|
HC TICK-BORNE AB CMPT 3
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
30200520
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Aetna Commercial |
$23.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.20
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cofinity Advantage |
$19.60
|
| Rate for Payer: Cofinity Commercial |
$24.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.40
|
| Rate for Payer: Healthscope Commercial |
$25.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.00
|
| Rate for Payer: PHP Commercial |
$23.80
|
| Rate for Payer: Priority Health SBD |
$17.64
|
|
|
HC TICK-BORNE AB CMPT 3
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
30200520
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Aetna Commercial |
$23.80
|
| Rate for Payer: Aetna Medicare |
$10.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.72
|
| Rate for Payer: BCBS Complete |
$5.59
|
| Rate for Payer: BCBS MAPPO |
$10.18
|
| Rate for Payer: BCBS Trust/PPO |
$10.86
|
| Rate for Payer: BCN Commercial |
$10.86
|
| Rate for Payer: BCN Medicare Advantage |
$10.18
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cofinity Advantage |
$19.60
|
| Rate for Payer: Cofinity Commercial |
$24.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.18
|
| Rate for Payer: Healthscope Commercial |
$25.20
|
| Rate for Payer: Mclaren Medicaid |
$5.32
|
| Rate for Payer: Mclaren Medicare |
$10.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.69
|
| Rate for Payer: Meridian Medicaid |
$10.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.80
|
| Rate for Payer: Nomi Health Commercial |
$15.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.00
|
| Rate for Payer: PACE Medicare |
$9.67
|
| Rate for Payer: PACE SWMI |
$10.18
|
| Rate for Payer: PHP Commercial |
$23.80
|
| Rate for Payer: PHP Medicare Advantage |
$10.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10.18
|
| Rate for Payer: Priority Health Medicare |
$10.18
|
| Rate for Payer: Priority Health SBD |
$17.64
|
| Rate for Payer: Priority Health Tiered Network |
$8.14
|
| Rate for Payer: Railroad Medicare Medicare |
$10.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.27
|
| Rate for Payer: UHC Core |
$15.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.18
|
| Rate for Payer: UHC Exchange |
$15.27
|
| Rate for Payer: UHC Medicaid |
$5.32
|
| Rate for Payer: UHCCP Medicaid |
$5.32
|
| Rate for Payer: VA VA |
$10.18
|
|
|
HC TIER 1 MAJOR TRAUMA RESUSCITATION
|
Facility
|
OP
|
$6,142.45
|
|
| Hospital Charge Code |
68100001
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$2,413.98 |
| Max. Negotiated Rate |
$5,528.20 |
| Rate for Payer: Aetna Commercial |
$5,221.08
|
| Rate for Payer: Aetna Medicare |
$3,071.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,992.59
|
| Rate for Payer: BCBS Complete |
$2,456.98
|
| Rate for Payer: Cash Price |
$4,913.96
|
| Rate for Payer: Cofinity Advantage |
$4,299.72
|
| Rate for Payer: Cofinity Commercial |
$5,282.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,913.96
|
| Rate for Payer: Healthscope Commercial |
$5,528.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,913.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,221.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,606.84
|
| Rate for Payer: PHP Commercial |
$5,221.08
|
| Rate for Payer: Priority Health SBD |
$3,869.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,992.59
|
| Rate for Payer: UHC Core |
$3,200.22
|
| Rate for Payer: UHC Exchange |
$2,413.98
|
|
|
HC TIER 1 MAJOR TRAUMA RESUSCITATION
|
Facility
|
IP
|
$6,142.45
|
|
| Hospital Charge Code |
68100001
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$3,869.74 |
| Max. Negotiated Rate |
$5,528.20 |
| Rate for Payer: Aetna Commercial |
$5,221.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,992.59
|
| Rate for Payer: Cash Price |
$4,913.96
|
| Rate for Payer: Cofinity Advantage |
$4,299.72
|
| Rate for Payer: Cofinity Commercial |
$5,282.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,913.96
|
| Rate for Payer: Healthscope Commercial |
$5,528.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,221.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,606.84
|
| Rate for Payer: PHP Commercial |
$5,221.08
|
| Rate for Payer: Priority Health SBD |
$3,869.74
|
|
|
HC TIER 2 TRAUMA RESUSCITATION
|
Facility
|
IP
|
$4,684.51
|
|
| Hospital Charge Code |
68200001
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$2,951.24 |
| Max. Negotiated Rate |
$4,216.06 |
| Rate for Payer: Aetna Commercial |
$3,981.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,044.93
