for Payer: UHC Exchange |
$168.98
|
| Rate for Payer: UHC Medicaid |
$200.99
|
| Rate for Payer: UHCCP Medicaid |
$200.99
|
| Rate for Payer: VA VA |
$384.31
|
|
|
HC RO TRTMNT >1 MEV SIMPLE
|
Facility
|
IP
|
$235.86
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
33300048
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$148.59 |
| Max. Negotiated Rate |
$212.27 |
| Rate for Payer: Aetna Commercial |
$200.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.31
|
| Rate for Payer: Cash Price |
$188.69
|
| Rate for Payer: Cofinity Advantage |
$165.10
|
| Rate for Payer: Cofinity Commercial |
$202.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.69
|
| Rate for Payer: Healthscope Commercial |
$212.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.90
|
| Rate for Payer: PHP Commercial |
$200.48
|
| Rate for Payer: Priority Health SBD |
$148.59
|
|
|
HC RO TRTMNT >1 MEV SIMPLE
|
Facility
|
OP
|
$235.86
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
33300048
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$53.17 |
| Max. Negotiated Rate |
$328.77 |
| Rate for Payer: Aetna Commercial |
$200.48
|
| Rate for Payer: Aetna Medicare |
$105.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$127.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$127.08
|
| Rate for Payer: BCBS Complete |
$55.83
|
| Rate for Payer: BCBS MAPPO |
$101.66
|
| Rate for Payer: BCBS Trust/PPO |
$164.00
|
| Rate for Payer: BCN Commercial |
$164.00
|
| Rate for Payer: BCN Medicare Advantage |
$101.66
|
| Rate for Payer: Cash Price |
$188.69
|
| Rate for Payer: Cash Price |
$188.69
|
| Rate for Payer: Cofinity Advantage |
$165.10
|
| Rate for Payer: Cofinity Commercial |
$202.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.66
|
| Rate for Payer: Healthscope Commercial |
$212.27
|
| Rate for Payer: Mclaren Medicaid |
$53.17
|
| Rate for Payer: Mclaren Medicare |
$101.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.74
|
| Rate for Payer: Meridian Medicaid |
$106.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.48
|
| Rate for Payer: Nomi Health Commercial |
$304.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.90
|
| Rate for Payer: PACE Medicare |
$96.58
|
| Rate for Payer: PACE SWMI |
$101.66
|
| Rate for Payer: PHP Commercial |
$200.48
|
| Rate for Payer: PHP Medicare Advantage |
$101.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$328.77
|
| Rate for Payer: Priority Health Medicare |
$101.66
|
| Rate for Payer: Priority Health SBD |
$148.59
|
| Rate for Payer: Priority Health Tiered Network |
$263.02
|
| Rate for Payer: Railroad Medicare Medicare |
$101.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.31
|
| Rate for Payer: UHC Core |
$122.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$101.66
|
| Rate for Payer: UHC Exchange |
$92.69
|
| Rate for Payer: UHC Medicaid |
$53.17
|
| Rate for Payer: UHCCP Medicaid |
$53.17
|
| Rate for Payer: VA VA |
$101.66
|
|
|
HC RO TRTMNT LEVEL 1
|
Facility
|
OP
|
$254.15
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
33300078
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$53.17 |
| Max. Negotiated Rate |
$328.77 |
| Rate for Payer: Aetna Commercial |
$216.03
|
| Rate for Payer: Aetna Medicare |
$105.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$127.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$127.08
|
| Rate for Payer: BCBS Complete |
$55.83
|
| Rate for Payer: BCBS MAPPO |
$101.66
|
| Rate for Payer: BCBS Trust/PPO |
$164.00
|
| Rate for Payer: BCN Commercial |
$164.00
|
| Rate for Payer: BCN Medicare Advantage |
$101.66
|
| Rate for Payer: Cash Price |
$203.32
|
| Rate for Payer: Cash Price |
$203.32
|
| Rate for Payer: Cofinity Advantage |
$177.91
|
| Rate for Payer: Cofinity Commercial |
$218.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.66
|
| Rate for Payer: Healthscope Commercial |
$228.74
|
| Rate for Payer: Mclaren Medicaid |
$53.17
|
| Rate for Payer: Mclaren Medicare |
$101.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.74
|
| Rate for Payer: Meridian Medicaid |
$106.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.03
|
| Rate for Payer: Nomi Health Commercial |
$304.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.61
|
| Rate for Payer: PACE Medicare |
$96.58
|
| Rate for Payer: PACE SWMI |
$101.66
|
| Rate for Payer: PHP Commercial |
$216.03
|
| Rate for Payer: PHP Medicare Advantage |
$101.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$328.77
|
| Rate for Payer: Priority Health Medicare |
$101.66
|
| Rate for Payer: Priority Health SBD |
$160.11
|
| Rate for Payer: Priority Health Tiered Network |
$263.02
|
| Rate for Payer: Railroad Medicare Medicare |
$101.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.20
|
| Rate for Payer: UHC Core |
$132.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$101.66
|
| Rate for Payer: UHC Exchange |
