|
HC SELECTIVE EXTRA/INTRACRANIAL ARTERY UNI
|
Facility
|
OP
|
$11,185.55
|
|
|
Service Code
|
CPT 36223
|
| Hospital Charge Code |
36100378
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,899.76 |
| Max. Negotiated Rate |
$17,930.33 |
| Rate for Payer: Aetna Commercial |
$9,507.72
|
| Rate for Payer: Aetna Medicare |
$5,766.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,270.61
|
| 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 |
$3,647.30
|
| Rate for Payer: BCN Commercial |
$3,647.30
|
| Rate for Payer: BCN Medicare Advantage |
$5,544.48
|
| Rate for Payer: Cash Price |
$8,948.44
|
| Rate for Payer: Cash Price |
$8,948.44
|
| Rate for Payer: Cash Price |
$8,948.44
|
| Rate for Payer: Cofinity Advantage |
$7,829.89
|
| Rate for Payer: Cofinity Commercial |
$9,619.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,948.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,544.48
|
| Rate for Payer: Healthscope Commercial |
$10,067.00
|
| 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 |
$9,507.72
|
| Rate for Payer: Nomi Health Commercial |
$16,633.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,389.16
|
| Rate for Payer: PACE Medicare |
$5,267.26
|
| Rate for Payer: PACE SWMI |
$5,544.48
|
| Rate for Payer: PHP Commercial |
$9,507.72
|
| 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 |
$7,046.90
|
| 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
|
|
|
HC SELECTIVE INTRACRANIAL ART UNI
|
Facility
|
OP
|
$13,546.53
|
|
|
Service Code
|
CPT 36224
|
| Hospital Charge Code |
36100385
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,899.76 |
| Max. Negotiated Rate |
$17,930.33 |
| Rate for Payer: Aetna Commercial |
$11,514.55
|
| Rate for Payer: Aetna Medicare |
$5,766.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,805.24
|
| 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 |
$4,539.94
|
| Rate for Payer: BCN Commercial |
$4,539.94
|
| Rate for Payer: BCN Medicare Advantage |
$5,544.48
|
| Rate for Payer: Cash Price |
$10,837.22
|
| Rate for Payer: Cash Price |
$10,837.22
|
| Rate for Payer: Cash Price |
$10,837.22
|
| Rate for Payer: Cofinity Advantage |
$9,482.57
|
| Rate for Payer: Cofinity Commercial |
$11,650.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,837.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,544.48
|
| Rate for Payer: Healthscope Commercial |
$12,191.88
|
| 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 |
$11,514.55
|
| Rate for Payer: Nomi Health Commercial |
$16,633.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,159.90
|
| Rate for Payer: PACE Medicare |
$5,267.26
|
| Rate for Payer: PACE SWMI |
$5,544.48
|
| Rate for Payer: PHP Commercial |
$11,514.55
|
| 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 |
$8,534.31
|
| 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
|
|
|
HC SELECTIVE INTRACRANIAL ART UNI
|
Facility
|
IP
|
$13,546.53
|
|
|
Service Code
|
CPT 36224
|
| Hospital Charge Code |
36100385
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,534.31 |
| Max. Negotiated Rate |
$12,191.88 |
| Rate for Payer: Aetna Commercial |
$11,514.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,805.24
|
| Rate for Payer: Cash Price |
$10,837.22
|
| Rate for Payer: Cofinity Advantage |
$9,482.57
|
| Rate for Payer: Cofinity Commercial |
$11,650.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,837.22
|
| Rate for Payer: Healthscope Commercial |
$12,191.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,514.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,159.90
|
| Rate for Payer: PHP Commercial |
$11,514.55
|
| Rate for Payer: Priority Health SBD |
$8,534.31
|
|
|
HC SELECTIVE VERTEBRAL ARTERY UNI
|
Facility
|
OP
|
$13,546.53
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
36100381
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,899.76 |
| Max. Negotiated Rate |
$17,930.33 |
| Rate for Payer: Aetna Commercial |
$11,514.55
|
| Rate for Payer: Aetna Medicare |
