|
HC SPYGLASS CHOLANGIOSCOPY
|
Facility
|
IP
|
$6,262.87
|
|
| Hospital Charge Code |
36000086
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,945.61 |
| Max. Negotiated Rate |
$5,636.58 |
| Rate for Payer: Aetna Commercial |
$5,323.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,070.87
|
| Rate for Payer: Cash Price |
$5,010.30
|
| Rate for Payer: Cofinity Commercial |
$4,384.01
|
| Rate for Payer: Cofinity Commercial |
$5,386.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,384.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,010.30
|
| Rate for Payer: Healthscope Commercial |
$5,636.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,323.44
|
| Rate for Payer: PHP Commercial |
$5,323.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,070.87
|
| Rate for Payer: Priority Health SBD |
$3,945.61
|
|
|
HC SPYGLASS CHOLANGIOSCOPY
|
Facility
|
OP
|
$6,262.87
|
|
| Hospital Charge Code |
36000086
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,505.15 |
| Max. Negotiated Rate |
$5,636.58 |
| Rate for Payer: Aetna Commercial |
$5,323.44
|
| Rate for Payer: Aetna Medicare |
$3,131.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,070.87
|
| Rate for Payer: BCBS Complete |
$2,505.15
|
| Rate for Payer: Cash Price |
$5,010.30
|
| Rate for Payer: Cofinity Commercial |
$4,384.01
|
| Rate for Payer: Cofinity Commercial |
$5,386.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,384.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,010.30
|
| Rate for Payer: Healthscope Commercial |
$5,636.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,323.44
|
| Rate for Payer: PHP Commercial |
$5,323.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,070.87
|
| Rate for Payer: Priority Health SBD |
$3,945.61
|
|
|
HC SPYGLASS FORCEPS
|
Facility
|
OP
|
$2,444.83
|
|
| Hospital Charge Code |
27200151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$977.93 |
| Max. Negotiated Rate |
$2,200.35 |
| Rate for Payer: Aetna Commercial |
$2,078.11
|
| Rate for Payer: Aetna Medicare |
$1,222.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,589.14
|
| Rate for Payer: BCBS Complete |
$977.93
|
| Rate for Payer: Cash Price |
$1,955.86
|
| Rate for Payer: Cofinity Commercial |
$1,711.38
|
| Rate for Payer: Cofinity Commercial |
$2,102.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,711.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,955.86
|
| Rate for Payer: Healthscope Commercial |
$2,200.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,078.11
|
| Rate for Payer: PHP Commercial |
$2,078.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,589.14
|
| Rate for Payer: Priority Health SBD |
$1,540.24
|
|
|
HC SPYGLASS FORCEPS
|
Facility
|
IP
|
$2,444.83
|
|
| Hospital Charge Code |
27200151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,540.24 |
| Max. Negotiated Rate |
$2,200.35 |
| Rate for Payer: Aetna Commercial |
$2,078.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,589.14
|
| Rate for Payer: Cash Price |
$1,955.86
|
| Rate for Payer: Cofinity Commercial |
$1,711.38
|
| Rate for Payer: Cofinity Commercial |
$2,102.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,711.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,955.86
|
| Rate for Payer: Healthscope Commercial |
$2,200.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,078.11
|
| Rate for Payer: PHP Commercial |
$2,078.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,589.14
|
| Rate for Payer: Priority Health SBD |
$1,540.24
|
|
|
HC SP Z ANGIO SUPERSEL ECT RENAL BIL
|
Facility
|
OP
|
$3,849.48
|
|
|
Service Code
|
CPT 36254
|
| Hospital Charge Code |
36100350
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$8,640.87 |
| Rate for Payer: Aetna Commercial |
$3,272.06
|
| Rate for Payer: Aetna Medicare |
$3,192.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,502.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Cash Price |
$3,079.58
|
| Rate for Payer: Cash Price |
$3,079.58
|
| Rate for Payer: Cofinity Commercial |
$3,310.55
|
| Rate for Payer: Cofinity Commercial |
$2,694.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,694.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,079.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Healthscope Commercial |
$3,464.53
