|
HC RECOVERY PHASE 2 EA MIN CHARGE
|
Facility
|
OP
|
$9.00
|
|
| Hospital Charge Code |
71000037
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna Commercial |
$7.65
|
| Rate for Payer: Aetna Medicare |
$4.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.85
|
| Rate for Payer: BCBS Complete |
$3.60
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cofinity Commercial |
$6.30
|
| Rate for Payer: Cofinity Commercial |
$7.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.20
|
| Rate for Payer: Healthscope Commercial |
$8.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.65
|
| Rate for Payer: PHP Commercial |
$7.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.85
|
| Rate for Payer: Priority Health SBD |
$5.67
|
|
|
HC RED CEDAR IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200099
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| 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 |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| 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 |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC RED CEDAR IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200099
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
|
|
HC RED CELL GENO MI BLD
|
Facility
|
IP
|
$302.94
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
31000135
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$190.85 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Aetna Commercial |
$257.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.91
|
| Rate for Payer: Cash Price |
$242.35
|
| Rate for Payer: Cofinity Commercial |
$212.06
|
| Rate for Payer: Cofinity Commercial |
$260.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$212.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.35
|
| Rate for Payer: Healthscope Commercial |
$272.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.50
|
| Rate for Payer: PHP Commercial |
$257.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.91
|
| Rate for Payer: Priority Health SBD |
$190.85
|
|
|
HC RED CELL GENO MI BLD
|
Facility
|
OP
|
$302.94
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
31000135
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$99.27 |
| Max. Negotiated Rate |
$521.32 |
| Rate for Payer: Aetna Commercial |
$257.50
|
| Rate for Payer: Aetna Medicare |
$192.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.91
|
| 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 |
$104.23
|
| Rate for Payer: BCBS MAPPO |
$185.20
|
| Rate for Payer: BCN Medicare Advantage |
$185.20
|
| Rate for Payer: Cash Price |
$242.35
|
| Rate for Payer: Cash Price |
$242.35
|
| Rate for Payer: Cofinity Commercial |
$260.53
|
| Rate for Payer: Cofinity Commercial |
$212.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$212.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.20
|
| Rate for Payer: Healthscope Commercial |
$272.65
|
| Rate for Payer: Mclaren Medicaid |
$99.27
|
| 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 |
$104.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.50
|
| Rate for Payer: PACE Medicare |
$175.94
|
| Rate for Payer: PACE SWMI |
$185.20
|
| Rate for Payer: PHP Commercial |
$257.50
|
| Rate for Payer: PHP Medicare Advantage |
$185.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.91
|
| Rate for Payer: Priority Health Medicare |
$185.20
|
| Rate for Payer: Priority Health SBD |
$190.85
|
| Rate for Payer: Railroad Medicare Medicare |
$185.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$521.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$185.20
|
| Rate for Payer: UHC Medicare Advantage |
$185.20
|
| Rate for Payer: UHCCP Medicaid |
$104.27
|
| Rate for Payer: VA VA |
$185.20
|
|
|
HC RED CELL GENO MI BLD CMPT
|
Facility
|
OP
|
$218.10
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
31000136
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$87.24 |
| Max. Negotiated Rate |
$196.29 |
| Rate for Payer: Aetna Commercial |
$185.38
|
| Rate for Payer: Aetna Medicare |
$109.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.76
|
| Rate for Payer: BCBS Complete |
$87.24
|
| Rate for Payer: Cash Price |
$174.48
|
| Rate for Payer: Cofinity Commercial |
$152.67
|
| Rate for Payer: Cofinity Commercial |
$187.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.48
|
| Rate for Payer: Healthscope Commercial |
$196.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.38
|
| Rate for Payer: PHP Commercial |
$185.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.76
|
| Rate for Payer: Priority Health SBD |
$137.40
|
|
|
HC RED CELL GENO MI BLD CMPT
|
Facility
|
IP
|
$218.10
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
31000136