$99.88
|
| Rate for Payer: UHC Medicaid |
$53.17
|
| Rate for Payer: UHCCP Medicaid |
$53.17
|
| Rate for Payer: VA VA |
$101.66
|
|
|
HC RO TRTMNT LEVEL 1
|
Facility
|
IP
|
$254.15
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
33300078
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$160.11 |
| Max. Negotiated Rate |
$228.74 |
| Rate for Payer: Aetna Commercial |
$216.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.20
|
| Rate for Payer: Cash Price |
$203.32
|
| Rate for Payer: Cofinity Advantage |
$177.91
|
| Rate for Payer: Cofinity Commercial |
$218.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.32
|
| Rate for Payer: Healthscope Commercial |
$228.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.61
|
| Rate for Payer: PHP Commercial |
$216.03
|
| Rate for Payer: Priority Health SBD |
$160.11
|
|
|
HC RO TRTMNT LEVEL 2
|
Facility
|
OP
|
$960.76
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
33300079
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$164.00 |
| Max. Negotiated Rate |
$1,242.83 |
| Rate for Payer: Aetna Commercial |
$816.65
|
| Rate for Payer: Aetna Medicare |
$399.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$624.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$480.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$480.39
|
| Rate for Payer: BCBS Complete |
$211.06
|
| Rate for Payer: BCBS MAPPO |
$384.31
|
| Rate for Payer: BCBS Trust/PPO |
$164.00
|
| Rate for Payer: BCN Commercial |
$164.00
|
| Rate for Payer: BCN Medicare Advantage |
$384.31
|
| Rate for Payer: Cash Price |
$768.61
|
| Rate for Payer: Cash Price |
$768.61
|
| Rate for Payer: Cofinity Advantage |
$672.53
|
| Rate for Payer: Cofinity Commercial |
$826.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$768.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$384.31
|
| Rate for Payer: Healthscope Commercial |
$864.68
|
| Rate for Payer: Mclaren Medicaid |
$200.99
|
| Rate for Payer: Mclaren Medicare |
$384.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$403.53
|
| Rate for Payer: Meridian Medicaid |
$403.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$441.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$422.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$816.65
|
| Rate for Payer: Nomi Health Commercial |
$1,152.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$720.57
|
| Rate for Payer: PACE Medicare |
$365.09
|
| Rate for Payer: PACE SWMI |
$384.31
|
| Rate for Payer: PHP Commercial |
$816.65
|
| Rate for Payer: PHP Medicare Advantage |
$384.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,242.83
|
| Rate for Payer: Priority Health Medicare |
$384.31
|
| Rate for Payer: Priority Health SBD |
$605.28
|
| Rate for Payer: Priority Health Tiered Network |
$994.26
|
| Rate for Payer: Railroad Medicare Medicare |
$384.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$624.49
|
| Rate for Payer: UHC Core |
$500.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$384.31
|
| Rate for Payer: UHC Exchange |
$377.58
|
| Rate for Payer: UHC Medicaid |
$200.99
|
| Rate for Payer: UHCCP Medicaid |
$200.99
|
| Rate for Payer: VA VA |
$384.31
|
|
|
HC RO TRTMNT LEVEL 2
|
Facility
|
IP
|
$960.76
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
33300079
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$605.28 |
| Max. Negotiated Rate |
$864.68 |
| Rate for Payer: Aetna Commercial |
$816.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$624.49
|
| Rate for Payer: Cash Price |
$768.61
|
| Rate for Payer: Cofinity Advantage |
$672.53
|
| Rate for Payer: Cofinity Commercial |
$826.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$768.61
|
| Rate for Payer: Healthscope Commercial |
$864.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$816.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$720.57
|
| Rate for Payer: PHP Commercial |
$816.65
|
| Rate for Payer: Priority Health SBD |
$605.28
|
|
|
HC RO TRTMNT LEVEL 3
|
Facility
|
OP
|
$1,376.40
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
33300080
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$287.94 |
| Max. Negotiated Rate |
$1,780.43 |
| Rate for Payer: Aetna Commercial |
$1,169.94
|
| Rate for Payer: Aetna Medicare |
$572.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$894.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$688.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$688.20
|
| Rate for Payer: BCBS Complete |
$302.37
|
| Rate for Payer: BCBS MAPPO |
$550.56
|
| Rate for Payer: BCBS Trust/PPO |
$288.87
|
| Rate for Payer: BCN Commercial |
$288.87
|
| Rate for Payer: BCN Medicare Advantage |
$550.56
|
| Rate for Payer: Cash Price |
$1,101.12
|
| Rate for Payer: Cash Price |
$1,101.12
|
| Rate for Payer: Cofinity Advantage |
$963.48
|
| Rate for Payer: Cofinity Commercial |
$1,183.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$550.56