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,272.06
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Commercial |
$3,272.06
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,502.16
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Priority Health SBD |
$2,425.17
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,640.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,728.24
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
HC SP Z ANGIO SUPERSEL ECT RENAL BIL
|
Facility
|
IP
|
$3,849.48
|
|
|
Service Code
|
CPT 36254
|
| Hospital Charge Code |
36100350
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,425.17 |
| Max. Negotiated Rate |
$3,464.53 |
| Rate for Payer: Aetna Commercial |
$3,272.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,502.16
|
| Rate for Payer: Cash Price |
$3,079.58
|
| Rate for Payer: Cofinity Commercial |
$2,694.64
|
| Rate for Payer: Cofinity Commercial |
$3,310.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,694.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,079.58
|
| Rate for Payer: Healthscope Commercial |
$3,464.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,272.06
|
| Rate for Payer: PHP Commercial |
$3,272.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,502.16
|
| Rate for Payer: Priority Health SBD |
$2,425.17
|
|
|
HC SP Z ANGIO SUPERSELECT RENAL UNI
|
Facility
|
IP
|
$3,849.48
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
36100349
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,425.17 |
| Max. Negotiated Rate |
$3,464.53 |
| Rate for Payer: Aetna Commercial |
$3,272.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,502.16
|
| Rate for Payer: Cash Price |
$3,079.58
|
| Rate for Payer: Cofinity Commercial |
$2,694.64
|
| Rate for Payer: Cofinity Commercial |
$3,310.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,694.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,079.58
|
| Rate for Payer: Healthscope Commercial |
$3,464.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,272.06
|
| Rate for Payer: PHP Commercial |
$3,272.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,502.16
|
| Rate for Payer: Priority Health SBD |
$2,425.17
|
|
|
HC SP Z ANGIO SUPERSELECT RENAL UNI
|
Facility
|
OP
|
$3,849.48
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
36100349
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,425.17 |
| Max. Negotiated Rate |
$14,840.35 |
| Rate for Payer: Aetna Commercial |
$3,272.06
|
| Rate for Payer: Aetna Medicare |
$5,482.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,502.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,590.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,590.09
|
| Rate for Payer: BCBS Complete |
$2,967.12
|
| Rate for Payer: BCBS MAPPO |
$5,272.07
|
| Rate for Payer: BCN Medicare Advantage |
$5,272.07
|
| Rate for Payer: Cash Price |
$3,079.58
|
| Rate for Payer: Cash Price |
$3,079.58
|
| Rate for Payer: Cofinity Commercial |
$3,310.55
|
| Rate for Payer: Cofinity Commercial |
$2,694.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,694.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,079.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,272.07
|
| Rate for Payer: Healthscope Commercial |
$3,464.53
|
| Rate for Payer: Mclaren Medicaid |
$2,825.83
|
| Rate for Payer: Mclaren Medicare |
$5,272.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,535.67
|
| Rate for Payer: Meridian Medicaid |
$2,967.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,062.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,272.06
|
| Rate for Payer: PACE Medicare |
$5,008.47
|
| Rate for Payer: PACE SWMI |
$5,272.07
|
| Rate for Payer: PHP Commercial |
$3,272.06
|
| Rate for Payer: PHP Medicare Advantage |
$5,272.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,825.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,502.16
|
| Rate for Payer: Priority Health Medicare |
$5,272.07
|
| Rate for Payer: Priority Health SBD |
$2,425.17
|
| Rate for Payer: Railroad Medicare Medicare |
$5,272.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,840.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,272.07
|
| Rate for Payer: UHC Medicare Advantage |
$5,272.07
|
| Rate for Payer: UHCCP Medicaid |
$2,968.18
|
| Rate for Payer: VA VA |