$5,766.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,805.24
|
| 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 |
$6,413.16
|
| Rate for Payer: BCN Commercial |
$6,413.16
|
| Rate for Payer: BCN Medicare Advantage |
$5,544.48
|
| Rate for Payer: Cash Price |
$10,837.22
|
| Rate for Payer: Cash Price |
$10,837.22
|
| Rate for Payer: Cash Price |
$10,837.22
|
| Rate for Payer: Cofinity Advantage |
$9,482.57
|
| Rate for Payer: Cofinity Commercial |
$11,650.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,837.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,544.48
|
| Rate for Payer: Healthscope Commercial |
$12,191.88
|
| 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 |
$11,514.55
|
| Rate for Payer: Nomi Health Commercial |
$16,633.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,159.90
|
| Rate for Payer: PACE Medicare |
$5,267.26
|
| Rate for Payer: PACE SWMI |
$5,544.48
|
| Rate for Payer: PHP Commercial |
$11,514.55
|
| 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 |
$8,534.31
|
| 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
|
|
|
HC SELECTIVE VERTEBRAL ARTERY UNI
|
Facility
|
IP
|
$13,546.53
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
36100381
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,534.31 |
| Max. Negotiated Rate |
$12,191.88 |
| Rate for Payer: Aetna Commercial |
$11,514.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,805.24
|
| Rate for Payer: Cash Price |
$10,837.22
|
| Rate for Payer: Cofinity Advantage |
$9,482.57
|
| Rate for Payer: Cofinity Commercial |
$11,650.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,837.22
|
| Rate for Payer: Healthscope Commercial |
$12,191.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,514.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,159.90
|
| Rate for Payer: PHP Commercial |
$11,514.55
|
| Rate for Payer: Priority Health SBD |
$8,534.31
|
|
|
HC SELECT SPECIALTY CATHETER INSERTION
|
Facility
|
IP
|
$1,686.32
|
|
| Hospital Charge Code |
36100565
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,062.38 |
| Max. Negotiated Rate |
$1,517.69 |
| Rate for Payer: Aetna Commercial |
$1,433.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,096.11
|
| Rate for Payer: Cash Price |
$1,349.06
|
| Rate for Payer: Cofinity Advantage |
$1,180.42
|
| Rate for Payer: Cofinity Commercial |
$1,450.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,349.06
|
| Rate for Payer: Healthscope Commercial |
$1,517.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,433.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,264.74
|
| Rate for Payer: PHP Commercial |
$1,433.37
|
| Rate for Payer: Priority Health SBD |
$1,062.38
|
|
|
HC SELECT SPECIALTY CATHETER INSERTION
|
Facility
|
OP
|
$1,686.32
|
|
| Hospital Charge Code |
36100565
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$674.53 |
| Max. Negotiated Rate |
$1,517.69 |
| Rate for Payer: Aetna Commercial |
$1,433.37
|
| Rate for Payer: Aetna Medicare |
$843.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,096.11
|
| Rate for Payer: BCBS Complete |
$674.53
|
| Rate for Payer: Cash Price |
$1,349.06
|
| Rate for Payer: Cofinity Advantage |
$1,180.42
|
| Rate for Payer: Cofinity Commercial |
$1,450.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,349.06
|
| Rate for Payer: Healthscope Commercial |
$1,517.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,349.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,433.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,264.74
|
| Rate for Payer: PHP Commercial |
$1,433.37
|
| Rate for Payer: Priority Health SBD |
$1,062.38
|
|
|
HC SELENIUM LEVEL
|
Facility
|
OP
|
$53.06
|
|
|
Service Code
|
CPT 84255
|
| Hospital Charge Code |
30100420
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.35 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna Medicare |
$26.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.91
|
| Rate for Payer: BCBS Complete |
