|
HC RO ISODOSE BRACHY CALC INTRM
|
Facility
|
OP
|
$622.67
|
|
|
Service Code
|
CPT 77317
|
| Hospital Charge Code |
33300046
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$191.36 |
| Max. Negotiated Rate |
$1,004.98 |
| Rate for Payer: Aetna Commercial |
$529.27
|
| Rate for Payer: Aetna Medicare |
$371.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$404.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.27
|
| Rate for Payer: BCBS Complete |
$200.93
|
| Rate for Payer: BCBS MAPPO |
$357.02
|
| Rate for Payer: BCN Medicare Advantage |
$357.02
|
| Rate for Payer: Cash Price |
$498.14
|
| Rate for Payer: Cash Price |
$498.14
|
| Rate for Payer: Cofinity Commercial |
$535.50
|
| Rate for Payer: Cofinity Commercial |
$435.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$435.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$498.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.02
|
| Rate for Payer: Healthscope Commercial |
$560.40
|
| Rate for Payer: Mclaren Medicaid |
$191.36
|
| Rate for Payer: Mclaren Medicare |
$357.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$374.87
|
| Rate for Payer: Meridian Medicaid |
$200.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$529.27
|
| Rate for Payer: PACE Medicare |
$339.17
|
| Rate for Payer: PACE SWMI |
$357.02
|
| Rate for Payer: PHP Commercial |
$529.27
|
| Rate for Payer: PHP Medicare Advantage |
$357.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.74
|
| Rate for Payer: Priority Health Medicare |
$357.02
|
| Rate for Payer: Priority Health SBD |
$392.28
|
| Rate for Payer: Railroad Medicare Medicare |
$357.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,004.98
|
| Rate for Payer: UHC Core |
$460.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$357.02
|
| Rate for Payer: UHC Exchange |
$460.78
|
| Rate for Payer: UHC Medicare Advantage |
$357.02
|
| Rate for Payer: UHCCP Medicaid |
$201.00
|
| Rate for Payer: VA VA |
$357.02
|
|
|
HC RO ISODOSE BRACHY CALC INTRM
|
Facility
|
IP
|
$622.67
|
|
|
Service Code
|
CPT 77317
|
| Hospital Charge Code |
33300046
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$392.28 |
| Max. Negotiated Rate |
$560.40 |
| Rate for Payer: Aetna Commercial |
$529.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$404.74
|
| Rate for Payer: Cash Price |
$498.14
|
| Rate for Payer: Cofinity Commercial |
$435.87
|
| Rate for Payer: Cofinity Commercial |
$535.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$435.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$498.14
|
| Rate for Payer: Healthscope Commercial |
$560.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$529.27
|
| Rate for Payer: PHP Commercial |
$529.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.74
|
| Rate for Payer: Priority Health SBD |
$392.28
|
|
|
HC RO ISODOSE TELETHRPY COMPLEX
|
Facility
|
IP
|
$1,157.97
|
|
|
Service Code
|
CPT 77307
|
| Hospital Charge Code |
33300044
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$729.52 |
| Max. Negotiated Rate |
$1,042.17 |
| Rate for Payer: Aetna Commercial |
$984.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$752.68
|
| Rate for Payer: Cash Price |
$926.38
|
| Rate for Payer: Cofinity Commercial |
$810.58
|
| Rate for Payer: Cofinity Commercial |
$995.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$810.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$926.38
|
| Rate for Payer: Healthscope Commercial |
$1,042.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$984.27
|
| Rate for Payer: PHP Commercial |
$984.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$752.68
|
| Rate for Payer: Priority Health SBD |
$729.52
|
|
|
HC RO ISODOSE TELETHRPY COMPLEX
|
Facility
|
OP
|
$1,157.97
|
|
|
Service Code
|
CPT 77307
|
| Hospital Charge Code |
33300044
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$191.36 |
| Max. Negotiated Rate |
$1,042.17 |
| Rate for Payer: Aetna Commercial |
$984.27
|
| Rate for Payer: Aetna Medicare |
$371.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$752.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.27
|
| Rate for Payer: BCBS Complete |
$200.93
|
| Rate for Payer: BCBS MAPPO |
$357.02
|
| Rate for Payer: BCN Medicare Advantage |
$357.02
|
| Rate for Payer: Cash Price |
$926.38
|
| Rate for Payer: Cash Price |
$926.38
|
| Rate for Payer: Cofinity Commercial |
$995.85
|
| Rate for Payer: Cofinity Commercial |