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$137.40 |
| Max. Negotiated Rate |
$196.29 |
| Rate for Payer: Aetna Commercial |
$185.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.76
|
| Rate for Payer: Cash Price |
$174.48
|
| Rate for Payer: Cofinity Commercial |
$152.67
|
| Rate for Payer: Cofinity Commercial |
$187.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.48
|
| Rate for Payer: Healthscope Commercial |
$196.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.38
|
| Rate for Payer: PHP Commercial |
$185.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.76
|
| Rate for Payer: Priority Health SBD |
$137.40
|
|
|
HC RED CELLS, DIRECTED, LEUKO RED
|
Facility
|
IP
|
$1,106.29
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
39000061
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$696.96 |
| Max. Negotiated Rate |
$995.66 |
| Rate for Payer: Aetna Commercial |
$940.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$719.09
|
| Rate for Payer: Cash Price |
$885.03
|
| Rate for Payer: Cofinity Commercial |
$774.40
|
| Rate for Payer: Cofinity Commercial |
$951.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$774.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$885.03
|
| Rate for Payer: Healthscope Commercial |
$995.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$940.35
|
| Rate for Payer: PHP Commercial |
$940.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$719.09
|
| Rate for Payer: Priority Health SBD |
$696.96
|
|
|
HC RED CELLS, DIRECTED, LEUKO RED
|
Facility
|
OP
|
$1,106.29
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
39000061
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$95.14 |
| Max. Negotiated Rate |
$995.66 |
| Rate for Payer: Aetna Commercial |
$940.35
|
| Rate for Payer: Aetna Medicare |
$184.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$719.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$221.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$221.88
|
| Rate for Payer: BCBS Complete |
$99.90
|
| Rate for Payer: BCBS MAPPO |
$177.50
|
| Rate for Payer: BCN Medicare Advantage |
$177.50
|
| Rate for Payer: Cash Price |
$885.03
|
| Rate for Payer: Cash Price |
$885.03
|
| Rate for Payer: Cofinity Commercial |
$951.41
|
| Rate for Payer: Cofinity Commercial |
$774.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$774.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$885.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.50
|
| Rate for Payer: Healthscope Commercial |
$995.66
|
| Rate for Payer: Mclaren Medicaid |
$95.14
|
| Rate for Payer: Mclaren Medicare |
$177.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$186.38
|
| Rate for Payer: Meridian Medicaid |
$99.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$940.35
|
| Rate for Payer: PACE Medicare |
$168.62
|
| Rate for Payer: PACE SWMI |
$177.50
|
| Rate for Payer: PHP Commercial |
$940.35
|
| Rate for Payer: PHP Medicare Advantage |
$177.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$719.09
|
| Rate for Payer: Priority Health Medicare |
$177.50
|
| Rate for Payer: Priority Health SBD |
$696.96
|
| Rate for Payer: Railroad Medicare Medicare |
$177.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$499.64
|
| Rate for Payer: UHC Core |
$818.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.50
|
| Rate for Payer: UHC Exchange |
$818.65
|
| Rate for Payer: UHC Medicare Advantage |
$177.50
|
| Rate for Payer: UHCCP Medicaid |
$99.93
|
| Rate for Payer: VA VA |
$177.50
|
|
|
HC REDTOP BENT GRASS IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200057
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| 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 |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| 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 |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC REDTOP BENT GRASS IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200057
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
|
|
HC REDUCER W/LL ASY 1/4 X 3/8
|
Facility
|
OP
|
$9.18
|
|
| Hospital Charge Code |
27000679
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.67 |
| 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 Commercial |
$6.43
|
| Rate for Payer: Cofinity Commercial |
$7.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.43
|
| 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: PHP Commercial |
$7.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.97
|
| Rate for Payer: Priority Health SBD |
$5.78
|
|
|
HC REDUCER W/LL ASY 1/4 X 3/8
|
Facility
|
IP
|
$9.18
|
|
| Hospital Charge Code |
27000679
|
|
Hospital Revenue Code
|
270
|
| 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 Commercial |
$6.43
|
| Rate for Payer: Cofinity Commercial |