|
| Rate for Payer: Cash Price |
$3,747.61
|
| Rate for Payer: Cofinity Advantage |
$3,279.16
|
| Rate for Payer: Cofinity Commercial |
$4,028.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,747.61
|
| Rate for Payer: Healthscope Commercial |
$4,216.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,981.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,513.38
|
| Rate for Payer: PHP Commercial |
$3,981.83
|
| Rate for Payer: Priority Health SBD |
$2,951.24
|
|
|
HC TIER 2 TRAUMA RESUSCITATION
|
Facility
|
OP
|
$4,684.51
|
|
| Hospital Charge Code |
68200001
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$1,841.01 |
| Max. Negotiated Rate |
$4,216.06 |
| Rate for Payer: Aetna Commercial |
$3,981.83
|
| Rate for Payer: Aetna Medicare |
$2,342.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,044.93
|
| Rate for Payer: BCBS Complete |
$1,873.80
|
| Rate for Payer: Cash Price |
$3,747.61
|
| Rate for Payer: Cofinity Advantage |
$3,279.16
|
| Rate for Payer: Cofinity Commercial |
$4,028.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,747.61
|
| Rate for Payer: Healthscope Commercial |
$4,216.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,747.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,981.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,513.38
|
| Rate for Payer: PHP Commercial |
$3,981.83
|
| Rate for Payer: Priority Health SBD |
$2,951.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,044.93
|
| Rate for Payer: UHC Core |
$2,440.63
|
| Rate for Payer: UHC Exchange |
$1,841.01
|
|
|
HC TIER 3 TRAUMA CONSULT
|
Facility
|
OP
|
$3,573.09
|
|
| Hospital Charge Code |
68100002
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$1,404.22 |
| Max. Negotiated Rate |
$3,215.78 |
| Rate for Payer: Aetna Commercial |
$3,037.13
|
| Rate for Payer: Aetna Medicare |
$1,786.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,322.51
|
| Rate for Payer: BCBS Complete |
$1,429.24
|
| Rate for Payer: Cash Price |
$2,858.47
|
| Rate for Payer: Cofinity Advantage |
$2,501.16
|
| Rate for Payer: Cofinity Commercial |
$3,072.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,858.47
|
| Rate for Payer: Healthscope Commercial |
$3,215.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,858.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,037.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,679.82
|
| Rate for Payer: PHP Commercial |
$3,037.13
|
| Rate for Payer: Priority Health SBD |
$2,251.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,322.51
|
| Rate for Payer: UHC Core |
$1,861.58
|
| Rate for Payer: UHC Exchange |
$1,404.22
|
|
|
HC TIER 3 TRAUMA CONSULT
|
Facility
|
IP
|
$3,573.09
|
|
| Hospital Charge Code |
68100002
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$2,251.05 |
| Max. Negotiated Rate |
$3,215.78 |
| Rate for Payer: Aetna Commercial |
$3,037.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,322.51
|
| Rate for Payer: Cash Price |
$2,858.47
|
| Rate for Payer: Cofinity Advantage |
$2,501.16
|
| Rate for Payer: Cofinity Commercial |
$3,072.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,858.47
|
| Rate for Payer: Healthscope Commercial |
$3,215.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,037.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,679.82
|
| Rate for Payer: PHP Commercial |
$3,037.13
|
| Rate for Payer: Priority Health SBD |
$2,251.05
|
|
|
HC TIER 4 TRAUMA CONSULT
|
Facility
|
OP
|
$2,726.25
|
|
| Hospital Charge Code |
68100003
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$1,071.42 |
| Max. Negotiated Rate |
$2,453.62 |
| Rate for Payer: Aetna Commercial |
$2,317.31
|
| Rate for Payer: Aetna Medicare |
$1,363.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,772.06
|
| Rate for Payer: BCBS Complete |
$1,090.50
|
| Rate for Payer: Cash Price |
$2,181.00
|
| Rate for Payer: Cofinity Advantage |
$1,908.38
|
| Rate for Payer: Cofinity Commercial |
$2,344.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,181.00
|
| Rate for Payer: Healthscope Commercial |
$2,453.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,181.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,317.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,044.69
|
| Rate for Payer: PHP Commercial |
$2,317.31
|
| Rate for Payer: Priority Health SBD |
$1,717.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,772.06
|
| Rate for Payer: UHC Core |
$1,420.38
|
| Rate for Payer: UHC Exchange |
$1,071.42
|
|
|
HC TIER 4 TRAUMA CONSULT
|
Facility
|
IP
|
$2,726.25
|
|
| Hospital Charge Code |
68100003