$810.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$810.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$926.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.02
|
| Rate for Payer: Healthscope Commercial |
$1,042.17
|
| Rate for Payer: Mclaren Medicaid |
$191.36
|
| Rate for Payer: Mclaren Medicare |
$357.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$374.87
|
| Rate for Payer: Meridian Medicaid |
$200.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$984.27
|
| Rate for Payer: PACE Medicare |
$339.17
|
| Rate for Payer: PACE SWMI |
$357.02
|
| Rate for Payer: PHP Commercial |
$984.27
|
| Rate for Payer: PHP Medicare Advantage |
$357.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$752.68
|
| Rate for Payer: Priority Health Medicare |
$357.02
|
| Rate for Payer: Priority Health SBD |
$729.52
|
| Rate for Payer: Railroad Medicare Medicare |
$357.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,004.98
|
| Rate for Payer: UHC Core |
$856.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$357.02
|
| Rate for Payer: UHC Exchange |
$856.90
|
| Rate for Payer: UHC Medicare Advantage |
$357.02
|
| Rate for Payer: UHCCP Medicaid |
$201.00
|
| Rate for Payer: VA VA |
$357.02
|
|
|
HC RO ISODOSE TELETHRPY SIMPLE
|
Facility
|
IP
|
$252.82
|
|
|
Service Code
|
CPT 77306
|
| Hospital Charge Code |
33300043
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$159.28 |
| Max. Negotiated Rate |
$227.54 |
| Rate for Payer: Aetna Commercial |
$214.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.33
|
| Rate for Payer: Cash Price |
$202.26
|
| Rate for Payer: Cofinity Commercial |
$176.97
|
| Rate for Payer: Cofinity Commercial |
$217.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$176.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.26
|
| Rate for Payer: Healthscope Commercial |
$227.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.90
|
| Rate for Payer: PHP Commercial |
$214.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.33
|
| Rate for Payer: Priority Health SBD |
$159.28
|
|
|
HC RO ISODOSE TELETHRPY SIMPLE
|
Facility
|
OP
|
$252.82
|
|
|
Service Code
|
CPT 77306
|
| Hospital Charge Code |
33300043
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$159.28 |
| Max. Negotiated Rate |
$1,004.98 |
| Rate for Payer: Aetna Commercial |
$214.90
|
| Rate for Payer: Aetna Medicare |
$371.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.27
|
| Rate for Payer: BCBS Complete |
$200.93
|
| Rate for Payer: BCBS MAPPO |
$357.02
|
| Rate for Payer: BCN Medicare Advantage |
$357.02
|
| Rate for Payer: Cash Price |
$202.26
|
| Rate for Payer: Cash Price |
$202.26
|
| Rate for Payer: Cofinity Commercial |
$217.43
|
| Rate for Payer: Cofinity Commercial |
$176.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$176.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.02
|
| Rate for Payer: Healthscope Commercial |
$227.54
|
| Rate for Payer: Mclaren Medicaid |
$191.36
|
| Rate for Payer: Mclaren Medicare |
$357.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$374.87
|
| Rate for Payer: Meridian Medicaid |
$200.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.90
|
| Rate for Payer: PACE Medicare |
$339.17
|
| Rate for Payer: PACE SWMI |
$357.02
|
| Rate for Payer: PHP Commercial |
$214.90
|
| Rate for Payer: PHP Medicare Advantage |
$357.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.33
|
| Rate for Payer: Priority Health Medicare |
$357.02
|
| Rate for Payer: Priority Health SBD |
$159.28
|
| Rate for Payer: Railroad Medicare Medicare |
$357.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,004.98
|
| Rate for Payer: UHC Core |
$187.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$357.02
|
| Rate for Payer: UHC Exchange |
$187.09
|
| Rate for Payer: UHC Medicare Advantage |
$357.02
|
| Rate for Payer: UHCCP Medicaid |
$201.00
|
| Rate for Payer: VA VA |
$357.02
|
|
|
HC RO LINAC SBRT PER SESSION
|
Facility
|
IP
|
$3,546.01
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
33300041
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$2,233.99 |
| Max. Negotiated Rate |
$3,191.41 |
| Rate for Payer: Aetna Commercial |
$3,014.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,304.91
|
| Rate for Payer: Cash Price |
$2,836.81
|
| Rate for Payer: Cofinity Commercial |
$2,482.21
|
| Rate for Payer: Cofinity Commercial |
$3,049.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,482.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,836.81
|
| Rate for Payer: Healthscope Commercial |
$3,191.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,014.11