$5,272.07
|
|
|
HC SP Z EMBOLIZATION COIL BODY
|
Facility
|
OP
|
$414.53
|
|
| Hospital Charge Code |
27800058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.81 |
| Max. Negotiated Rate |
$373.08 |
| Rate for Payer: Aetna Commercial |
$352.35
|
| Rate for Payer: Aetna Medicare |
$207.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.44
|
| Rate for Payer: BCBS Complete |
$165.81
|
| Rate for Payer: Cash Price |
$331.62
|
| Rate for Payer: Cofinity Commercial |
$290.17
|
| Rate for Payer: Cofinity Commercial |
$356.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$290.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.62
|
| Rate for Payer: Healthscope Commercial |
$373.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.35
|
| Rate for Payer: PHP Commercial |
$352.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.44
|
| Rate for Payer: Priority Health SBD |
$261.15
|
|
|
HC SP Z EMBOLIZATION COIL BODY
|
Facility
|
IP
|
$414.53
|
|
| Hospital Charge Code |
27800058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$261.15 |
| Max. Negotiated Rate |
$373.08 |
| Rate for Payer: Aetna Commercial |
$352.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.44
|
| Rate for Payer: Cash Price |
$331.62
|
| Rate for Payer: Cofinity Commercial |
$290.17
|
| Rate for Payer: Cofinity Commercial |
$356.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$290.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.62
|
| Rate for Payer: Healthscope Commercial |
$373.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.35
|
| Rate for Payer: PHP Commercial |
$352.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.44
|
| Rate for Payer: Priority Health SBD |
$261.15
|
|
|
HC SP Z EMBOLIZATION SPHERES
|
Facility
|
OP
|
$1,024.11
|
|
| Hospital Charge Code |
27800057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.64 |
| Max. Negotiated Rate |
$921.70 |
| Rate for Payer: Aetna Commercial |
$870.49
|
| Rate for Payer: Aetna Medicare |
$512.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$665.67
|
| Rate for Payer: BCBS Complete |
$409.64
|
| Rate for Payer: Cash Price |
$819.29
|
| Rate for Payer: Cofinity Commercial |
$716.88
|
| Rate for Payer: Cofinity Commercial |
$880.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$716.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$819.29
|
| Rate for Payer: Healthscope Commercial |
$921.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$870.49
|
| Rate for Payer: PHP Commercial |
$870.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.67
|
| Rate for Payer: Priority Health SBD |
$645.19
|
|
|
HC SP Z EMBOLIZATION SPHERES
|
Facility
|
IP
|
$1,024.11
|
|
| Hospital Charge Code |
27800057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$645.19 |
| Max. Negotiated Rate |
$921.70 |
| Rate for Payer: Aetna Commercial |
$870.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$665.67
|
| Rate for Payer: Cash Price |
$819.29
|
| Rate for Payer: Cofinity Commercial |
$716.88
|
| Rate for Payer: Cofinity Commercial |
$880.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$716.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$819.29
|
| Rate for Payer: Healthscope Commercial |
$921.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$870.49
|
| Rate for Payer: PHP Commercial |
$870.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.67
|
| Rate for Payer: Priority Health SBD |
$645.19
|
|
|
HC SP Z SEL CATH SEG SUBSEG PULM ART
|
Facility
|
OP
|
$1,277.63
|
|
|
Service Code
|
CPT 36015
|
| Hospital Charge Code |
36100318
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$511.05 |
| Max. Negotiated Rate |
$1,149.87 |
| Rate for Payer: Aetna Commercial |
$1,085.99
|
| Rate for Payer: Aetna Medicare |
$638.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$830.46
|
| Rate for Payer: BCBS Complete |
$511.05
|
| Rate for Payer: Cash Price |
$1,022.10
|
| Rate for Payer: Cofinity Commercial |
$1,098.76
|
| Rate for Payer: Cofinity Commercial |
$894.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$894.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,022.10
|
| Rate for Payer: Healthscope Commercial |
$1,149.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,085.99
|
| Rate for Payer: PHP Commercial |