$14.02
|
| Rate for Payer: BCBS MAPPO |
$25.53
|
| Rate for Payer: BCBS Trust/PPO |
$27.22
|
| Rate for Payer: BCN Commercial |
$27.22
|
| Rate for Payer: BCN Medicare Advantage |
$25.53
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Advantage |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.53
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Mclaren Medicaid |
$13.35
|
| Rate for Payer: Mclaren Medicare |
$25.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.81
|
| Rate for Payer: Meridian Medicaid |
$26.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$38.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PACE Medicare |
$24.25
|
| Rate for Payer: PACE SWMI |
$25.53
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: PHP Medicare Advantage |
$25.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$25.53
|
| Rate for Payer: Priority Health Medicare |
$25.53
|
| Rate for Payer: Priority Health SBD |
$33.43
|
| Rate for Payer: Priority Health Tiered Network |
$20.42
|
| Rate for Payer: Railroad Medicare Medicare |
$25.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.30
|
| Rate for Payer: UHC Core |
$38.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$25.53
|
| Rate for Payer: UHC Exchange |
$38.30
|
| Rate for Payer: UHC Medicaid |
$13.35
|
| Rate for Payer: UHCCP Medicaid |
$13.35
|
| Rate for Payer: VA VA |
$25.53
|
|
|
HC SELENIUM LEVEL
|
Facility
|
IP
|
$53.06
|
|
|
Service Code
|
CPT 84255
|
| Hospital Charge Code |
30100420
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.43 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.49
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Advantage |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: Priority Health SBD |
$33.43
|
|
|
HC SELF-ADMINISTRABLE DRUG
|
Facility
|
OP
|
$0.53
|
|
| Hospital Charge Code |
63700003
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Aetna Commercial |
$0.45
|
| Rate for Payer: Aetna Medicare |
$0.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.34
|
| Rate for Payer: BCBS Complete |
$0.21
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cofinity Advantage |
$0.37
|
| Rate for Payer: Cofinity Commercial |
$0.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.42
|
| Rate for Payer: Healthscope Commercial |
$0.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.40
|
| Rate for Payer: PHP Commercial |
$0.45
|
| Rate for Payer: Priority Health SBD |
$0.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.34
|
| Rate for Payer: UHC Core |
$0.28
|
| Rate for Payer: UHC Exchange |
$0.21
|
|
|
HC SELF-ADMINISTRABLE DRUG
|
Facility
|
IP
|
$0.53
|
|
| Hospital Charge Code |
63700003
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Aetna Commercial |
$0.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.34
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cofinity Advantage |
$0.37
|
| Rate for Payer: Cofinity Commercial |
$0.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.42
|
| Rate for Payer: Healthscope Commercial |
$0.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.40
|
| Rate for Payer: PHP Commercial |
$0.45
|
| Rate for Payer: Priority Health SBD |
$0.33
|
|
|
HC SELF-MGMT EDUC & TRAIN 1 PT PER 30 MIN
|
Facility
|
OP
|
$57.53
|
|
|
Service Code
|
CPT 98960
|
| Hospital Charge Code |
94200039
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$22.61 |
| Max. Negotiated Rate |
$136.21 |
| Rate for Payer: Aetna Commercial |
$48.90
|
| Rate for Payer: Aetna Medicare |
$28.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.39
|
| Rate for Payer: BCBS Complete |
$23.01
|
| Rate for Payer: BCBS Trust/PPO |
$136.21
|
| Rate for Payer: BCN Commercial |
$136.21
|
| Rate for Payer: Cash Price |
$46.02
|
| Rate for Payer: Cash Price |
$46.02
|
| Rate for Payer: Cofinity Advantage |
$40.27
|
| Rate for Payer: Cofinity Commercial |
$49.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.02
|
| Rate for Payer: Healthscope Commercial |