|
| Rate for Payer: PHP Commercial |
$3,014.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,304.91
|
| Rate for Payer: Priority Health SBD |
$2,233.99
|
|
|
HC RO LINAC SBRT PER SESSION
|
Facility
|
OP
|
$3,546.01
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
33300041
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$917.90 |
| Max. Negotiated Rate |
$4,820.52 |
| Rate for Payer: Aetna Commercial |
$3,014.11
|
| Rate for Payer: Aetna Medicare |
$1,781.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,304.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,140.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,140.62
|
| Rate for Payer: BCBS Complete |
$963.79
|
| Rate for Payer: BCBS MAPPO |
$1,712.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,712.50
|
| Rate for Payer: Cash Price |
$2,836.81
|
| Rate for Payer: Cash Price |
$2,836.81
|
| Rate for Payer: Cofinity Commercial |
$3,049.57
|
| Rate for Payer: Cofinity Commercial |
$2,482.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,482.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,836.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,712.50
|
| Rate for Payer: Healthscope Commercial |
$3,191.41
|
| Rate for Payer: Mclaren Medicaid |
$917.90
|
| Rate for Payer: Mclaren Medicare |
$1,712.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,798.12
|
| Rate for Payer: Meridian Medicaid |
$963.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,969.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,014.11
|
| Rate for Payer: PACE Medicare |
$1,626.88
|
| Rate for Payer: PACE SWMI |
$1,712.50
|
| Rate for Payer: PHP Commercial |
$3,014.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,712.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$917.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,304.91
|
| Rate for Payer: Priority Health Medicare |
$1,712.50
|
| Rate for Payer: Priority Health SBD |
$2,233.99
|
| Rate for Payer: Railroad Medicare Medicare |
$1,712.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,820.52
|
| Rate for Payer: UHC Core |
$2,624.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,712.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,712.50
|
| Rate for Payer: UHCCP Medicaid |
$964.14
|
| Rate for Payer: VA VA |
$1,712.50
|
|
|
HC ROMOSOZUMAB-AQQG INJ 1 MG
|
Facility
|
OP
|
$11.44
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
63600150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$33.98 |
| Rate for Payer: Aetna Commercial |
$9.72
|
| Rate for Payer: Aetna Medicare |
$12.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.09
|
| Rate for Payer: BCBS Complete |
$6.79
|
| Rate for Payer: BCBS MAPPO |
$12.07
|
| Rate for Payer: BCN Medicare Advantage |
$12.07
|
| Rate for Payer: Cash Price |
$9.15
|
| Rate for Payer: Cash Price |
$9.15
|
| Rate for Payer: Cofinity Commercial |
$9.84
|
| Rate for Payer: Cofinity Commercial |
$8.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.07
|
| Rate for Payer: Healthscope Commercial |
$10.30
|
| Rate for Payer: Mclaren Medicaid |
$6.47
|
| Rate for Payer: Mclaren Medicare |
$12.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.67
|
| Rate for Payer: Meridian Medicaid |
$6.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.72
|
| Rate for Payer: PACE Medicare |
$11.47
|
| Rate for Payer: PACE SWMI |
$12.07
|
| Rate for Payer: PHP Commercial |
$9.72
|
| Rate for Payer: PHP Medicare Advantage |
$12.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.44
|
| Rate for Payer: Priority Health Medicare |
$12.07
|
| Rate for Payer: Priority Health SBD |
$7.21
|
| Rate for Payer: Railroad Medicare Medicare |
$12.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.07
|
| Rate for Payer: UHC Medicare Advantage |
$12.07
|
| Rate for Payer: UHCCP Medicaid |
$6.80
|
| Rate for Payer: VA VA |
$12.07
|
|
|
HC ROMOSOZUMAB-AQQG INJ 1 MG
|
Facility
|
IP
|
$11.44
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
63600150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$10.30 |
| Rate for Payer: Aetna Commercial |
$9.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.44
|
| Rate for Payer: Cash Price |
$9.15
|
| Rate for Payer: Cofinity Commercial |
$8.01
|
| Rate for Payer: Cofinity Commercial |
$9.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.15
|
| Rate for Payer: Healthscope Commercial |
$10.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.72
|
| Rate for Payer: PHP Commercial |
