|
HC SP Z ANGIO SUPERSEL ECT RENAL BIL
|
Facility
|
IP
|
$3,926.47
|
|
|
Service Code
|
CPT 36254
|
| Hospital Charge Code |
36100350
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,473.68 |
| Max. Negotiated Rate |
$3,533.82 |
| Rate for Payer: Aetna Commercial |
$3,337.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,552.21
|
| Rate for Payer: Cash Price |
$3,141.18
|
| Rate for Payer: Cofinity Advantage |
$2,748.53
|
| Rate for Payer: Cofinity Commercial |
$3,376.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,141.18
|
| Rate for Payer: Healthscope Commercial |
$3,533.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,337.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,944.85
|
| Rate for Payer: PHP Commercial |
$3,337.50
|
| Rate for Payer: Priority Health SBD |
$2,473.68
|
|
|
HC SP Z ANGIO SUPERSELECT RENAL UNI
|
Facility
|
IP
|
$3,926.47
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
36100349
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,473.68 |
| Max. Negotiated Rate |
$3,533.82 |
| Rate for Payer: Aetna Commercial |
$3,337.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,552.21
|
| Rate for Payer: Cash Price |
$3,141.18
|
| Rate for Payer: Cofinity Advantage |
$2,748.53
|
| Rate for Payer: Cofinity Commercial |
$3,376.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,141.18
|
| Rate for Payer: Healthscope Commercial |
$3,533.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,337.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,944.85
|
| Rate for Payer: PHP Commercial |
$3,337.50
|
| Rate for Payer: Priority Health SBD |
$2,473.68
|
|
|
HC SP Z ANGIO SUPERSELECT RENAL UNI
|
Facility
|
OP
|
$3,926.47
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
36100349
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,022.27 |
| Max. Negotiated Rate |
$17,930.33 |
| Rate for Payer: Aetna Commercial |
$3,337.50
|
| Rate for Payer: Aetna Medicare |
$5,766.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,552.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,930.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,930.60
|
| Rate for Payer: BCBS Complete |
$3,045.03
|
| Rate for Payer: BCBS MAPPO |
$5,544.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,022.27
|
| Rate for Payer: BCN Commercial |
$2,022.27
|
| Rate for Payer: BCN Medicare Advantage |
$5,544.48
|
| Rate for Payer: Cash Price |
$3,141.18
|
| Rate for Payer: Cash Price |
$3,141.18
|
| Rate for Payer: Cash Price |
$3,141.18
|
| Rate for Payer: Cofinity Advantage |
$2,748.53
|
| Rate for Payer: Cofinity Commercial |
$3,376.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,141.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,544.48
|
| Rate for Payer: Healthscope Commercial |
$3,533.82
|
| 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 |
$3,337.50
|
| Rate for Payer: Nomi Health Commercial |
$16,633.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,944.85
|
| Rate for Payer: PACE Medicare |
$5,267.26
|
| Rate for Payer: PACE SWMI |
$5,544.48
|
| Rate for Payer: PHP Commercial |
$3,337.50
|
| 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 |
$2,473.68
|
| 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 SP Z EMBOLIZATION COIL BODY
|
Facility
|
IP
|
$422.82
|
|
| Hospital Charge Code |
27800058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.38 |
| Max. Negotiated Rate |
$380.54 |
| Rate for Payer: Aetna Commercial |
$359.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.83
|
| Rate for Payer: Cash Price |
$338.26
|
| Rate for Payer: Cofinity Advantage |
$295.97
|
| Rate for Payer: Cofinity Commercial |
$363.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.26
|
| Rate for Payer: Healthscope Commercial |
$380.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$317.12
|
| Rate for Payer: PHP Commercial |
$359.40
|
| Rate for Payer: Priority Health SBD |
$266.38
|
|
|
HC SP Z EMBOLIZATION COIL BODY
|
Facility
|
OP
|
$422.82
|
|
| Hospital Charge Code |
