|
HC STRIP PASTE
|
Facility
|
IP
|
$4.59
|
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.98
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Advantage |
$3.21
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.44
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: Priority Health SBD |
$2.89
|
|
|
HC STRIP PASTE
|
Facility
|
OP
|
$4.59
|
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna Medicare |
$2.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.98
|
| Rate for Payer: BCBS Complete |
$1.84
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Advantage |
$3.21
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.44
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: Priority Health SBD |
$2.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.98
|
| Rate for Payer: UHC Core |
$2.39
|
| Rate for Payer: UHC Exchange |
$1.80
|
|
|
HC STRONGYLOIDES ANTIBODY, IGG, SERUM
|
Facility
|
OP
|
$89.06
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
30200490
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$80.15 |
| Rate for Payer: Aetna Commercial |
$75.70
|
| Rate for Payer: Aetna Medicare |
$13.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.26
|
| Rate for Payer: BCBS Complete |
$7.15
|
| Rate for Payer: BCBS MAPPO |
$13.01
|
| Rate for Payer: BCBS Trust/PPO |
$13.87
|
| Rate for Payer: BCN Commercial |
$13.87
|
| Rate for Payer: BCN Medicare Advantage |
$13.01
|
| Rate for Payer: Cash Price |
$71.25
|
| Rate for Payer: Cash Price |
$71.25
|
| Rate for Payer: Cofinity Advantage |
$62.34
|
| Rate for Payer: Cofinity Commercial |
$76.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.01
|
| Rate for Payer: Healthscope Commercial |
$80.15
|
| Rate for Payer: Mclaren Medicaid |
$6.80
|
| Rate for Payer: Mclaren Medicare |
$13.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.66
|
| Rate for Payer: Meridian Medicaid |
$13.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.70
|
| Rate for Payer: Nomi Health Commercial |
$19.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.80
|
| Rate for Payer: PACE Medicare |
$12.36
|
| Rate for Payer: PACE SWMI |
$13.01
|
| Rate for Payer: PHP Commercial |
$75.70
|
| Rate for Payer: PHP Medicare Advantage |
$13.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.01
|
| Rate for Payer: Priority Health Medicare |
$13.01
|
| Rate for Payer: Priority Health SBD |
$56.11
|
| Rate for Payer: Priority Health Tiered Network |
$10.41
|
| Rate for Payer: Railroad Medicare Medicare |
$13.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.52
|
| Rate for Payer: UHC Core |
$19.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.01
|
| Rate for Payer: UHC Exchange |
$19.52
|
| Rate for Payer: UHC Medicaid |
$6.80
|
| Rate for Payer: UHCCP Medicaid |
$6.80
|
| Rate for Payer: VA VA |
$13.01
|
|
|
HC STRONGYLOIDES ANTIBODY, IGG, SERUM
|
Facility
|
IP
|
$89.06
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
30200490
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$56.11 |
| Max. Negotiated Rate |
$80.15 |
| Rate for Payer: Aetna Commercial |
$75.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.89
|
| Rate for Payer: Cash Price |
$71.25
|
| Rate for Payer: Cofinity Advantage |
$62.34
|
| Rate for Payer: Cofinity Commercial |
$76.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.25
|
| Rate for Payer: Healthscope Commercial |
$80.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.80
|
| Rate for Payer: PHP Commercial |
$75.70
|
| Rate for Payer: Priority Health SBD |
$56.11
|
|
|
HC STUDY INSERT NON TUNNELED CENTRAL LINE > 5 YRS
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
36100588
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Aetna Commercial |
$33.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.35
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Advantage |
$27.30
|
| Rate for Payer: Cofinity Commercial |
$33.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.20
|
| Rate for Payer: Healthscope Commercial |
$35.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.25
|
| Rate for Payer: PHP Commercial |
$33.15
|