$9.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.44
|
| Rate for Payer: Priority Health SBD |
$7.21
|
|
|
HC ROOM & BOARD PSYCH
|
Facility
|
IP
|
$1,810.72
|
|
| Hospital Charge Code |
12400001
|
|
Hospital Revenue Code
|
124
|
| Min. Negotiated Rate |
$1,140.75 |
| Max. Negotiated Rate |
$1,629.65 |
| Rate for Payer: Aetna Commercial |
$1,539.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,176.97
|
| Rate for Payer: Cash Price |
$1,448.58
|
| Rate for Payer: Cofinity Commercial |
$1,267.50
|
| Rate for Payer: Cofinity Commercial |
$1,557.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,267.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,448.58
|
| Rate for Payer: Healthscope Commercial |
$1,629.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,539.11
|
| Rate for Payer: PHP Commercial |
$1,539.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,176.97
|
| Rate for Payer: Priority Health SBD |
$1,140.75
|
|
|
HC ROOM MED SURG
|
Facility
|
IP
|
$3,356.84
|
|
| Hospital Charge Code |
12100001
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$2,114.81 |
| Max. Negotiated Rate |
$3,021.16 |
| Rate for Payer: Aetna Commercial |
$2,853.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,181.95
|
| Rate for Payer: Cash Price |
$2,685.47
|
| Rate for Payer: Cofinity Commercial |
$2,349.79
|
| Rate for Payer: Cofinity Commercial |
$2,886.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,349.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,685.47
|
| Rate for Payer: Healthscope Commercial |
$3,021.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,853.31
|
| Rate for Payer: PHP Commercial |
$2,853.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,181.95
|
| Rate for Payer: Priority Health SBD |
$2,114.81
|
|
|
HC ROOM SCU
|
Facility
|
IP
|
$2,352.06
|
|
| Hospital Charge Code |
20000002
|
|
Hospital Revenue Code
|
200
|
| Min. Negotiated Rate |
$1,481.80 |
| Max. Negotiated Rate |
$2,116.85 |
| Rate for Payer: Aetna Commercial |
$1,999.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,528.84
|
| Rate for Payer: Cash Price |
$1,881.65
|
| Rate for Payer: Cofinity Commercial |
$1,646.44
|
| Rate for Payer: Cofinity Commercial |
$2,022.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,646.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,881.65
|
| Rate for Payer: Healthscope Commercial |
$2,116.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,999.25
|
| Rate for Payer: PHP Commercial |
$1,999.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,528.84
|
| Rate for Payer: Priority Health SBD |
$1,481.80
|
|
|
HC RO OR SSA SJOGRENS AB
|
Facility
|
IP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200162
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.16 |
| Max. Negotiated Rate |
$31.65 |
| Rate for Payer: Aetna Commercial |
$29.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.86
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$24.62
|
| Rate for Payer: Cofinity Commercial |
$30.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Healthscope Commercial |
$31.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: PHP Commercial |
$29.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: Priority Health SBD |
$22.16
|
|
|
HC RO OR SSA SJOGRENS AB
|
Facility
|
OP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200162
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$50.47 |
| Rate for Payer: Aetna Commercial |
$29.89
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$30.25
|
| Rate for Payer: Cofinity Commercial |
$24.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$31.65
|
| Rate for Payer: Mclaren Medicaid |
$9.61
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$10.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$29.89
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$22.16
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Medicare Advantage |
$17.93
|
| Rate for Payer: UHCCP Medicaid |
$10.09
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC ROPIVACAINE HYDROCHLORIDE 1 MG
|
Facility
|
OP
|
$4.08
|
|
|
Service Code
|
CPT J2795
|
| Hospital Charge Code |
63600236
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: Aetna Medicare |
$2.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.65
|
| Rate for Payer: BCBS Complete |
$1.63
|
| Rate for Payer: Cash Price |
$3.26
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Cofinity Commercial |
$3.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.26