27800058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$166.17 |
| Max. Negotiated Rate |
$380.54 |
| Rate for Payer: Aetna Commercial |
$359.40
|
| Rate for Payer: Aetna Medicare |
$211.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.83
|
| Rate for Payer: BCBS Complete |
$169.13
|
| Rate for Payer: Cash Price |
$338.26
|
| Rate for Payer: Cofinity Advantage |
$295.97
|
| Rate for Payer: Cofinity Commercial |
$363.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.26
|
| Rate for Payer: Healthscope Commercial |
$380.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$338.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$317.12
|
| Rate for Payer: PHP Commercial |
$359.40
|
| Rate for Payer: Priority Health SBD |
$266.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.83
|
| Rate for Payer: UHC Core |
$220.29
|
| Rate for Payer: UHC Exchange |
$166.17
|
|
|
HC SP Z EMBOLIZATION SPHERES
|
Facility
|
IP
|
$1,044.59
|
|
| Hospital Charge Code |
27800057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$658.09 |
| Max. Negotiated Rate |
$940.13 |
| Rate for Payer: Aetna Commercial |
$887.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$678.98
|
| Rate for Payer: Cash Price |
$835.67
|
| Rate for Payer: Cofinity Advantage |
$731.21
|
| Rate for Payer: Cofinity Commercial |
$898.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$835.67
|
| Rate for Payer: Healthscope Commercial |
$940.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$887.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$783.44
|
| Rate for Payer: PHP Commercial |
$887.90
|
| Rate for Payer: Priority Health SBD |
$658.09
|
|
|
HC SP Z EMBOLIZATION SPHERES
|
Facility
|
OP
|
$1,044.59
|
|
| Hospital Charge Code |
27800057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$410.52 |
| Max. Negotiated Rate |
$940.13 |
| Rate for Payer: Aetna Commercial |
$887.90
|
| Rate for Payer: Aetna Medicare |
$522.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$678.98
|
| Rate for Payer: BCBS Complete |
$417.84
|
| Rate for Payer: Cash Price |
$835.67
|
| Rate for Payer: Cofinity Advantage |
$731.21
|
| Rate for Payer: Cofinity Commercial |
$898.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$835.67
|
| Rate for Payer: Healthscope Commercial |
$940.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$835.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$887.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$783.44
|
| Rate for Payer: PHP Commercial |
$887.90
|
| Rate for Payer: Priority Health SBD |
$658.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$678.98
|
| Rate for Payer: UHC Core |
$544.23
|
| Rate for Payer: UHC Exchange |
$410.52
|
|
|
HC SP Z SEL CATH SEG SUBSEG PULM ART
|
Facility
|
IP
|
$1,303.18
|
|
|
Service Code
|
CPT 36015
|
| Hospital Charge Code |
36100318
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$821.00 |
| Max. Negotiated Rate |
$1,172.86 |
| Rate for Payer: Aetna Commercial |
$1,107.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$847.07
|
| Rate for Payer: Cash Price |
$1,042.54
|
| Rate for Payer: Cofinity Advantage |
$912.23
|
| Rate for Payer: Cofinity Commercial |
$1,120.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,042.54
|
| Rate for Payer: Healthscope Commercial |
$1,172.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,107.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$977.38
|
| Rate for Payer: PHP Commercial |
$1,107.70
|
| Rate for Payer: Priority Health SBD |
$821.00
|
|
|
HC SP Z SEL CATH SEG SUBSEG PULM ART
|
Facility
|
OP
|
$1,303.18
|
|
|
Service Code
|
CPT 36015
|
| Hospital Charge Code |
36100318
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$521.27 |
| Max. Negotiated Rate |
$2,268.11 |
| Rate for Payer: Aetna Commercial |
$1,107.70
|
| Rate for Payer: Aetna Medicare |
$651.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$847.07
|
| Rate for Payer: BCBS Complete |
$521.27
|
| Rate for Payer: BCBS Trust/PPO |
$2,268.11
|