| Rate for Payer: Priority Health SBD |
$24.57
|
|
|
HC STUDY INSERT NON TUNNELED CENTRAL LINE > 5 YRS
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
36100588
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$10,174.29 |
| Rate for Payer: Aetna Commercial |
$33.15
|
| Rate for Payer: Aetna Medicare |
$3,271.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,456.16
|
| Rate for Payer: BCN Commercial |
$2,456.16
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Advantage |
$27.30
|
| Rate for Payer: Cofinity Commercial |
$33.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$35.10
|
| Rate for Payer: Mclaren Medicaid |
$1,645.43
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$3,303.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.15
|
| Rate for Payer: Nomi Health Commercial |
$9,438.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.25
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$33.15
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,174.29
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health SBD |
$24.57
|
| Rate for Payer: Priority Health Tiered Network |
$8,139.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
HC SUBCLASS IGG4, SERUM
|
Facility
|
IP
|
$135.25
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
30100720
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$85.21 |
| Max. Negotiated Rate |
$121.72 |
| Rate for Payer: Aetna Commercial |
$114.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.91
|
| Rate for Payer: Cash Price |
$108.20
|
| Rate for Payer: Cofinity Advantage |
$94.67
|
| Rate for Payer: Cofinity Commercial |
$116.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.20
|
| Rate for Payer: Healthscope Commercial |
$121.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.44
|
| Rate for Payer: PHP Commercial |
$114.96
|
| Rate for Payer: Priority Health SBD |
$85.21
|
|
|
HC SUBCLASS IGG4, SERUM
|
Facility
|
OP
|
$135.25
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
30100720
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$121.72 |
| Rate for Payer: Aetna Commercial |
$114.96
|
| Rate for Payer: Aetna Medicare |
$8.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.03
|
| Rate for Payer: BCBS Complete |
$4.40
|
| Rate for Payer: BCBS MAPPO |
$8.02
|
| Rate for Payer: BCBS Trust/PPO |
$8.56
|
| Rate for Payer: BCN Commercial |
$8.56
|
| Rate for Payer: BCN Medicare Advantage |
$8.02
|
| Rate for Payer: Cash Price |
$108.20
|
| Rate for Payer: Cash Price |
$108.20
|
| Rate for Payer: Cofinity Advantage |
$94.67
|
| Rate for Payer: Cofinity Commercial |
$116.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.02
|
| Rate for Payer: Healthscope Commercial |
$121.72
|
| Rate for Payer: Mclaren Medicaid |
$4.19
|
| Rate for Payer: Mclaren Medicare |
$8.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.42
|
| Rate for Payer: Meridian Medicaid |
$8.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.96
|
| Rate for Payer: Nomi Health Commercial |
$12.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.44
|
| Rate for Payer: PACE Medicare |
$7.62
|
| Rate for Payer: PACE SWMI |
$8.02
|
| Rate for Payer: PHP Commercial |
$114.96
|
| Rate for Payer: PHP Medicare Advantage |
$8.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8.02
|
| Rate for Payer: Priority Health Medicare |
$8.02
|
| Rate for Payer: Priority Health SBD |
$85.21
|
| Rate for Payer: Priority Health Tiered Network |
$6.42
|
| Rate for Payer: Railroad Medicare Medicare |
$8.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.03
|
| Rate for Payer: UHC Core |
$12.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.02
|
| Rate for Payer: UHC Exchange |
$12.03
|
| Rate for Payer: UHC Medicaid |
$4.19
|
| Rate for Payer: UHCCP Medicaid |
$4.19
|
| Rate for Payer: VA VA |
$8.02
|
|
|
HC SUBCUTANEOUS INF EA ADDL HR
|
Facility
|
OP
|
$135.66
|
|
|
Service Code
|
CPT 96370
|
| Hospital Charge Code |
26000014
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$150.88 |
| Rate for Payer: Aetna Commercial |
$115.31
|
| Rate for Payer: Aetna Medicare |