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$1,717.54 |
| Max. Negotiated Rate |
$2,453.62 |
| Rate for Payer: Aetna Commercial |
$2,317.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,772.06
|
| Rate for Payer: Cash Price |
$2,181.00
|
| Rate for Payer: Cofinity Advantage |
$1,908.38
|
| Rate for Payer: Cofinity Commercial |
$2,344.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,181.00
|
| Rate for Payer: Healthscope Commercial |
$2,453.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,317.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,044.69
|
| Rate for Payer: PHP Commercial |
$2,317.31
|
| Rate for Payer: Priority Health SBD |
$1,717.54
|
|
|
HC TILT TABLE STRESS
|
Facility
|
OP
|
$1,145.32
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
48200002
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$194.46 |
| Max. Negotiated Rate |
$1,202.41 |
| Rate for Payer: Aetna Commercial |
$973.52
|
| Rate for Payer: Aetna Medicare |
$386.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$744.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$331.62
|
| Rate for Payer: BCN Commercial |
$331.62
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Cash Price |
$916.26
|
| Rate for Payer: Cash Price |
$916.26
|
| Rate for Payer: Cofinity Advantage |
$801.72
|
| Rate for Payer: Cofinity Commercial |
$984.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$916.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Healthscope Commercial |
$1,030.79
|
| Rate for Payer: Mclaren Medicaid |
$194.46
|
| Rate for Payer: Mclaren Medicare |
$371.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.41
|
| Rate for Payer: Meridian Medicaid |
$390.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$973.52
|
| Rate for Payer: Nomi Health Commercial |
$1,115.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$858.99
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Commercial |
$973.52
|
| Rate for Payer: PHP Medicare Advantage |
$371.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,202.41
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health SBD |
$721.55
|
| Rate for Payer: Priority Health Tiered Network |
$961.93
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$744.46
|
| Rate for Payer: UHC Core |
$596.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$450.11
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: VA VA |
$371.82
|
|
|
HC TILT TABLE STRESS
|
Facility
|
IP
|
$1,145.32
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
48200002
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$721.55 |
| Max. Negotiated Rate |
$1,030.79 |
| Rate for Payer: Aetna Commercial |
$973.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$744.46
|
| Rate for Payer: Cash Price |
$916.26
|
| Rate for Payer: Cofinity Advantage |
$801.72
|
| Rate for Payer: Cofinity Commercial |
$984.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$916.26
|
| Rate for Payer: Healthscope Commercial |
$1,030.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$973.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$858.99
|
| Rate for Payer: PHP Commercial |
$973.52
|
| Rate for Payer: Priority Health SBD |
$721.55
|
|
|
HC TIMOTHY GRASS IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200063
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC TIMOTHY GRASS IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200063
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
|
|
HC TIP PUMP SUCTION
|
Facility
|
OP
|
$43.70
|
|
| Hospital Charge Code |
27000111
|
|
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 TIP PUMP SUCTION
|
Facility
|
IP
|
$43.70
|
|
| Hospital Charge Code |
27000111
|
|
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 TISSUE IN SITU HYB QUANT EA ADD
|
Facility
|
IP
|
$274.85
|
|
|
Service Code
|
CPT 88369
|
| Hospital Charge Code |
31000123
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$173.16 |
| Max. Negotiated Rate |
$247.37 |
| Rate for Payer: Aetna Commercial |
$233.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.65
|
| Rate for Payer: Cash Price |
$219.88
|
| Rate for Payer: Cofinity Advantage |
$192.40
|
| Rate for Payer: Cofinity Commercial |
$236.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.88
|
| Rate for Payer: Healthscope Commercial |
$247.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.14
|
| Rate for Payer: PHP Commercial |
$233.62
|
| Rate for Payer: Priority Health SBD |
$173.16
|
|
|
HC TISSUE IN SITU HYB QUANT EA ADD
|
Facility
|
OP
|
$274.85
|
|
|
Service Code
|
CPT 88369
|
| Hospital Charge Code |
31000123
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$109.94 |