$1,085.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$830.46
|
| Rate for Payer: Priority Health SBD |
$804.91
|
|
|
HC SP Z SEL CATH SEG SUBSEG PULM ART
|
Facility
|
IP
|
$1,277.63
|
|
|
Service Code
|
CPT 36015
|
| Hospital Charge Code |
36100318
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$804.91 |
| Max. Negotiated Rate |
$1,149.87 |
| Rate for Payer: Aetna Commercial |
$1,085.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$830.46
|
| Rate for Payer: Cash Price |
$1,022.10
|
| Rate for Payer: Cofinity Commercial |
$1,098.76
|
| Rate for Payer: Cofinity Commercial |
$894.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$894.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,022.10
|
| Rate for Payer: Healthscope Commercial |
$1,149.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,085.99
|
| Rate for Payer: PHP Commercial |
$1,085.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$830.46
|
| Rate for Payer: Priority Health SBD |
$804.91
|
|
|
HC SP Z TRUE FILL
|
Facility
|
OP
|
$6,757.01
|
|
| Hospital Charge Code |
27800059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,702.80 |
| Max. Negotiated Rate |
$6,081.31 |
| Rate for Payer: Aetna Commercial |
$5,743.46
|
| Rate for Payer: Aetna Medicare |
$3,378.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,392.06
|
| Rate for Payer: BCBS Complete |
$2,702.80
|
| Rate for Payer: Cash Price |
$5,405.61
|
| Rate for Payer: Cofinity Commercial |
$4,729.91
|
| Rate for Payer: Cofinity Commercial |
$5,811.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,729.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,405.61
|
| Rate for Payer: Healthscope Commercial |
$6,081.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,743.46
|
| Rate for Payer: PHP Commercial |
$5,743.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,392.06
|
| Rate for Payer: Priority Health SBD |
$4,256.92
|
|
|
HC SP Z TRUE FILL
|
Facility
|
IP
|
$6,757.01
|
|
| Hospital Charge Code |
27800059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,256.92 |
| Max. Negotiated Rate |
$6,081.31 |
| Rate for Payer: Aetna Commercial |
$5,743.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,392.06
|
| Rate for Payer: Cash Price |
$5,405.61
|
| Rate for Payer: Cofinity Commercial |
$4,729.91
|
| Rate for Payer: Cofinity Commercial |
$5,811.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,729.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,405.61
|
| Rate for Payer: Healthscope Commercial |
$6,081.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,743.46
|
| Rate for Payer: PHP Commercial |
$5,743.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,392.06
|
| Rate for Payer: Priority Health SBD |
$4,256.92
|
|
|
HC SQ ICD
|
Facility
|
IP
|
$56,418.24
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35,543.49 |
| Max. Negotiated Rate |
$50,776.42 |
| Rate for Payer: Aetna Commercial |
$47,955.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36,671.86
|
| Rate for Payer: Cash Price |
$45,134.59
|
| Rate for Payer: Cofinity Commercial |
$39,492.77
|
| Rate for Payer: Cofinity Commercial |
$48,519.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$39,492.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45,134.59
|
| Rate for Payer: Healthscope Commercial |
$50,776.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47,955.50
|
| Rate for Payer: PHP Commercial |
$47,955.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36,671.86
|
| Rate for Payer: Priority Health SBD |
$35,543.49
|
|
|
HC SQ ICD
|
Facility
|
OP
|
$56,418.24
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,567.30 |
| Max. Negotiated Rate |
$50,776.42 |
| Rate for Payer: Aetna Commercial |
$47,955.50
|
| Rate for Payer: Aetna Medicare |
$28,209.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36,671.86
|
| Rate for Payer: BCBS Complete |
$22,567.30
|
| Rate for Payer: Cash Price |
$45,134.59
|
| Rate for Payer: Cofinity Commercial |
$39,492.77
|
| Rate for Payer: Cofinity Commercial |
$48,519.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$39,492.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45,134.59
|
| Rate for Payer: Healthscope Commercial |
$50,776.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47,955.50
|
| Rate for Payer: PHP Commercial |