$51.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.15
|
| Rate for Payer: PHP Commercial |
$48.90
|
| Rate for Payer: Priority Health SBD |
$36.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.39
|
| Rate for Payer: UHC Core |
$29.97
|
| Rate for Payer: UHC Exchange |
$22.61
|
|
|
HC SELF-MGMT EDUC & TRAIN 1 PT PER 30 MIN
|
Facility
|
IP
|
$57.53
|
|
|
Service Code
|
CPT 98960
|
| Hospital Charge Code |
94200039
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$36.24 |
| Max. Negotiated Rate |
$51.78 |
| Rate for Payer: Aetna Commercial |
$48.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.39
|
| Rate for Payer: Cash Price |
$46.02
|
| Rate for Payer: Cofinity Advantage |
$40.27
|
| Rate for Payer: Cofinity Commercial |
$49.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.02
|
| Rate for Payer: Healthscope Commercial |
$51.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.15
|
| Rate for Payer: PHP Commercial |
$48.90
|
| Rate for Payer: Priority Health SBD |
$36.24
|
|
|
HC SEMEN EXAM FERTILITY
|
Facility
|
IP
|
$117.57
|
|
|
Service Code
|
CPT 89320
|
| Hospital Charge Code |
30000006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.07 |
| Max. Negotiated Rate |
$105.81 |
| Rate for Payer: Aetna Commercial |
$99.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.42
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cofinity Advantage |
$82.30
|
| Rate for Payer: Cofinity Commercial |
$101.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.06
|
| Rate for Payer: Healthscope Commercial |
$105.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.18
|
| Rate for Payer: PHP Commercial |
$99.93
|
| Rate for Payer: Priority Health SBD |
$74.07
|
|
|
HC SEMEN EXAM FERTILITY
|
Facility
|
OP
|
$117.57
|
|
|
Service Code
|
CPT 89320
|
| Hospital Charge Code |
30000006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$105.81 |
| Rate for Payer: Aetna Commercial |
$99.93
|
| Rate for Payer: Aetna Medicare |
$12.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.39
|
| Rate for Payer: BCBS Complete |
$6.76
|
| Rate for Payer: BCBS MAPPO |
$12.31
|
| Rate for Payer: BCBS Trust/PPO |
$13.12
|
| Rate for Payer: BCN Commercial |
$13.12
|
| Rate for Payer: BCN Medicare Advantage |
$12.31
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cofinity Advantage |
$82.30
|
| Rate for Payer: Cofinity Commercial |
$101.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.31
|
| Rate for Payer: Healthscope Commercial |
$105.81
|
| Rate for Payer: Mclaren Medicaid |
$6.44
|
| Rate for Payer: Mclaren Medicare |
$12.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.93
|
| Rate for Payer: Meridian Medicaid |
$12.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.93
|
| Rate for Payer: Nomi Health Commercial |
$18.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.18
|
| Rate for Payer: PACE Medicare |
$11.69
|
| Rate for Payer: PACE SWMI |
$12.31
|
| Rate for Payer: PHP Commercial |
$99.93
|
| Rate for Payer: PHP Medicare Advantage |
$12.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.31
|
| Rate for Payer: Priority Health Medicare |
$12.31
|
| Rate for Payer: Priority Health SBD |
$74.07
|
| Rate for Payer: Priority Health Tiered Network |
$9.85
|
| Rate for Payer: Railroad Medicare Medicare |
$12.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.47
|
| Rate for Payer: UHC Core |
$18.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.31
|
| Rate for Payer: UHC Exchange |
$18.47
|
| Rate for Payer: UHC Medicaid |
$6.44
|
| Rate for Payer: UHCCP Medicaid |
$6.44
|
| Rate for Payer: VA VA |
$12.31
|
|
|
HC SEMEN EXAM VASECTOMY
|
Facility
|
OP
|
$78.45
|
|
|
Service Code
|
CPT 89321
|
| Hospital Charge Code |
30000007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$70.61 |
| Rate for Payer: Aetna Commercial |
$66.68
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$12.85
|
| Rate for Payer: BCN Commercial |
$12.85
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cofinity Advantage |