| Max. Negotiated Rate |
$247.37 |
| Rate for Payer: Aetna Commercial |
$233.62
|
| Rate for Payer: Aetna Medicare |
$137.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.65
|
| Rate for Payer: BCBS Complete |
$109.94
|
| Rate for Payer: BCBS Trust/PPO |
$166.38
|
| Rate for Payer: BCCCP Commercial |
$121.51
|
| Rate for Payer: BCN Commercial |
$166.38
|
| Rate for Payer: Cash Price |
$219.88
|
| Rate for Payer: Cash Price |
$219.88
|
| Rate for Payer: Cofinity Advantage |
$192.40
|
| Rate for Payer: Cofinity Commercial |
$236.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.88
|
| Rate for Payer: Healthscope Commercial |
$247.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.14
|
| Rate for Payer: PHP Commercial |
$233.62
|
| Rate for Payer: Priority Health SBD |
$173.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.17
|
| Rate for Payer: UHC Core |
$142.17
|
| Rate for Payer: UHC Exchange |
$142.17
|
|
|
HC TISSUE IN SITU HYBRIDIZATION
|
Facility
|
OP
|
$379.45
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
31000060
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$88.78 |
| Max. Negotiated Rate |
$548.99 |
| Rate for Payer: Aetna Commercial |
$322.53
|
| Rate for Payer: Aetna Medicare |
$176.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$212.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$212.20
|
| Rate for Payer: BCBS Complete |
$93.23
|
| Rate for Payer: BCBS MAPPO |
$169.76
|
| Rate for Payer: BCBS Trust/PPO |
$226.01
|
| Rate for Payer: BCCCP Commercial |
$161.79
|
| Rate for Payer: BCN Commercial |
$226.01
|
| Rate for Payer: BCN Medicare Advantage |
$169.76
|
| Rate for Payer: Cash Price |
$303.56
|
| Rate for Payer: Cash Price |
$303.56
|
| Rate for Payer: Cofinity Advantage |
$265.62
|
| Rate for Payer: Cofinity Commercial |
$326.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.76
|
| Rate for Payer: Healthscope Commercial |
$341.50
|
| Rate for Payer: Mclaren Medicaid |
$88.78
|
| Rate for Payer: Mclaren Medicare |
$169.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.25
|
| Rate for Payer: Meridian Medicaid |
$178.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$186.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.53
|
| Rate for Payer: Nomi Health Commercial |
$509.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$284.59
|
| Rate for Payer: PACE Medicare |
$161.27
|
| Rate for Payer: PACE SWMI |
$169.76
|
| Rate for Payer: PHP Commercial |
$322.53
|
| Rate for Payer: PHP Medicare Advantage |
$169.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$548.99
|
| Rate for Payer: Priority Health Medicare |
$169.76
|
| Rate for Payer: Priority Health SBD |
$239.05
|
| Rate for Payer: Priority Health Tiered Network |
$439.19
|
| Rate for Payer: Railroad Medicare Medicare |
$169.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.04
|
| Rate for Payer: UHC Core |
$257.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$169.76
|
| Rate for Payer: UHC Exchange |
$257.04
|
| Rate for Payer: UHC Medicaid |
$88.78
|
| Rate for Payer: UHCCP Medicaid |
$88.78
|
| Rate for Payer: VA VA |
$169.76
|
|
|
HC TISSUE IN SITU HYBRIDIZATION
|
Facility
|
IP
|
$379.45
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
31000060
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$239.05 |
| Max. Negotiated Rate |
$341.50 |
| Rate for Payer: Aetna Commercial |
$322.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.64
|
| Rate for Payer: Cash Price |
$303.56
|
| Rate for Payer: Cofinity Advantage |
$265.62
|
| Rate for Payer: Cofinity Commercial |
$326.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.56
|
| Rate for Payer: Healthscope Commercial |
$341.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$284.59
|
| Rate for Payer: PHP Commercial |
$322.53
|
| Rate for Payer: Priority Health SBD |
$239.05
|
|
|
HC TISSUE IN SITU HYBRID QUANT
|
Facility
|
IP
|
$274.85
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000122
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$173.16 |
| Max. Negotiated Rate |
$247.37 |
| Rate for Payer: Aetna Commercial |
$233.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.65
|
| Rate for Payer: Cash Price |
$219.88
|
| Rate for Payer: Cofinity Advantage |
$192.40
|
| Rate for Payer: Cofinity Commercial |
$236.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.88
|
| Rate for Payer: Healthscope Commercial |
$247.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.14
|
| Rate for Payer: PHP Commercial |
$233.62
|
| Rate for Payer: Priority Health SBD |
$173.16
|
|
|
HC TISSUE IN SITU HYBRID QUANT