$48.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.33
|
| Rate for Payer: BCBS Complete |
$25.63
|
| Rate for Payer: BCBS MAPPO |
$46.66
|
| Rate for Payer: BCBS Trust/PPO |
$64.27
|
| Rate for Payer: BCN Commercial |
$64.27
|
| Rate for Payer: BCN Medicare Advantage |
$46.66
|
| Rate for Payer: Cash Price |
$108.53
|
| Rate for Payer: Cash Price |
$108.53
|
| Rate for Payer: Cofinity Advantage |
$94.96
|
| Rate for Payer: Cofinity Commercial |
$116.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.66
|
| Rate for Payer: Healthscope Commercial |
$122.09
|
| Rate for Payer: Mclaren Medicaid |
$24.40
|
| Rate for Payer: Mclaren Medicare |
$46.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.99
|
| Rate for Payer: Meridian Medicaid |
$48.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.31
|
| Rate for Payer: Nomi Health Commercial |
$139.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.75
|
| Rate for Payer: PACE Medicare |
$44.33
|
| Rate for Payer: PACE SWMI |
$46.66
|
| Rate for Payer: PHP Commercial |
$115.31
|
| Rate for Payer: PHP Medicare Advantage |
$46.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$150.88
|
| Rate for Payer: Priority Health Medicare |
$46.66
|
| Rate for Payer: Priority Health SBD |
$85.47
|
| Rate for Payer: Priority Health Tiered Network |
$120.70
|
| Rate for Payer: Railroad Medicare Medicare |
$46.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.18
|
| Rate for Payer: UHC Core |
$70.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$46.66
|
| Rate for Payer: UHC Exchange |
$53.31
|
| Rate for Payer: UHC Medicaid |
$24.40
|
| Rate for Payer: UHCCP Medicaid |
$24.40
|
| Rate for Payer: VA VA |
$46.66
|
|
|
HC SUBCUTANEOUS INF EA ADDL HR
|
Facility
|
IP
|
$135.66
|
|
|
Service Code
|
CPT 96370
|
| Hospital Charge Code |
26000014
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$85.47 |
| Max. Negotiated Rate |
$122.09 |
| Rate for Payer: Healthscope Commercial |
$122.09
|
| Rate for Payer: Aetna Commercial |
$115.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.18
|
| Rate for Payer: Cash Price |
$108.53
|
| Rate for Payer: Cofinity Advantage |
$94.96
|
| Rate for Payer: Cofinity Commercial |
$116.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.75
|
| Rate for Payer: PHP Commercial |
$115.31
|
| Rate for Payer: Priority Health SBD |
$85.47
|
|
|
HC SUBCUTANEOUS INF INIT HR W/PUMP SET UP
|
Facility
|
OP
|
$751.74
|
|
|
Service Code
|
CPT 96369
|
| Hospital Charge Code |
26000013
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$110.84 |
| Max. Negotiated Rate |
$685.39 |
| Rate for Payer: Aetna Commercial |
$638.98
|
| Rate for Payer: Aetna Medicare |
$220.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$488.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$264.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$264.93
|
| Rate for Payer: BCBS Complete |
$116.40
|
| Rate for Payer: BCBS MAPPO |
$211.94
|
| Rate for Payer: BCBS Trust/PPO |
$544.26
|
| Rate for Payer: BCN Commercial |
$544.26
|
| Rate for Payer: BCN Medicare Advantage |
$211.94
|
| Rate for Payer: Cash Price |
$601.39
|
| Rate for Payer: Cash Price |
$601.39
|
| Rate for Payer: Cofinity Advantage |
$526.22
|
| Rate for Payer: Cofinity Commercial |
$646.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$601.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.94
|
| Rate for Payer: Healthscope Commercial |
$676.57
|
| Rate for Payer: Mclaren Medicaid |
$110.84
|
| Rate for Payer: Mclaren Medicare |
$211.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$222.54
|
| Rate for Payer: Meridian Medicaid |
$222.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$243.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$233.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$638.98
|
| Rate for Payer: Nomi Health Commercial |
$635.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$563.80
|
| Rate for Payer: PACE Medicare |
$201.34
|
| Rate for Payer: PACE SWMI |
$211.94
|
| Rate for Payer: PHP Commercial |
$638.98
|
| Rate for Payer: PHP Medicare Advantage |
$211.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$685.39