$54.91
|
| Rate for Payer: Cofinity Commercial |
$67.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$70.61
|
| Rate for Payer: Mclaren Medicaid |
$6.30
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.68
|
| Rate for Payer: Nomi Health Commercial |
$18.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.84
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$66.68
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.05
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$49.42
|
| Rate for Payer: Priority Health Tiered Network |
$9.64
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.08
|
| Rate for Payer: UHC Core |
$18.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.08
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC SEMEN EXAM VASECTOMY
|
Facility
|
IP
|
$78.45
|
|
|
Service Code
|
CPT 89321
|
| Hospital Charge Code |
30000007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$70.61 |
| Rate for Payer: Aetna Commercial |
$66.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.99
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cofinity Advantage |
$54.91
|
| Rate for Payer: Cofinity Commercial |
$67.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.76
|
| Rate for Payer: Healthscope Commercial |
$70.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.84
|
| Rate for Payer: PHP Commercial |
$66.68
|
| Rate for Payer: Priority Health SBD |
$49.42
|
|
|
HC SENSOR CDI 550 ART SHUNT
|
Facility
|
OP
|
$390.15
|
|
| Hospital Charge Code |
27000655
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$153.33 |
| Max. Negotiated Rate |
$351.13 |
| Rate for Payer: Aetna Commercial |
$331.63
|
| Rate for Payer: Aetna Medicare |
$195.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.60
|
| Rate for Payer: BCBS Complete |
$156.06
|
| Rate for Payer: Cash Price |
$312.12
|
| Rate for Payer: Cofinity Advantage |
$273.11
|
| Rate for Payer: Cofinity Commercial |
$335.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.12
|
| Rate for Payer: Healthscope Commercial |
$351.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$312.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.61
|
| Rate for Payer: PHP Commercial |
$331.63
|
| Rate for Payer: Priority Health SBD |
$245.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$253.60
|
| Rate for Payer: UHC Core |
$203.27
|
| Rate for Payer: UHC Exchange |
$153.33
|
|
|
HC SENSOR CDI 550 ART SHUNT
|
Facility
|
IP
|
$390.15
|
|
| Hospital Charge Code |
27000655
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$245.79 |
| Max. Negotiated Rate |
$351.13 |
| Rate for Payer: Aetna Commercial |
$331.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.60
|
| Rate for Payer: Cash Price |
$312.12
|
| Rate for Payer: Cofinity Advantage |
$273.11
|
| Rate for Payer: Cofinity Commercial |
$335.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.12
|
| Rate for Payer: Healthscope Commercial |
$351.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.61
|
| Rate for Payer: PHP Commercial |
$331.63
|
| Rate for Payer: Priority Health SBD |
$245.79
|
|
|
HC SENSOR PAD LEVEL DETECTOR
|
Facility
|
OP
|
$17.95
|
|
| Hospital Charge Code |
27000656
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$16.16 |
| Rate for Payer: Aetna Commercial |
$15.26
|
| Rate for Payer: Aetna Medicare |
$8.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.67
|
| Rate for Payer: BCBS Complete |
$7.18
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Cofinity Advantage |
$12.56
|
| Rate for Payer: Cofinity Commercial |
$15.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.36
|
| Rate for Payer: Healthscope Commercial |
$16.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.46
|
| Rate for Payer: PHP Commercial |
$15.26
|
| Rate for Payer: Priority Health SBD |
$11.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.67
|
| Rate for Payer: UHC Core |
$9.35
|
| Rate for Payer: UHC Exchange |
$7.05
|
|
|