$47,955.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36,671.86
|
| Rate for Payer: Priority Health SBD |
$35,543.49
|
|
|
HC SQ ICD LEAD
|
Facility
|
OP
|
$14,662.50
|
|
|
Service Code
|
HCPCS C1896
|
| Hospital Charge Code |
27800123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,865.00 |
| Max. Negotiated Rate |
$13,196.25 |
| Rate for Payer: Aetna Commercial |
$12,463.12
|
| Rate for Payer: Aetna Medicare |
$7,331.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,530.62
|
| Rate for Payer: BCBS Complete |
$5,865.00
|
| Rate for Payer: Cash Price |
$11,730.00
|
| Rate for Payer: Cofinity Commercial |
$10,263.75
|
| Rate for Payer: Cofinity Commercial |
$12,609.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,263.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,730.00
|
| Rate for Payer: Healthscope Commercial |
$13,196.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,463.12
|
| Rate for Payer: PHP Commercial |
$12,463.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,530.62
|
| Rate for Payer: Priority Health SBD |
$9,237.38
|
|
|
HC SQ ICD LEAD
|
Facility
|
IP
|
$14,662.50
|
|
|
Service Code
|
HCPCS C1896
|
| Hospital Charge Code |
27800123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,237.38 |
| Max. Negotiated Rate |
$13,196.25 |
| Rate for Payer: Aetna Commercial |
$12,463.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,530.62
|
| Rate for Payer: Cash Price |
$11,730.00
|
| Rate for Payer: Cofinity Commercial |
$10,263.75
|
| Rate for Payer: Cofinity Commercial |
$12,609.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,263.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,730.00
|
| Rate for Payer: Healthscope Commercial |
$13,196.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,463.12
|
| Rate for Payer: PHP Commercial |
$12,463.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,530.62
|
| Rate for Payer: Priority Health SBD |
$9,237.38
|
|
|
HC SQ IM CHEMO HORMONAL
|
Facility
|
IP
|
$246.51
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
33100002
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$155.30 |
| Max. Negotiated Rate |
$221.86 |
| Rate for Payer: Aetna Commercial |
$209.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.23
|
| Rate for Payer: Cash Price |
$197.21
|
| Rate for Payer: Cofinity Commercial |
$172.56
|
| Rate for Payer: Cofinity Commercial |
$212.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.21
|
| Rate for Payer: Healthscope Commercial |
$221.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.53
|
| Rate for Payer: PHP Commercial |
$209.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.23
|
| Rate for Payer: Priority Health SBD |
$155.30
|
|
|
HC SQ IM CHEMO HORMONAL
|
Facility
|
OP
|
$246.51
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
33100002
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$221.86 |
| Rate for Payer: Aetna Commercial |
$209.53
|
| Rate for Payer: Aetna Medicare |
$72.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.76
|
| Rate for Payer: BCBS Complete |
$39.06
|
| Rate for Payer: BCBS MAPPO |
$69.41
|
| Rate for Payer: BCN Medicare Advantage |
$69.41
|
| Rate for Payer: Cash Price |
$197.21
|
| Rate for Payer: Cash Price |
$197.21
|
| Rate for Payer: Cofinity Commercial |
$212.00
|
| Rate for Payer: Cofinity Commercial |
$172.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.41
|
| Rate for Payer: Healthscope Commercial |
$221.86
|
| Rate for Payer: Mclaren Medicaid |
$37.20
|
| Rate for Payer: Mclaren Medicare |
$69.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.88
|
| Rate for Payer: Meridian Medicaid |
$39.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.53
|
| Rate for Payer: PACE Medicare |
$65.94
|
| Rate for Payer: PACE SWMI |
$69.41
|
| Rate for Payer: PHP Commercial |
$209.53
|
| Rate for Payer: PHP Medicare Advantage |
$69.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.23
|
| Rate for Payer: Priority Health Medicare |
$69.41
|
| Rate for Payer: Priority Health SBD |
$155.30
|
| Rate for Payer: Railroad Medicare Medicare |
$69.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.38
|
| Rate for Payer: UHC Core |
$182.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.41
|
| Rate for Payer: UHC Exchange |
$182.42
|
| Rate for Payer: UHC Medicare Advantage |