|
| Rate for Payer: Healthscope Commercial |
$3.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.47
|
| Rate for Payer: PHP Commercial |
$3.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.65
|
| Rate for Payer: Priority Health SBD |
$2.57
|
|
|
HC ROPIVACAINE HYDROCHLORIDE 1 MG
|
Facility
|
IP
|
$4.08
|
|
|
Service Code
|
CPT J2795
|
| Hospital Charge Code |
63600236
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.65
|
| Rate for Payer: Cash Price |
$3.26
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Cofinity Commercial |
$3.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.26
|
| Rate for Payer: Healthscope Commercial |
$3.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.47
|
| Rate for Payer: PHP Commercial |
$3.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.65
|
| Rate for Payer: Priority Health SBD |
$2.57
|
|
|
HC RO SUPERFICIAL AND/OR ORTHO
|
Facility
|
OP
|
$199.76
|
|
|
Service Code
|
CPT 77401
|
| Hospital Charge Code |
33300036
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$57.24 |
| Max. Negotiated Rate |
$300.60 |
| Rate for Payer: Aetna Commercial |
$169.80
|
| Rate for Payer: Aetna Medicare |
$111.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$133.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$133.49
|
| Rate for Payer: BCBS Complete |
$60.10
|
| Rate for Payer: BCBS MAPPO |
$106.79
|
| Rate for Payer: BCN Medicare Advantage |
$106.79
|
| Rate for Payer: Cash Price |
$159.81
|
| Rate for Payer: Cash Price |
$159.81
|
| Rate for Payer: Cofinity Commercial |
$171.79
|
| Rate for Payer: Cofinity Commercial |
$139.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.79
|
| Rate for Payer: Healthscope Commercial |
$179.78
|
| Rate for Payer: Mclaren Medicaid |
$57.24
|
| Rate for Payer: Mclaren Medicare |
$106.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$112.13
|
| Rate for Payer: Meridian Medicaid |
$60.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.80
|
| Rate for Payer: PACE Medicare |
$101.45
|
| Rate for Payer: PACE SWMI |
$106.79
|
| Rate for Payer: PHP Commercial |
$169.80
|
| Rate for Payer: PHP Medicare Advantage |
$106.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.84
|
| Rate for Payer: Priority Health Medicare |
$106.79
|
| Rate for Payer: Priority Health SBD |
$125.85
|
| Rate for Payer: Railroad Medicare Medicare |
$106.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.60
|
| Rate for Payer: UHC Core |
$147.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.79
|
| Rate for Payer: UHC Exchange |
$147.82
|
| Rate for Payer: UHC Medicare Advantage |
$106.79
|
| Rate for Payer: UHCCP Medicaid |
$60.12
|
| Rate for Payer: VA VA |
$106.79
|
|
|
HC RO SUPERFICIAL AND/OR ORTHO
|
Facility
|
IP
|
$199.76
|
|
|
Service Code
|
CPT 77401
|
| Hospital Charge Code |
33300036
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$125.85 |
| Max. Negotiated Rate |
$179.78 |
| Rate for Payer: Aetna Commercial |
$169.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.84
|
| Rate for Payer: Cash Price |
$159.81
|
| Rate for Payer: Cofinity Commercial |
$139.83
|
| Rate for Payer: Cofinity Commercial |
$171.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.81
|
| Rate for Payer: Healthscope Commercial |
$179.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.80
|
| Rate for Payer: PHP Commercial |
$169.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.84
|
| Rate for Payer: Priority Health SBD |
$125.85
|
|
|
HC ROTABLATOR BURR
|
Facility
|
OP
|
$4,184.71
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27200069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,673.88 |
| Max. Negotiated Rate |
$3,766.24 |
| Rate for Payer: Aetna Commercial |
$3,557.00
|
| Rate for Payer: Aetna Medicare |
$2,092.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,720.06
|
| Rate for Payer: BCBS Complete |
$1,673.88
|
| Rate for Payer: Cash Price |
$3,347.77
|
| Rate for Payer: Cofinity Commercial |
$2,929.30
|
| Rate for Payer: Cofinity Commercial |
$3,598.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,929.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,347.77
|
| Rate for Payer: Healthscope Commercial |
$3,766.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,557.00
|
| Rate for Payer: PHP Commercial |
$3,557.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,720.06
|
| Rate for Payer: Priority Health SBD |
$2,636.37
|
|
|
HC ROTABLATOR BURR
|
Facility
|
IP
|
$4,184.71