HC SENSOR PAD LEVEL DETECTOR
|
Facility
|
IP
|
$17.95
|
|
| Hospital Charge Code |
27000656
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$16.16 |
| Rate for Payer: Aetna Commercial |
$15.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.67
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Cofinity Advantage |
$12.56
|
| Rate for Payer: Cofinity Commercial |
$15.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.36
|
| Rate for Payer: Healthscope Commercial |
$16.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.46
|
| Rate for Payer: PHP Commercial |
$15.26
|
| Rate for Payer: Priority Health SBD |
$11.31
|
|
|
HC SENSORS CEREBRAL OXIMETER
|
Facility
|
OP
|
$249.70
|
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$98.13 |
| Max. Negotiated Rate |
$224.73 |
| Rate for Payer: Aetna Commercial |
$212.25
|
| Rate for Payer: Aetna Medicare |
$124.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.31
|
| Rate for Payer: BCBS Complete |
$99.88
|
| Rate for Payer: Cash Price |
$199.76
|
| Rate for Payer: Cofinity Advantage |
$174.79
|
| Rate for Payer: Cofinity Commercial |
$214.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.76
|
| Rate for Payer: Healthscope Commercial |
$224.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.28
|
| Rate for Payer: PHP Commercial |
$212.25
|
| Rate for Payer: Priority Health SBD |
$157.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.31
|
| Rate for Payer: UHC Core |
$130.09
|
| Rate for Payer: UHC Exchange |
$98.13
|
|
|
HC SENSORS CEREBRAL OXIMETER
|
Facility
|
IP
|
$249.70
|
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$157.31 |
| Max. Negotiated Rate |
$224.73 |
| Rate for Payer: Aetna Commercial |
$212.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.31
|
| Rate for Payer: Cash Price |
$199.76
|
| Rate for Payer: Cofinity Advantage |
$174.79
|
| Rate for Payer: Cofinity Commercial |
$214.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.76
|
| Rate for Payer: Healthscope Commercial |
$224.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.28
|
| Rate for Payer: PHP Commercial |
$212.25
|
| Rate for Payer: Priority Health SBD |
$157.31
|
|
|
HC SENSORY INTEGRATION
|
Facility
|
IP
|
$92.60
|
|
|
Service Code
|
CPT 97533
|
| Hospital Charge Code |
42000029
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$58.34 |
| Max. Negotiated Rate |
$83.34 |
| Rate for Payer: Aetna Commercial |
$78.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.19
|
| Rate for Payer: Cash Price |
$74.08
|
| Rate for Payer: Cofinity Advantage |
$64.82
|
| Rate for Payer: Cofinity Commercial |
$79.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.08
|
| Rate for Payer: Healthscope Commercial |
$83.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.45
|
| Rate for Payer: PHP Commercial |
$78.71
|
| Rate for Payer: Priority Health SBD |
$58.34
|
|
|
HC SENSORY INTEGRATION
|
Facility
|
OP
|
$92.60
|
|
|
Service Code
|
CPT 97533
|
| Hospital Charge Code |
42000029
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$78.71
|
| Rate for Payer: Aetna Medicare |
$46.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.19
|
| Rate for Payer: BCBS Complete |
$37.04
|
| Rate for Payer: Cash Price |
$74.08
|
| Rate for Payer: Cash Price |
$74.08
|
| Rate for Payer: Cash Price |
$74.08
|
| Rate for Payer: Cofinity Advantage |
$64.82
|
| Rate for Payer: Cofinity Commercial |
$79.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.08
|
| Rate for Payer: Healthscope Commercial |
$83.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.71
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.45
|
| Rate for Payer: PHP Commercial |
$78.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$28.00
|
| Rate for Payer: Priority Health SBD |
$58.34
|
| Rate for Payer: Priority Health Tiered Network |
$22.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.19
|
| Rate for Payer: UHC Core |
$48.24
|
| Rate for Payer: UHC Exchange |
$36.39
|
|