$69.41
|
| Rate for Payer: UHCCP Medicaid |
$39.08
|
| Rate for Payer: VA VA |
$69.41
|
|
|
HC SQ IM CHEMO NON-HORMONAL
|
Facility
|
OP
|
$498.94
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
33100001
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$449.05 |
| Rate for Payer: Aetna Commercial |
$424.10
|
| Rate for Payer: Aetna Medicare |
$72.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.76
|
| Rate for Payer: BCBS Complete |
$39.06
|
| Rate for Payer: BCBS MAPPO |
$69.41
|
| Rate for Payer: BCN Medicare Advantage |
$69.41
|
| Rate for Payer: Cash Price |
$399.15
|
| Rate for Payer: Cash Price |
$399.15
|
| Rate for Payer: Cofinity Commercial |
$349.26
|
| Rate for Payer: Cofinity Commercial |
$429.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.41
|
| Rate for Payer: Healthscope Commercial |
$449.05
|
| Rate for Payer: Mclaren Medicaid |
$37.20
|
| Rate for Payer: Mclaren Medicare |
$69.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.88
|
| Rate for Payer: Meridian Medicaid |
$39.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.10
|
| Rate for Payer: PACE Medicare |
$65.94
|
| Rate for Payer: PACE SWMI |
$69.41
|
| Rate for Payer: PHP Commercial |
$424.10
|
| Rate for Payer: PHP Medicare Advantage |
$69.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.31
|
| Rate for Payer: Priority Health Medicare |
$69.41
|
| Rate for Payer: Priority Health SBD |
$314.33
|
| Rate for Payer: Railroad Medicare Medicare |
$69.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.38
|
| Rate for Payer: UHC Core |
$369.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.41
|
| Rate for Payer: UHC Exchange |
$369.22
|
| Rate for Payer: UHC Medicare Advantage |
$69.41
|
| Rate for Payer: UHCCP Medicaid |
$39.08
|
| Rate for Payer: VA VA |
$69.41
|
|
|
HC SQ IM CHEMO NON-HORMONAL
|
Facility
|
IP
|
$498.94
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
33100001
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$314.33 |
| Max. Negotiated Rate |
$449.05 |
| Rate for Payer: Aetna Commercial |
$424.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.31
|
| Rate for Payer: Cash Price |
$399.15
|
| Rate for Payer: Cofinity Commercial |
$349.26
|
| Rate for Payer: Cofinity Commercial |
$429.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.15
|
| Rate for Payer: Healthscope Commercial |
$449.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.10
|
| Rate for Payer: PHP Commercial |
$424.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.31
|
| Rate for Payer: Priority Health SBD |
$314.33
|
|
|
HC SQ OR IM INJECTION
|
Facility
|
OP
|
$149.79
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
51000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$195.38 |
| Rate for Payer: Aetna Commercial |
$127.32
|
| Rate for Payer: Aetna Medicare |
$72.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.76
|
| Rate for Payer: BCBS Complete |
$39.06
|
| Rate for Payer: BCBS MAPPO |
$69.41
|
| Rate for Payer: BCN Medicare Advantage |
$69.41
|
| Rate for Payer: Cash Price |
$119.83
|
| Rate for Payer: Cash Price |
$119.83
|
| Rate for Payer: Cofinity Commercial |
$128.82
|
| Rate for Payer: Cofinity Commercial |
$104.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.41
|
| Rate for Payer: Healthscope Commercial |
$134.81
|
| Rate for Payer: Mclaren Medicaid |
$37.20
|
| Rate for Payer: Mclaren Medicare |
$69.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.88
|
| Rate for Payer: Meridian Medicaid |
$39.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.32
|
| Rate for Payer: PACE Medicare |
$65.94
|
| Rate for Payer: PACE SWMI |
$69.41
|
| Rate for Payer: PHP Commercial |
$127.32
|
| Rate for Payer: PHP Medicare Advantage |
$69.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.36
|
| Rate for Payer: Priority Health Medicare |
$69.41
|
| Rate for Payer: Priority Health SBD |
$94.37
|
| Rate for Payer: Railroad Medicare Medicare |
$69.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.38
|
| Rate for Payer: UHC Core |
$110.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.41
|
| Rate for Payer: UHC Exchange |
$110.84
|
| Rate for Payer: UHC Medicare Advantage |
$69.41
|
| Rate for Payer: UHCCP Medicaid |
$39.08
|
| Rate for Payer: VA VA |
$69.41
|
|