|
| Rate for Payer: Healthscope Commercial |
$1,238.76
|
| Rate for Payer: Mclaren Medicaid |
$287.94
|
| Rate for Payer: Mclaren Medicare |
$550.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$578.09
|
| Rate for Payer: Meridian Medicaid |
$578.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$633.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$605.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,169.94
|
| Rate for Payer: Nomi Health Commercial |
$1,651.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,032.30
|
| Rate for Payer: PACE Medicare |
$523.03
|
| Rate for Payer: PACE SWMI |
$550.56
|
| Rate for Payer: PHP Commercial |
$1,169.94
|
| Rate for Payer: PHP Medicare Advantage |
$550.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$287.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,780.43
|
| Rate for Payer: Priority Health Medicare |
$550.56
|
| Rate for Payer: Priority Health SBD |
$867.13
|
| Rate for Payer: Priority Health Tiered Network |
$1,424.34
|
| Rate for Payer: Railroad Medicare Medicare |
$550.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$894.66
|
| Rate for Payer: UHC Core |
$717.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$550.56
|
| Rate for Payer: UHC Exchange |
$540.93
|
| Rate for Payer: UHC Medicaid |
$287.94
|
| Rate for Payer: UHCCP Medicaid |
$287.94
|
| Rate for Payer: VA VA |
$550.56
|
|
|
HC RO TRTMNT LEVEL 3
|
Facility
|
IP
|
$1,376.40
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
33300080
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$867.13 |
| Max. Negotiated Rate |
$1,238.76 |
| Rate for Payer: Aetna Commercial |
$1,169.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$894.66
|
| Rate for Payer: Cash Price |
$1,101.12
|
| Rate for Payer: Cofinity Advantage |
$963.48
|
| Rate for Payer: Cofinity Commercial |
$1,183.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.12
|
| Rate for Payer: Healthscope Commercial |
$1,238.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,169.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,032.30
|
| Rate for Payer: PHP Commercial |
$1,169.94
|
| Rate for Payer: Priority Health SBD |
$867.13
|
|
|
HC ROUGH MARSH ELDER IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200058
|
|
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 ROUGH MARSH ELDER IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200058
|
|
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 RPR BLOOD VSL GRF OTH/THN VEIN UPPER EXTREMITY
|
Facility
|
OP
|
$15,687.60
|
|
|
Service Code
|
CPT 35266
|
| Hospital Charge Code |
36000124
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,694.34 |
| Max. Negotiated Rate |
$17,930.33 |
| Rate for Payer: Aetna Commercial |
$13,334.46
|
| Rate for Payer: Aetna Medicare |
$5,766.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,196.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,930.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,930.60
|
| Rate for Payer: BCBS Complete |
$3,045.03
|
| Rate for Payer: BCBS MAPPO |
$5,544.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,694.34
|
| Rate for Payer: BCN Commercial |
$2,694.34
|
| Rate for Payer: BCN Medicare Advantage |
$5,544.48
|
| Rate for Payer: Cash Price |
$12,550.08
|
| Rate for Payer: Cash Price |
$12,550.08
|
| Rate for Payer: Cash Price |
$12,550.08
|
| Rate for Payer: Cofinity Advantage |
$10,981.32
|
| Rate for Payer: Cofinity Commercial |
$13,491.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,550.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,544.48
|
| Rate for Payer: Healthscope Commercial |
$14,118.84
|
| Rate for Payer: Mclaren Medicaid |
$2,899.76
|
| Rate for Payer: Mclaren Medicare |
$5,544.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,821.70
|
| Rate for Payer: Meridian Medicaid |
$5,821.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,376.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,098.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,334.46
|
| Rate for Payer: Nomi Health Commercial |
$16,633.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,765.70
|
| Rate for Payer: PACE Medicare |
$5,267.26
|
| Rate for Payer: PACE SWMI |
$5,544.48
|
| Rate for Payer: PHP Commercial |
$13,334.46
|
| Rate for Payer: PHP Medicare Advantage |
$5,544.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,899.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,930.33
|
| Rate for Payer: Priority Health Medicare |
$5,544.48
|
| Rate for Payer: Priority Health SBD |
$9,883.19
|
| Rate for Payer: Priority Health Tiered Network |
$14,344.26
|
| Rate for Payer: Railroad Medicare Medicare |
$5,544.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,544.48
|
| Rate for Payer: UHC Medicaid |
$2,899.76
|
| Rate for Payer: UHCCP Medicaid |
$2,899.76
|
| Rate for Payer: VA VA |
$5,544.48
|
|