$7.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.43
|
| 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: PHP Commercial |
$7.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.97
|
| Rate for Payer: Priority Health SBD |
$5.78
|
|
|
HC REFILL AND MAINTENANCE OF IMPLANTED PUMP
|
Facility
|
IP
|
$438.65
|
|
|
Service Code
|
HCPCS 96522
|
| Hospital Charge Code |
33500009
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$276.35 |
| Max. Negotiated Rate |
$394.79 |
| Rate for Payer: Aetna Commercial |
$372.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.12
|
| Rate for Payer: Cash Price |
$350.92
|
| Rate for Payer: Cofinity Commercial |
$307.06
|
| Rate for Payer: Cofinity Commercial |
$377.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.92
|
| Rate for Payer: Healthscope Commercial |
$394.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.85
|
| Rate for Payer: PHP Commercial |
$372.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.12
|
| Rate for Payer: Priority Health SBD |
$276.35
|
|
|
HC REFILL AND MAINTENANCE OF IMPLANTED PUMP
|
Facility
|
OP
|
$438.65
|
|
|
Service Code
|
HCPCS 96522
|
| Hospital Charge Code |
33500009
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$110.14 |
| Max. Negotiated Rate |
$578.41 |
| Rate for Payer: Aetna Commercial |
$372.85
|
| Rate for Payer: Aetna Medicare |
$213.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$256.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$256.85
|
| Rate for Payer: BCBS Complete |
$115.64
|
| Rate for Payer: BCBS MAPPO |
$205.48
|
| Rate for Payer: BCN Medicare Advantage |
$205.48
|
| Rate for Payer: Cash Price |
$350.92
|
| Rate for Payer: Cash Price |
$350.92
|
| Rate for Payer: Cofinity Commercial |
$377.24
|
| Rate for Payer: Cofinity Commercial |
$307.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.48
|
| Rate for Payer: Healthscope Commercial |
$394.79
|
| Rate for Payer: Mclaren Medicaid |
$110.14
|
| Rate for Payer: Mclaren Medicare |
$205.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$215.75
|
| Rate for Payer: Meridian Medicaid |
$115.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$236.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.85
|
| Rate for Payer: PACE Medicare |
$195.21
|
| Rate for Payer: PACE SWMI |
$205.48
|
| Rate for Payer: PHP Commercial |
$372.85
|
| Rate for Payer: PHP Medicare Advantage |
$205.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.12
|
| Rate for Payer: Priority Health Medicare |
$205.48
|
| Rate for Payer: Priority Health SBD |
$276.35
|
| Rate for Payer: Railroad Medicare Medicare |
$205.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$578.41
|
| Rate for Payer: UHC Core |
$324.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$205.48
|
| Rate for Payer: UHC Exchange |
$324.60
|
| Rate for Payer: UHC Medicare Advantage |
$205.48
|
| Rate for Payer: UHCCP Medicaid |
$115.69
|
| Rate for Payer: VA VA |
$205.48
|
|
|
HC REFILL AND MAINTENANCE OF PORT PUMP
|
Facility
|
IP
|
$881.99
|
|
|
Service Code
|
CPT 96521
|
| Hospital Charge Code |
33500008
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$555.65 |
| Max. Negotiated Rate |
$793.79 |
| Rate for Payer: Aetna Commercial |
$749.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$573.29
|
| Rate for Payer: Cash Price |
$705.59
|
| Rate for Payer: Cofinity Commercial |
$617.39
|
| Rate for Payer: Cofinity Commercial |
$758.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$617.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$705.59
|
| Rate for Payer: Healthscope Commercial |
$793.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$749.69
|
| Rate for Payer: PHP Commercial |
$749.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$573.29
|
| Rate for Payer: Priority Health SBD |
$555.65
|
|
|
HC REFILL AND MAINTENANCE OF PORT PUMP
|
Facility
|
OP
|
$881.99
|
|
|
Service Code
|
CPT 96521
|
| Hospital Charge Code |
33500008
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$110.14 |
| Max. Negotiated Rate |
$793.79 |
| Rate for Payer: Aetna Commercial |
$749.69
|
| Rate for Payer: Aetna Medicare |
$213.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$573.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$256.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$256.85
|
| Rate for Payer: BCBS Complete |
$115.64
|
| Rate for Payer: BCBS MAPPO |
$205.48
|
| Rate for Payer: BCN Medicare Advantage |
$205.48
|
| Rate for Payer: Cash Price |
$705.59
|
| Rate for Payer: Cash Price |
$705.59
|
| Rate for Payer: Cofinity Commercial |
$758.51
|
| Rate for Payer: Cofinity Commercial |
$617.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$617.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$705.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.48