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27200069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,636.37 |
| Max. Negotiated Rate |
$3,766.24 |
| Rate for Payer: Aetna Commercial |
$3,557.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,720.06
|
| Rate for Payer: Cash Price |
$3,347.77
|
| Rate for Payer: Cofinity Commercial |
$2,929.30
|
| Rate for Payer: Cofinity Commercial |
$3,598.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,929.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,347.77
|
| Rate for Payer: Healthscope Commercial |
$3,766.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,557.00
|
| Rate for Payer: PHP Commercial |
$3,557.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,720.06
|
| Rate for Payer: Priority Health SBD |
$2,636.37
|
|
|
HC ROTAVIRUS ANTIGEN
|
Facility
|
IP
|
$109.75
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
30600145
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$69.14 |
| Max. Negotiated Rate |
$98.78 |
| Rate for Payer: Aetna Commercial |
$93.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.34
|
| Rate for Payer: Cash Price |
$87.80
|
| Rate for Payer: Cofinity Commercial |
$76.83
|
| Rate for Payer: Cofinity Commercial |
$94.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.80
|
| Rate for Payer: Healthscope Commercial |
$98.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.29
|
| Rate for Payer: PHP Commercial |
$93.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.34
|
| Rate for Payer: Priority Health SBD |
$69.14
|
|
|
HC ROTAVIRUS ANTIGEN
|
Facility
|
OP
|
$109.75
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
30600145
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$98.78 |
| Rate for Payer: Aetna Commercial |
$93.29
|
| Rate for Payer: Aetna Medicare |
$12.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.34
|
| 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 |
$6.74
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$87.80
|
| Rate for Payer: Cash Price |
$87.80
|
| Rate for Payer: Cofinity Commercial |
$94.39
|
| Rate for Payer: Cofinity Commercial |
$76.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$98.78
|
| Rate for Payer: Mclaren Medicaid |
$6.42
|
| 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 |
$6.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.29
|
| Rate for Payer: PACE Medicare |
$11.38
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$93.29
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.34
|
| Rate for Payer: Priority Health Medicare |
$11.98
|
| Rate for Payer: Priority Health SBD |
$69.14
|
| Rate for Payer: Railroad Medicare Medicare |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.98
|
| Rate for Payer: UHC Medicare Advantage |
$11.98
|
| Rate for Payer: UHCCP Medicaid |
$6.74
|
| Rate for Payer: VA VA |
$11.98
|
|
|
HC ROTAVIRUS ATTEN 2 DOSE SCHED LIVE ORAL
|
Facility
|
IP
|
$178.53
|
|
|
Service Code
|
CPT 90681
|
| Hospital Charge Code |
63600121
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$112.47 |
| Max. Negotiated Rate |
$160.68 |
| Rate for Payer: Aetna Commercial |
$151.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.04
|
| Rate for Payer: Cash Price |
$142.82
|
| Rate for Payer: Cofinity Commercial |
$124.97
|
| Rate for Payer: Cofinity Commercial |
$153.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.82
|
| Rate for Payer: Healthscope Commercial |
$160.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.75
|
| Rate for Payer: PHP Commercial |
$151.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.04
|
| Rate for Payer: Priority Health SBD |
$112.47
|
|
|
HC ROTAVIRUS ATTEN 2 DOSE SCHED LIVE ORAL
|
Facility
|
OP
|
$178.53
|
|
|
Service Code
|
CPT 90681
|
| Hospital Charge Code |
63600121
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.41 |
| Max. Negotiated Rate |
$160.68 |
| Rate for Payer: Aetna Commercial |
$151.75
|
| Rate for Payer: Aetna Medicare |
$89.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.04
|
| Rate for Payer: BCBS Complete |
$71.41
|
| Rate for Payer: Cash Price |
$142.82
|
| Rate for Payer: Cofinity Commercial |
$124.97
|
| Rate for Payer: Cofinity Commercial |
$153.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.82
|
| Rate for Payer: Healthscope Commercial |
$160.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.75
|
| Rate for Payer: PHP Commercial |
$151.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.04
|
| Rate for Payer: Priority Health SBD |
$112.47
|
|