| Rate for Payer: BCN Commercial |
$2,268.11
|
| Rate for Payer: Cash Price |
$1,042.54
|
| Rate for Payer: Cash Price |
$1,042.54
|
| Rate for Payer: Cofinity Advantage |
$912.23
|
| Rate for Payer: Cofinity Commercial |
$1,120.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,042.54
|
| Rate for Payer: Healthscope Commercial |
$1,172.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,042.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,107.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$977.38
|
| Rate for Payer: PHP Commercial |
$1,107.70
|
| Rate for Payer: Priority Health SBD |
$821.00
|
|
|
HC SP Z TRUE FILL
|
Facility
|
IP
|
$6,892.15
|
|
| Hospital Charge Code |
27800059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,342.05 |
| Max. Negotiated Rate |
$6,202.94 |
| Rate for Payer: Aetna Commercial |
$5,858.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,479.90
|
| Rate for Payer: Cash Price |
$5,513.72
|
| Rate for Payer: Cofinity Advantage |
$4,824.51
|
| Rate for Payer: Cofinity Commercial |
$5,927.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,513.72
|
| Rate for Payer: Healthscope Commercial |
$6,202.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,858.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,169.11
|
| Rate for Payer: PHP Commercial |
$5,858.33
|
| Rate for Payer: Priority Health SBD |
$4,342.05
|
|
|
HC SP Z TRUE FILL
|
Facility
|
OP
|
$6,892.15
|
|
| Hospital Charge Code |
27800059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,708.61 |
| Max. Negotiated Rate |
$6,202.94 |
| Rate for Payer: Aetna Commercial |
$5,858.33
|
| Rate for Payer: Aetna Medicare |
$3,446.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,479.90
|
| Rate for Payer: BCBS Complete |
$2,756.86
|
| Rate for Payer: Cash Price |
$5,513.72
|
| Rate for Payer: Cofinity Advantage |
$4,824.51
|
| Rate for Payer: Cofinity Commercial |
$5,927.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,513.72
|
| Rate for Payer: Healthscope Commercial |
$6,202.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,513.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,858.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,169.11
|
| Rate for Payer: PHP Commercial |
$5,858.33
|
| Rate for Payer: Priority Health SBD |
$4,342.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,479.90
|
| Rate for Payer: UHC Core |
$3,590.81
|
| Rate for Payer: UHC Exchange |
$2,708.61
|
|
|
HC SQ ICD
|
Facility
|
IP
|
$57,546.60
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36,254.36 |
| Max. Negotiated Rate |
$51,791.94 |
| Rate for Payer: Aetna Commercial |
$48,914.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37,405.29
|
| Rate for Payer: Cash Price |
$46,037.28
|
| Rate for Payer: Cofinity Advantage |
$40,282.62
|
| Rate for Payer: Cofinity Commercial |
$49,490.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46,037.28
|
| Rate for Payer: Healthscope Commercial |
$51,791.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48,914.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43,159.95
|
| Rate for Payer: PHP Commercial |
$48,914.61
|
| Rate for Payer: Priority Health SBD |
$36,254.36
|
|
|
HC SQ ICD
|
Facility
|
OP
|
$57,546.60
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,615.81 |
| Max. Negotiated Rate |
$51,791.94 |
| Rate for Payer: Aetna Commercial |
$48,914.61
|
| Rate for Payer: Aetna Medicare |
$28,773.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37,405.29
|
| Rate for Payer: BCBS Complete |
$23,018.64
|
| Rate for Payer: Cash Price |
$46,037.28
|
| Rate for Payer: Cofinity Advantage |
$40,282.62
|
| Rate for Payer: Cofinity Commercial |
$49,490.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46,037.28
|
| Rate for Payer: Healthscope Commercial |
$51,791.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46,037.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48,914.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43,159.95
|
| Rate for Payer: PHP Commercial |