|
| Rate for Payer: Healthscope Commercial |
$793.79
|
| Rate for Payer: Mclaren Medicaid |
$110.14
|
| Rate for Payer: Mclaren Medicare |
$205.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$215.75
|
| Rate for Payer: Meridian Medicaid |
$115.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$236.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$749.69
|
| Rate for Payer: PACE Medicare |
$195.21
|
| Rate for Payer: PACE SWMI |
$205.48
|
| Rate for Payer: PHP Commercial |
$749.69
|
| Rate for Payer: PHP Medicare Advantage |
$205.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$573.29
|
| Rate for Payer: Priority Health Medicare |
$205.48
|
| Rate for Payer: Priority Health SBD |
$555.65
|
| Rate for Payer: Railroad Medicare Medicare |
$205.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$578.41
|
| Rate for Payer: UHC Core |
$652.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$205.48
|
| Rate for Payer: UHC Exchange |
$652.67
|
| Rate for Payer: UHC Medicare Advantage |
$205.48
|
| Rate for Payer: UHCCP Medicaid |
$115.69
|
| Rate for Payer: VA VA |
$205.48
|
|
|
HC REFILL AND REPROGRAM INTRATHECAL INF PUMP
|
Facility
|
IP
|
$421.57
|
|
|
Service Code
|
CPT 62370
|
| Hospital Charge Code |
36100587
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$265.59 |
| Max. Negotiated Rate |
$379.41 |
| Rate for Payer: Aetna Commercial |
$358.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.02
|
| Rate for Payer: Cash Price |
$337.26
|
| Rate for Payer: Cofinity Commercial |
$295.10
|
| Rate for Payer: Cofinity Commercial |
$362.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$295.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.26
|
| Rate for Payer: Healthscope Commercial |
$379.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.33
|
| Rate for Payer: PHP Commercial |
$358.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.02
|
| Rate for Payer: Priority Health SBD |
$265.59
|
|
|
HC REFILL AND REPROGRAM INTRATHECAL INF PUMP
|
Facility
|
OP
|
$421.57
|
|
|
Service Code
|
CPT 62370
|
| Hospital Charge Code |
36100587
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$156.78 |
| Max. Negotiated Rate |
$823.36 |
| Rate for Payer: Aetna Commercial |
$358.33
|
| Rate for Payer: Aetna Medicare |
$304.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$365.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$365.62
|
| Rate for Payer: BCBS Complete |
$164.62
|
| Rate for Payer: BCBS MAPPO |
$292.50
|
| Rate for Payer: BCN Medicare Advantage |
$292.50
|
| Rate for Payer: Cash Price |
$337.26
|
| Rate for Payer: Cash Price |
$337.26
|
| Rate for Payer: Cofinity Commercial |
$362.55
|
| Rate for Payer: Cofinity Commercial |
$295.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$295.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$292.50
|
| Rate for Payer: Healthscope Commercial |
$379.41
|
| Rate for Payer: Mclaren Medicaid |
$156.78
|
| Rate for Payer: Mclaren Medicare |
$292.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$307.12
|
| Rate for Payer: Meridian Medicaid |
$164.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$336.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.33
|
| Rate for Payer: PACE Medicare |
$277.88
|
| Rate for Payer: PACE SWMI |
$292.50
|
| Rate for Payer: PHP Commercial |
$358.33
|
| Rate for Payer: PHP Medicare Advantage |
$292.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.02
|
| Rate for Payer: Priority Health Medicare |
$292.50
|
| Rate for Payer: Priority Health SBD |
$265.59
|
| Rate for Payer: Railroad Medicare Medicare |
$292.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$823.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$292.50
|
| Rate for Payer: UHC Medicare Advantage |
$292.50
|
| Rate for Payer: UHCCP Medicaid |
$164.68
|
| Rate for Payer: VA VA |
$292.50
|
|
|
HC REFLEX BETHESDA UNITS
|
Facility
|
IP
|
$155.02
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30500042
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$97.66 |
| Max. Negotiated Rate |
$139.52 |
| Rate for Payer: Aetna Commercial |
$131.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.76
|
| Rate for Payer: Cash Price |
$124.02
|
| Rate for Payer: Cofinity Commercial |
$108.51
|
| Rate for Payer: Cofinity Commercial |
$133.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.02
|
| Rate for Payer: Healthscope Commercial |
$139.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.77
|
| Rate for Payer: PHP Commercial |
$131.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.76
|
| Rate for Payer: Priority Health SBD |
$97.66
|
|
|
HC REFLEX BETHESDA UNITS
|
Facility