|
| Rate for Payer: Priority Health Medicare |
$211.94
|
| Rate for Payer: Priority Health SBD |
$473.60
|
| Rate for Payer: Priority Health Tiered Network |
$548.31
|
| Rate for Payer: Railroad Medicare Medicare |
$211.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.63
|
| Rate for Payer: UHC Core |
$391.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$211.94
|
| Rate for Payer: UHC Exchange |
$295.43
|
| Rate for Payer: UHC Medicaid |
$110.84
|
| Rate for Payer: UHCCP Medicaid |
$110.84
|
| Rate for Payer: VA VA |
$211.94
|
|
|
HC SUBCUTANEOUS INF INIT HR W/PUMP SET UP
|
Facility
|
IP
|
$751.74
|
|
|
Service Code
|
CPT 96369
|
| Hospital Charge Code |
26000013
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$473.60 |
| Max. Negotiated Rate |
$676.57 |
| Rate for Payer: Aetna Commercial |
$638.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$488.63
|
| Rate for Payer: Cash Price |
$601.39
|
| Rate for Payer: Cofinity Advantage |
$526.22
|
| Rate for Payer: Cofinity Commercial |
$646.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$601.39
|
| Rate for Payer: Healthscope Commercial |
$676.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$638.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$563.80
|
| Rate for Payer: PHP Commercial |
$638.98
|
| Rate for Payer: Priority Health SBD |
$473.60
|
|
|
HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL
|
Facility
|
IP
|
$8,271.18
|
|
|
Service Code
|
CPT 30140
|
| Hospital Charge Code |
76100377
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,210.84 |
| Max. Negotiated Rate |
$7,444.06 |
| Rate for Payer: Aetna Commercial |
$7,030.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,376.27
|
| Rate for Payer: Cash Price |
$6,616.94
|
| Rate for Payer: Cofinity Advantage |
$5,789.83
|
| Rate for Payer: Cofinity Commercial |
$7,113.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,616.94
|
| Rate for Payer: Healthscope Commercial |
$7,444.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,030.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,203.39
|
| Rate for Payer: PHP Commercial |
$7,030.50
|
| Rate for Payer: Priority Health SBD |
$5,210.84
|
|
|
HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL
|
Facility
|
OP
|
$8,271.18
|
|
|
Service Code
|
CPT 30140
|
| Hospital Charge Code |
76100377
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,256.18 |
| Max. Negotiated Rate |
$10,683.35 |
| Rate for Payer: Aetna Commercial |
$7,030.50
|
| Rate for Payer: Aetna Medicare |
$3,435.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,376.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,129.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,129.43
|
| Rate for Payer: BCBS Complete |
$1,814.30
|
| Rate for Payer: BCBS MAPPO |
$3,303.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,256.18
|
| Rate for Payer: BCN Commercial |
$1,256.18
|
| Rate for Payer: BCN Medicare Advantage |
$3,303.54
|
| Rate for Payer: Cash Price |
$6,616.94
|
| Rate for Payer: Cash Price |
$6,616.94
|
| Rate for Payer: Cash Price |
$6,616.94
|
| Rate for Payer: Cofinity Advantage |
$5,789.83
|
| Rate for Payer: Cofinity Commercial |
$7,113.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,616.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,303.54
|
| Rate for Payer: Healthscope Commercial |
$7,444.06
|
| Rate for Payer: Mclaren Medicaid |
$1,727.75
|
| Rate for Payer: Mclaren Medicare |
$3,303.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,468.72
|
| Rate for Payer: Meridian Medicaid |
$3,468.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,799.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,633.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,030.50
|
| Rate for Payer: Nomi Health Commercial |
$9,910.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,203.39
|
| Rate for Payer: PACE Medicare |
$3,138.36
|
| Rate for Payer: PACE SWMI |
$3,303.54
|
| Rate for Payer: PHP Commercial |
$7,030.50
|
| Rate for Payer: PHP Medicare Advantage |
$3,303.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,727.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,683.35