$48,914.61
|
| Rate for Payer: Priority Health SBD |
$36,254.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37,405.29
|
| Rate for Payer: UHC Core |
$29,981.78
|
| Rate for Payer: UHC Exchange |
$22,615.81
|
|
|
HC SQ ICD LEAD
|
Facility
|
IP
|
$14,955.75
|
|
|
Service Code
|
HCPCS C1896
|
| Hospital Charge Code |
27800123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,422.12 |
| Max. Negotiated Rate |
$13,460.17 |
| Rate for Payer: Aetna Commercial |
$12,712.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,721.24
|
| Rate for Payer: Cash Price |
$11,964.60
|
| Rate for Payer: Cofinity Advantage |
$10,469.02
|
| Rate for Payer: Cofinity Commercial |
$12,861.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,964.60
|
| Rate for Payer: Healthscope Commercial |
$13,460.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,712.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,216.81
|
| Rate for Payer: PHP Commercial |
$12,712.39
|
| Rate for Payer: Priority Health SBD |
$9,422.12
|
|
|
HC SQ ICD LEAD
|
Facility
|
OP
|
$14,955.75
|
|
|
Service Code
|
HCPCS C1896
|
| Hospital Charge Code |
27800123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,877.61 |
| Max. Negotiated Rate |
$13,460.17 |
| Rate for Payer: Aetna Commercial |
$12,712.39
|
| Rate for Payer: Aetna Medicare |
$7,477.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,721.24
|
| Rate for Payer: BCBS Complete |
$5,982.30
|
| Rate for Payer: Cash Price |
$11,964.60
|
| Rate for Payer: Cofinity Advantage |
$10,469.02
|
| Rate for Payer: Cofinity Commercial |
$12,861.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,964.60
|
| Rate for Payer: Healthscope Commercial |
$13,460.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,964.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,712.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,216.81
|
| Rate for Payer: PHP Commercial |
$12,712.39
|
| Rate for Payer: Priority Health SBD |
$9,422.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,721.24
|
| Rate for Payer: UHC Core |
$7,791.95
|
| Rate for Payer: UHC Exchange |
$5,877.61
|
|
|
HC SQ IM CHEMO HORMONAL
|
Facility
|
OP
|
$251.44
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
33100002
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$37.52 |
| Max. Negotiated Rate |
$232.01 |
| Rate for Payer: Aetna Commercial |
$213.72
|
| Rate for Payer: Aetna Medicare |
$74.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.67
|
| Rate for Payer: BCBS Complete |
$39.40
|
| Rate for Payer: BCBS MAPPO |
$71.74
|
| Rate for Payer: BCBS Trust/PPO |
$141.64
|
| Rate for Payer: BCN Commercial |
$141.64
|
| Rate for Payer: BCN Medicare Advantage |
$71.74
|
| Rate for Payer: Cash Price |
$201.15
|
| Rate for Payer: Cash Price |
$201.15
|
| Rate for Payer: Cofinity Advantage |
$176.01
|
| Rate for Payer: Cofinity Commercial |
$216.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.74
|
| Rate for Payer: Healthscope Commercial |
$226.30
|
| Rate for Payer: Mclaren Medicaid |
$37.52
|
| Rate for Payer: Mclaren Medicare |
$71.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.33
|
| Rate for Payer: Meridian Medicaid |
$75.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.72
|
| Rate for Payer: Nomi Health Commercial |
$215.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$188.58
|
| Rate for Payer: PACE Medicare |
$68.15
|
| Rate for Payer: PACE SWMI |
$71.74
|
| Rate for Payer: PHP Commercial |
$213.72
|
| Rate for Payer: PHP Medicare Advantage |
$71.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$232.01
|
| Rate for Payer: Priority Health Medicare |
$71.74
|
| Rate for Payer: Priority Health SBD |
$158.41
|
| Rate for Payer: Priority Health Tiered Network |
$185.61
|
| Rate for Payer: Railroad Medicare Medicare |
$71.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.44
|
| Rate for Payer: UHC Core |
$131.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.74
|
| Rate for Payer: UHC Exchange |