|
Facility
|
OP
|
$274.85
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000122
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$138.78 |
| Max. Negotiated Rate |
$1,155.01 |
| Rate for Payer: Aetna Commercial |
$233.62
|
| Rate for Payer: Aetna Medicare |
$371.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.45
|
| Rate for Payer: BCBS Complete |
$196.15
|
| Rate for Payer: BCBS MAPPO |
$357.16
|
| Rate for Payer: BCBS Trust/PPO |
$183.98
|
| Rate for Payer: BCCCP Commercial |
$138.78
|
| Rate for Payer: BCN Commercial |
$183.98
|
| Rate for Payer: BCN Medicare Advantage |
$357.16
|
| Rate for Payer: Cash Price |
$219.88
|
| Rate for Payer: Cash Price |
$219.88
|
| Rate for Payer: Cofinity Advantage |
$192.40
|
| Rate for Payer: Cofinity Commercial |
$236.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.16
|
| Rate for Payer: Healthscope Commercial |
$247.37
|
| Rate for Payer: Mclaren Medicaid |
$186.79
|
| Rate for Payer: Mclaren Medicare |
$357.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$375.02
|
| Rate for Payer: Meridian Medicaid |
$375.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$392.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.62
|
| Rate for Payer: Nomi Health Commercial |
$1,071.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.14
|
| Rate for Payer: PACE Medicare |
$339.30
|
| Rate for Payer: PACE SWMI |
$357.16
|
| Rate for Payer: PHP Commercial |
$233.62
|
| Rate for Payer: PHP Medicare Advantage |
$357.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,155.01
|
| Rate for Payer: Priority Health Medicare |
$357.16
|
| Rate for Payer: Priority Health SBD |
$173.16
|
| Rate for Payer: Priority Health Tiered Network |
$924.01
|
| Rate for Payer: Railroad Medicare Medicare |
$357.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$539.58
|
| Rate for Payer: UHC Core |
$539.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$357.16
|
| Rate for Payer: UHC Exchange |
$539.58
|
| Rate for Payer: UHC Medicaid |
$186.79
|
| Rate for Payer: UHCCP Medicaid |
$186.79
|
| Rate for Payer: VA VA |
$357.16
|
|
|
HC TISSUE MARKER IMPLANTABLE
|
Facility
|
OP
|
$1,499.49
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$589.30 |
| Max. Negotiated Rate |
$1,349.54 |
| Rate for Payer: Aetna Commercial |
$1,274.57
|
| Rate for Payer: Aetna Medicare |
$749.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$974.67
|
| Rate for Payer: BCBS Complete |
$599.80
|
| Rate for Payer: Cash Price |
$1,199.59
|
| Rate for Payer: Cofinity Advantage |
$1,049.64
|
| Rate for Payer: Cofinity Commercial |
$1,289.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,199.59
|
| Rate for Payer: Healthscope Commercial |
$1,349.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,199.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,274.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,124.62
|
| Rate for Payer: PHP Commercial |
$1,274.57
|
| Rate for Payer: Priority Health SBD |
$944.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$974.67
|
| Rate for Payer: UHC Core |
$781.23
|
| Rate for Payer: UHC Exchange |
$589.30
|
|
|
HC TISSUE MARKER IMPLANTABLE
|
Facility
|
IP
|
$1,499.49
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.68 |
| Max. Negotiated Rate |
$1,349.54 |
| Rate for Payer: Aetna Commercial |
$1,274.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$974.67
|
| Rate for Payer: Cash Price |
$1,199.59
|
| Rate for Payer: Cofinity Advantage |
$1,049.64
|
| Rate for Payer: Cofinity Commercial |
$1,289.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,199.59
|
| Rate for Payer: Healthscope Commercial |
$1,349.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,274.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,124.62
|
| Rate for Payer: PHP Commercial |
$1,274.57
|
| Rate for Payer: Priority Health SBD |
$944.68
|
|
|
HC TISSUE MARKER PROSTATE
|
Facility
|
IP
|
$1,357.72
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$855.36 |
| Max. Negotiated Rate |
$1,221.95 |
| Rate for Payer: Aetna Commercial |
$1,154.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$882.52
|
| Rate for Payer: Cash Price |
$1,086.18
|
| Rate for Payer: Cofinity Advantage |
$950.40
|
| Rate for Payer: Cofinity Commercial |
$1,167.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,086.18
|
| Rate for Payer: Healthscope Commercial |
$1,221.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,154.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,018.29
|
| Rate for Payer: PHP Commercial |
$1,154.06
|
| Rate for Payer: Priority Health SBD |
$855.36
|
|