|
OP
|
$155.02
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30500042
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$139.52 |
| Rate for Payer: Aetna Commercial |
$131.77
|
| Rate for Payer: Aetna Medicare |
$13.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: BCBS Complete |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$124.02
|
| Rate for Payer: Cash Price |
$124.02
|
| Rate for Payer: Cofinity Commercial |
$133.32
|
| Rate for Payer: Cofinity Commercial |
$108.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$139.52
|
| Rate for Payer: Mclaren Medicaid |
$6.90
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: Meridian Medicaid |
$7.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.77
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$131.77
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.76
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health SBD |
$97.66
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.87
|
| Rate for Payer: UHC Medicare Advantage |
$12.87
|
| Rate for Payer: UHCCP Medicaid |
$7.25
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC REFLEX COAG FACTOR VIII INHIBITOR
|
Facility
|
OP
|
$320.44
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30500043
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$288.40 |
| Rate for Payer: Aetna Commercial |
$272.37
|
| Rate for Payer: Aetna Medicare |
$13.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: BCBS Complete |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$256.35
|
| Rate for Payer: Cash Price |
$256.35
|
| Rate for Payer: Cofinity Commercial |
$275.58
|
| Rate for Payer: Cofinity Commercial |
$224.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$224.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$288.40
|
| Rate for Payer: Mclaren Medicaid |
$6.90
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: Meridian Medicaid |
$7.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.37
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$272.37
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.29
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health SBD |
$201.88
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.87
|
| Rate for Payer: UHC Medicare Advantage |
$12.87
|
| Rate for Payer: UHCCP Medicaid |
$7.25
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC REFLEX COAG FACTOR VIII INHIBITOR
|
Facility
|
IP
|
$320.44
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30500043
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$201.88 |
| Max. Negotiated Rate |
$288.40 |
| Rate for Payer: Aetna Commercial |
$272.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.29
|
| Rate for Payer: Cash Price |
$256.35
|
| Rate for Payer: Cofinity Commercial |
$224.31
|
| Rate for Payer: Cofinity Commercial |
$275.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$224.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.35
|
| Rate for Payer: Healthscope Commercial |
$288.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.37
|
| Rate for Payer: PHP Commercial |
$272.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.29
|
| Rate for Payer: Priority Health SBD |
$201.88
|
|
|
HC REG/SEDAT ADDL 15 MIN
|
Facility
|
IP
|
$117.78
|
|
| Hospital Charge Code |
37000011
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$106.00 |
| Rate for Payer: Aetna Commercial |
$100.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.56
|
| Rate for Payer: Cash Price |
$94.22
|
| Rate for Payer: Cofinity Commercial |
$101.29
|
| Rate for Payer: Cofinity Commercial |
$82.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.22
|
| Rate for Payer: Healthscope Commercial |
$106.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.11
|
| Rate for Payer: PHP Commercial |
$100.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.56
|
| Rate for Payer: Priority Health SBD |
$74.20
|
|
|
HC REG/SEDAT ADDL 15 MIN
|
Facility
|
OP
|
$117.78
|
|
| Hospital Charge Code |
37000011
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$47.11 |
| Max. Negotiated Rate |
$106.00 |
| Rate for Payer: Aetna Commercial |
$100.11
|
| Rate for Payer: Aetna Medicare |
$58.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.56
|
| Rate for Payer: BCBS Complete |
$47.11
|
| Rate for Payer: Cash Price |
$94.22
|
| Rate for Payer: Cofinity Commercial |
$101.29
|
| Rate for Payer: Cofinity Commercial |
$82.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.22
|
| Rate for Payer: Healthscope Commercial |
$106.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.11
|
| Rate for Payer: PHP Commercial |
$100.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.56
|
| Rate for Payer: Priority Health SBD |
$74.20
|
|