$98.82
|
| Rate for Payer: UHC Medicaid |
$37.52
|
| Rate for Payer: UHCCP Medicaid |
$37.52
|
| Rate for Payer: VA VA |
$71.74
|
|
|
HC SQ IM CHEMO HORMONAL
|
Facility
|
IP
|
$251.44
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
33100002
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$158.41 |
| Max. Negotiated Rate |
$226.30 |
| Rate for Payer: Aetna Commercial |
$213.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.44
|
| Rate for Payer: Cash Price |
$201.15
|
| Rate for Payer: Cofinity Advantage |
$176.01
|
| Rate for Payer: Cofinity Commercial |
$216.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.15
|
| Rate for Payer: Healthscope Commercial |
$226.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$188.58
|
| Rate for Payer: PHP Commercial |
$213.72
|
| Rate for Payer: Priority Health SBD |
$158.41
|
|
|
HC SQ IM CHEMO NON-HORMONAL
|
Facility
|
IP
|
$508.92
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
33100001
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$320.62 |
| Max. Negotiated Rate |
$458.03 |
| Rate for Payer: Aetna Commercial |
$432.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.80
|
| Rate for Payer: Cash Price |
$407.14
|
| Rate for Payer: Cofinity Advantage |
$356.24
|
| Rate for Payer: Cofinity Commercial |
$437.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.14
|
| Rate for Payer: Healthscope Commercial |
$458.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$381.69
|
| Rate for Payer: PHP Commercial |
$432.58
|
| Rate for Payer: Priority Health SBD |
$320.62
|
|
|
HC SQ IM CHEMO NON-HORMONAL
|
Facility
|
OP
|
$508.92
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
33100001
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$37.52 |
| Max. Negotiated Rate |
$458.03 |
| Rate for Payer: Aetna Commercial |
$432.58
|
| Rate for Payer: Aetna Medicare |
$74.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.67
|
| Rate for Payer: BCBS Complete |
$39.40
|
| Rate for Payer: BCBS MAPPO |
$71.74
|
| Rate for Payer: BCBS Trust/PPO |
$268.84
|
| Rate for Payer: BCN Commercial |
$268.84
|
| Rate for Payer: BCN Medicare Advantage |
$71.74
|
| Rate for Payer: Cash Price |
$407.14
|
| Rate for Payer: Cash Price |
$407.14
|
| Rate for Payer: Cofinity Advantage |
$356.24
|
| Rate for Payer: Cofinity Commercial |
$437.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.74
|
| Rate for Payer: Healthscope Commercial |
$458.03
|
| Rate for Payer: Mclaren Medicaid |
$37.52
|
| Rate for Payer: Mclaren Medicare |
$71.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.33
|
| Rate for Payer: Meridian Medicaid |
$75.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.58
|
| Rate for Payer: Nomi Health Commercial |
$215.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$381.69
|
| Rate for Payer: PACE Medicare |
$68.15
|
| Rate for Payer: PACE SWMI |
$71.74
|
| Rate for Payer: PHP Commercial |
$432.58
|
| Rate for Payer: PHP Medicare Advantage |
$71.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$232.01
|
| Rate for Payer: Priority Health Medicare |
$71.74
|
| Rate for Payer: Priority Health SBD |
$320.62
|
| Rate for Payer: Priority Health Tiered Network |
$185.61
|
| Rate for Payer: Railroad Medicare Medicare |
$71.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.80
|
| Rate for Payer: UHC Core |
$265.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.74
|
| Rate for Payer: UHC Exchange |
$200.01
|
| Rate for Payer: UHC Medicaid |
$37.52
|
| Rate for Payer: UHCCP Medicaid |
$37.52
|
| Rate for Payer: VA VA |
$71.74
|
|
|
HC SQ OR IM INJECTION
|
Facility
|
IP
|
$152.79
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
51000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$96.26 |
| Max. Negotiated Rate |
$137.51 |
| Rate for Payer: Aetna Commercial |
$129.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.31
|
| Rate for Payer: Cash Price |
$122.23
|
| Rate for Payer: Cofinity Advantage |
$106.95
|
| Rate for Payer: Cofinity Commercial |