|
| Rate for Payer: Priority Health Medicare |
$3,303.54
|
| Rate for Payer: Priority Health SBD |
$5,210.84
|
| Rate for Payer: Priority Health Tiered Network |
$8,546.68
|
| Rate for Payer: Railroad Medicare Medicare |
$3,303.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,376.27
|
| Rate for Payer: UHC Core |
$4,309.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,303.54
|
| Rate for Payer: UHC Exchange |
$3,250.57
|
| Rate for Payer: UHC Medicaid |
$1,727.75
|
| Rate for Payer: UHCCP Medicaid |
$1,727.75
|
| Rate for Payer: VA VA |
$3,303.54
|
|
|
HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL BILAT
|
Facility
|
OP
|
$12,406.77
|
|
|
Service Code
|
CPT 30140
|
| Hospital Charge Code |
76100378
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,256.18 |
| Max. Negotiated Rate |
$11,166.09 |
| Rate for Payer: Aetna Commercial |
$10,545.75
|
| Rate for Payer: Aetna Medicare |
$3,435.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,064.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,129.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,129.43
|
| Rate for Payer: BCBS Complete |
$1,814.30
|
| Rate for Payer: BCBS MAPPO |
$3,303.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,256.18
|
| Rate for Payer: BCN Commercial |
$1,256.18
|
| Rate for Payer: BCN Medicare Advantage |
$3,303.54
|
| Rate for Payer: Cash Price |
$9,925.42
|
| Rate for Payer: Cash Price |
$9,925.42
|
| Rate for Payer: Cash Price |
$9,925.42
|
| Rate for Payer: Cofinity Advantage |
$8,684.74
|
| Rate for Payer: Cofinity Commercial |
$10,669.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,925.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,303.54
|
| Rate for Payer: Healthscope Commercial |
$11,166.09
|
| Rate for Payer: Mclaren Medicaid |
$1,727.75
|
| Rate for Payer: Mclaren Medicare |
$3,303.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,468.72
|
| Rate for Payer: Meridian Medicaid |
$3,468.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,799.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,633.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,545.75
|
| Rate for Payer: Nomi Health Commercial |
$9,910.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,305.08
|
| Rate for Payer: PACE Medicare |
$3,138.36
|
| Rate for Payer: PACE SWMI |
$3,303.54
|
| Rate for Payer: PHP Commercial |
$10,545.75
|
| Rate for Payer: PHP Medicare Advantage |
$3,303.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,727.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,683.35
|
| Rate for Payer: Priority Health Medicare |
$3,303.54
|
| Rate for Payer: Priority Health SBD |
$7,816.27
|
| Rate for Payer: Priority Health Tiered Network |
$8,546.68
|
| Rate for Payer: Railroad Medicare Medicare |
$3,303.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,064.40
|
| Rate for Payer: UHC Core |
$6,463.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,303.54
|
| Rate for Payer: UHC Exchange |
$4,875.86
|
| Rate for Payer: UHC Medicaid |
$1,727.75
|
| Rate for Payer: UHCCP Medicaid |
$1,727.75
|
| Rate for Payer: VA VA |
$3,303.54
|
|
|
HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL BILAT
|
Facility
|
IP
|
$12,406.77
|
|
|
Service Code
|
CPT 30140
|
| Hospital Charge Code |
76100378
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7,816.27 |
| Max. Negotiated Rate |
$11,166.09 |
| Rate for Payer: Aetna Commercial |
$10,545.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,064.40
|
| Rate for Payer: Cash Price |
$9,925.42
|
| Rate for Payer: Cofinity Advantage |
$8,684.74
|
| Rate for Payer: Cofinity Commercial |
$10,669.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,925.42
|
| Rate for Payer: Healthscope Commercial |
$11,166.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,545.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,305.08
|
| Rate for Payer: PHP Commercial |
$10,545.75
|
| Rate for Payer: Priority Health SBD |
$7,816.27
|
|
|
HC SUCTION A&A LINE
|
Facility
|
IP
|
$32.77
|
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.65 |