$131.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.23
|
| Rate for Payer: Healthscope Commercial |
$137.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.59
|
| Rate for Payer: PHP Commercial |
$129.87
|
| Rate for Payer: Priority Health SBD |
$96.26
|
|
|
HC SQ OR IM INJECTION
|
Facility
|
OP
|
$152.79
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
51000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$37.52 |
| Max. Negotiated Rate |
$232.01 |
| Rate for Payer: Aetna Commercial |
$129.87
|
| Rate for Payer: Aetna Medicare |
$74.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.67
|
| Rate for Payer: BCBS Complete |
$39.40
|
| Rate for Payer: BCBS MAPPO |
$71.74
|
| Rate for Payer: BCBS Trust/PPO |
$37.80
|
| Rate for Payer: BCN Commercial |
$37.80
|
| Rate for Payer: BCN Medicare Advantage |
$71.74
|
| Rate for Payer: Cash Price |
$122.23
|
| Rate for Payer: Cash Price |
$122.23
|
| Rate for Payer: Cofinity Advantage |
$106.95
|
| Rate for Payer: Cofinity Commercial |
$131.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.74
|
| Rate for Payer: Healthscope Commercial |
$137.51
|
| Rate for Payer: Mclaren Medicaid |
$37.52
|
| Rate for Payer: Mclaren Medicare |
$71.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.33
|
| Rate for Payer: Meridian Medicaid |
$75.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.87
|
| Rate for Payer: Nomi Health Commercial |
$215.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.59
|
| Rate for Payer: PACE Medicare |
$68.15
|
| Rate for Payer: PACE SWMI |
$71.74
|
| Rate for Payer: PHP Commercial |
$129.87
|
| Rate for Payer: PHP Medicare Advantage |
$71.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$232.01
|
| Rate for Payer: Priority Health Medicare |
$71.74
|
| Rate for Payer: Priority Health SBD |
$96.26
|
| Rate for Payer: Priority Health Tiered Network |
$185.61
|
| Rate for Payer: Railroad Medicare Medicare |
$71.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.31
|
| Rate for Payer: UHC Core |
$79.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.74
|
| Rate for Payer: UHC Exchange |
$60.05
|
| Rate for Payer: UHC Medicaid |
$37.52
|
| Rate for Payer: UHCCP Medicaid |
$37.52
|
| Rate for Payer: VA VA |
$71.74
|
|
|
HC SRA, LMWH
|
Facility
|
OP
|
$339.59
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200424
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$305.63 |
| Rate for Payer: Aetna Commercial |
$288.65
|
| Rate for Payer: Aetna Medicare |
$19.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.96
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$18.37
|
| Rate for Payer: BCBS Trust/PPO |
$19.59
|
| Rate for Payer: BCN Commercial |
$19.59
|
| Rate for Payer: BCN Medicare Advantage |
$18.37
|
| Rate for Payer: Cash Price |
$271.67
|
| Rate for Payer: Cash Price |
$271.67
|
| Rate for Payer: Cofinity Advantage |
$237.71
|
| Rate for Payer: Cofinity Commercial |
$292.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.37
|
| Rate for Payer: Healthscope Commercial |
$305.63
|
| Rate for Payer: Mclaren Medicaid |
$9.61
|
| Rate for Payer: Mclaren Medicare |
$18.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.29
|
| Rate for Payer: Meridian Medicaid |
$19.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.65
|
| Rate for Payer: Nomi Health Commercial |
$27.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$254.69
|
| Rate for Payer: PACE Medicare |
$17.45
|
| Rate for Payer: PACE SWMI |
$18.37
|
| Rate for Payer: PHP Commercial |
$288.65
|
| Rate for Payer: PHP Medicare Advantage |
$18.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18.37
|
| Rate for Payer: Priority Health Medicare |
$18.37
|
| Rate for Payer: Priority Health SBD |
$213.94
|
| Rate for Payer: Priority Health Tiered Network |
$14.70
|
| Rate for Payer: Railroad Medicare Medicare |
$18.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.56
|
| Rate for Payer: UHC Core |
$27.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.37
|
| Rate for Payer: UHC Exchange |
$27.56
|
| Rate for Payer: UHC Medicaid |
$9.61
|
| Rate for Payer: UHCCP Medicaid |
$9.61
|
| Rate for Payer: VA VA |
$18.37
|
|
|
HC SRA, LMWH
|
Facility
|
IP
|
$339.59
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200424
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$213.94 |
| Max. Negotiated Rate |
$305.63 |
| Rate for Payer: Aetna Commercial |
$288.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.73
|
| Rate for Payer: Cash Price |
$271.67
|
| Rate for Payer: Cofinity Advantage |
$237.71
|
| Rate for Payer: Cofinity Commercial |
$292.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.67
|
| Rate for Payer: Healthscope Commercial |
$305.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$254.69
|
| Rate for Payer: PHP Commercial |
$288.65
|
| Rate for Payer: Priority Health SBD |
$213.94
|
|
|
HC SRS CRANIAL LESION LIN ACC
|
Facility
|
OP
|
$3,163.46
|
|
|
Service Code
|
CPT 77372
|
| Hospital Charge Code |
33300032
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,992.98 |
| Max. Negotiated Rate |
$23,733.03 |
| Rate for Payer: Aetna Commercial |
$2,688.94
|
| Rate for Payer: Aetna Medicare |
$7,632.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,056.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,173.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,173.51
|
| Rate for Payer: BCBS Complete |
$4,030.47
|
| Rate for Payer: BCBS MAPPO |
$7,338.81
|
| Rate for Payer: BCBS Trust/PPO |
$2,116.22
|
| Rate for Payer: BCN Commercial |
$2,116.22
|
| Rate for Payer: BCN Medicare Advantage |
$7,338.81
|
| Rate for Payer: Cash Price |
$2,530.77
|
| Rate for Payer: Cash Price |
$2,530.77
|
| Rate for Payer: Cofinity Advantage |
$2,214.42
|
| Rate for Payer: Cofinity Commercial |
$2,720.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,530.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,338.81
|
| Rate for Payer: Healthscope Commercial |
$2,847.11
|
| Rate for Payer: Mclaren Medicaid |
$3,838.20
|
| Rate for Payer: Mclaren Medicare |
$7,338.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,705.75
|
| Rate for Payer: Meridian Medicaid |
$7,705.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,439.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,072.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,688.94
|
| Rate for Payer: Nomi Health Commercial |
$22,016.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,372.59
|
| Rate for Payer: PACE Medicare |
$6,971.87
|
| Rate for Payer: PACE SWMI |
$7,338.81
|
| Rate for Payer: PHP Commercial |
$2,688.94
|
| Rate for Payer: PHP Medicare Advantage |
$7,338.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,838.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,733.03
|
| Rate for Payer: Priority Health Medicare |
$7,338.81
|
| Rate for Payer: Priority Health SBD |
$1,992.98
|
| Rate for Payer: Priority Health Tiered Network |
$18,986.42
|
| Rate for Payer: Railroad Medicare Medicare |
$7,338.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,338.81
|
| Rate for Payer: UHC Medicaid |
$3,838.20
|
| Rate for Payer: UHCCP Medicaid |
$3,838.20
|
| Rate for Payer: VA VA |
$7,338.81
|
|
|
HC SRS CRANIAL LESION LIN ACC
|
Facility
|
IP
|
$3,163.46
|
|
|
Service Code
|
CPT 77372
|
| Hospital Charge Code |
33300032
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,992.98 |
| Max. Negotiated Rate |
$2,847.11 |
| Rate for Payer: Aetna Commercial |
$2,688.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,056.25
|
| Rate for Payer: Cash Price |
$2,530.77
|
| Rate for Payer: Cofinity Advantage |
$2,214.42
|
| Rate for Payer: Cofinity Commercial |
$2,720.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,530.77
|
| Rate for Payer: Healthscope Commercial |
$2,847.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,688.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,372.59
|
| Rate for Payer: PHP Commercial |
$2,688.94
|
| Rate for Payer: Priority Health SBD |
$1,992.98
|
|