| Max. Negotiated Rate |
$29.49 |
| Rate for Payer: Aetna Commercial |
$27.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.30
|
| Rate for Payer: Cash Price |
$26.22
|
| Rate for Payer: Cofinity Advantage |
$22.94
|
| Rate for Payer: Cofinity Commercial |
$28.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.22
|
| Rate for Payer: Healthscope Commercial |
$29.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.58
|
| Rate for Payer: PHP Commercial |
$27.85
|
| Rate for Payer: Priority Health SBD |
$20.65
|
|
|
HC SUCTION A&A LINE
|
Facility
|
OP
|
$32.77
|
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$29.49 |
| Rate for Payer: Aetna Commercial |
$27.85
|
| Rate for Payer: Aetna Medicare |
$16.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.30
|
| Rate for Payer: BCBS Complete |
$13.11
|
| Rate for Payer: Cash Price |
$26.22
|
| Rate for Payer: Cofinity Advantage |
$22.94
|
| Rate for Payer: Cofinity Commercial |
$28.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.22
|
| Rate for Payer: Healthscope Commercial |
$29.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.58
|
| Rate for Payer: PHP Commercial |
$27.85
|
| Rate for Payer: Priority Health SBD |
$20.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.30
|
| Rate for Payer: UHC Core |
$17.07
|
| Rate for Payer: UHC Exchange |
$12.88
|
|
|
HC SUMP VENTRICULAR LIVANOVA
|
Facility
|
OP
|
$45.26
|
|
| Hospital Charge Code |
27000659
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.79 |
| Max. Negotiated Rate |
$40.73 |
| Rate for Payer: Aetna Commercial |
$38.47
|
| Rate for Payer: Aetna Medicare |
$22.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.42
|
| Rate for Payer: BCBS Complete |
$18.10
|
| Rate for Payer: Cash Price |
$36.21
|
| Rate for Payer: Cofinity Advantage |
$31.68
|
| Rate for Payer: Cofinity Commercial |
$38.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.21
|
| Rate for Payer: Healthscope Commercial |
$40.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.95
|
| Rate for Payer: PHP Commercial |
$38.47
|
| Rate for Payer: Priority Health SBD |
$28.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.42
|
| Rate for Payer: UHC Core |
$23.58
|
| Rate for Payer: UHC Exchange |
$17.79
|
|
|
HC SUMP VENTRICULAR LIVANOVA
|
Facility
|
IP
|
$45.26
|
|
| Hospital Charge Code |
27000659
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.51 |
| Max. Negotiated Rate |
$40.73 |
| Rate for Payer: Aetna Commercial |
$38.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.42
|
| Rate for Payer: Cash Price |
$36.21
|
| Rate for Payer: Cofinity Advantage |
$31.68
|
| Rate for Payer: Cofinity Commercial |
$38.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.21
|
| Rate for Payer: Healthscope Commercial |
$40.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.95
|
| Rate for Payer: PHP Commercial |
$38.47
|
| Rate for Payer: Priority Health SBD |
$28.51
|
|
|
HC SUMP VENTRICULAR MEDTRONIC
|
Facility
|
IP
|
$43.70
|
|
| Hospital Charge Code |
27000122
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.53 |
| Max. Negotiated Rate |
$39.33 |
| Rate for Payer: Aetna Commercial |
$37.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.41
|
| Rate for Payer: Cash Price |
$34.96
|
| Rate for Payer: Cofinity Advantage |
$30.59
|
| Rate for Payer: Cofinity Commercial |
$37.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.96
|
| Rate for Payer: Healthscope Commercial |
$39.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.77
|
| Rate for Payer: PHP Commercial |
$37.15
|
| Rate for Payer: Priority Health SBD |
$27.53
|
|
|
HC SUMP VENTRICULAR MEDTRONIC
|
Facility
|
OP
|
$43.70
|
|
| Hospital Charge Code |
27000122
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.17 |
| Max. Negotiated Rate |
$39.33 |
| Rate for Payer: Aetna Commercial |
$37.15
|
| Rate for Payer: Aetna Medicare |
$21.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.41
|
| Rate for Payer: BCBS Complete |
$17.48
|
| Rate for Payer: Cash Price |
$34.96
|
| Rate for Payer: Cofinity Advantage |
$30.59
|
| Rate for Payer: Cofinity Commercial |
$37.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.96
|
| Rate for Payer: Healthscope Commercial |
$39.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.77
|
| Rate for Payer: PHP Commercial |
$37.15
|
| Rate for Payer: Priority Health SBD |
$27.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.41
|
| Rate for Payer: UHC Core |
$22.77
|
| Rate for Payer: UHC Exchange |
$17.17
|
|
|
HC SUPERVISION & HANDLING
|
Facility
|
OP
|
$160.24
|
|
|
Service Code
|
CPT 77790
|
| Hospital Charge Code |
33300029
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$43.16 |
| Max. Negotiated Rate |
$144.22 |
| Rate for Payer: Aetna Commercial |
$136.20
|
| Rate for Payer: Aetna Medicare |
$80.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.16
|
| Rate for Payer: BCBS Complete |
$64.10
|
| Rate for Payer: BCBS Trust/PPO |
$43.16
|
| Rate for Payer: BCN Commercial |
$43.16
|
| Rate for Payer: Cash Price |
$128.19
|
| Rate for Payer: Cash Price |
$128.19
|
| Rate for Payer: Cofinity Advantage |
$112.17
|
| Rate for Payer: Cofinity Commercial |
$137.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.19
|
| Rate for Payer: Healthscope Commercial |
$144.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.18
|
| Rate for Payer: PHP Commercial |
$136.20
|
| Rate for Payer: Priority Health SBD |
$100.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.16
|
| Rate for Payer: UHC Core |
$83.49
|
| Rate for Payer: UHC Exchange |
$62.97
|
|
|
HC SUPERVISION & HANDLING
|
Facility
|
IP
|
$160.24
|
|
|
Service Code
|
CPT 77790
|
| Hospital Charge Code |
33300029
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$100.95 |
| Max. Negotiated Rate |
$144.22 |
| Rate for Payer: Aetna Commercial |
$136.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.16
|
| Rate for Payer: Cash Price |
$128.19
|
| Rate for Payer: Cofinity Advantage |
$112.17
|
| Rate for Payer: Cofinity Commercial |
$137.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.19
|
| Rate for Payer: Healthscope Commercial |
$144.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.18
|
| Rate for Payer: PHP Commercial |
$136.20
|
| Rate for Payer: Priority Health SBD |
$100.95
|
|
|
HC SUPPLEMENTAL NEWBORN SCRN
|
Facility
|
OP
|
$88.43
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
30100686
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.61 |
| Max. Negotiated Rate |
$79.59 |
| Rate for Payer: Aetna Commercial |
$75.17
|
| Rate for Payer: Aetna Medicare |
$25.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.14
|
| Rate for Payer: BCBS Complete |
$13.24
|
| Rate for Payer: BCBS MAPPO |
$24.11
|
| Rate for Payer: BCBS Trust/PPO |
$25.70
|
| Rate for Payer: BCN Commercial |
$25.70
|
| Rate for Payer: BCN Medicare Advantage |
$24.11
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cofinity Advantage |
$61.90
|
| Rate for Payer: Cofinity Commercial |
$76.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.11
|
| Rate for Payer: Healthscope Commercial |
$79.59
|
| Rate for Payer: Mclaren Medicaid |
$12.61
|
| Rate for Payer: Mclaren Medicare |
$24.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.32
|
| Rate for Payer: Meridian Medicaid |
$25.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.17
|
| Rate for Payer: Nomi Health Commercial |
$36.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.32
|
| Rate for Payer: PACE Medicare |
$22.90
|
| Rate for Payer: PACE SWMI |
$24.11
|
| Rate for Payer: PHP Commercial |
$75.17
|
| Rate for Payer: PHP Medicare Advantage |
$24.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24.11
|
| Rate for Payer: Priority Health Medicare |
$24.11
|
| Rate for Payer: Priority Health SBD |
$55.71
|
| Rate for Payer: Priority Health Tiered Network |
$19.29
|
| Rate for Payer: Railroad Medicare Medicare |
$24.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.17
|
| Rate for Payer: UHC Core |
$36.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.11
|
| Rate for Payer: UHC Exchange |
$36.17
|
| Rate for Payer: UHC Medicaid |
$12.61
|
| Rate for Payer: UHCCP Medicaid |
$12.61
|
| Rate for Payer: VA VA |
$24.11
|
|
