|
HC TRANSCRANIAL USN IMAGING COMPL
|
Facility
|
IP
|
$1,650.64
|
|
|
Service Code
|
CPT 93886
|
| Hospital Charge Code |
92100002
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,039.90 |
| Max. Negotiated Rate |
$1,485.58 |
| Rate for Payer: Aetna Commercial |
$1,403.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,072.92
|
| Rate for Payer: Cash Price |
$1,320.51
|
| Rate for Payer: Cofinity Advantage |
$1,155.45
|
| Rate for Payer: Cofinity Commercial |
$1,419.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,320.51
|
| Rate for Payer: Healthscope Commercial |
$1,485.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,403.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,237.98
|
| Rate for Payer: PHP Commercial |
$1,403.04
|
| Rate for Payer: Priority Health SBD |
$1,039.90
|
|
|
HC TRANSCRANIAL USN IMAGING LIMIT
|
Facility
|
OP
|
$733.73
|
|
|
Service Code
|
CPT 93888
|
| Hospital Charge Code |
92100003
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$660.36 |
| Rate for Payer: Aetna Commercial |
$623.67
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$476.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$558.14
|
| Rate for Payer: BCN Commercial |
$558.14
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$586.98
|
| Rate for Payer: Cash Price |
$586.98
|
| Rate for Payer: Cofinity Advantage |
$513.61
|
| Rate for Payer: Cofinity Commercial |
$631.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$586.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$660.36
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$623.67
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$550.30
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$623.67
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$462.25
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$476.92
|
| Rate for Payer: UHC Core |
$382.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$288.36
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC TRANSCRANIAL USN IMAGING LIMIT
|
Facility
|
IP
|
$733.73
|
|
|
Service Code
|
CPT 93888
|
| Hospital Charge Code |
92100003
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$462.25 |
| Max. Negotiated Rate |
$660.36 |
| Rate for Payer: Aetna Commercial |
$623.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$476.92
|
| Rate for Payer: Cash Price |
$586.98
|
| Rate for Payer: Cofinity Advantage |
$513.61
|
| Rate for Payer: Cofinity Commercial |
$631.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$586.98
|
| Rate for Payer: Healthscope Commercial |
$660.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$623.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$550.30
|
| Rate for Payer: PHP Commercial |
$623.67
|
| Rate for Payer: Priority Health SBD |
$462.25
|
|
|
HC TRANSCRAN LE MOTOR STIM
|
Facility
|
IP
|
$446.38
|
|
|
Service Code
|
CPT 95929
|
| Hospital Charge Code |
92200017
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$281.22 |
| Max. Negotiated Rate |
$401.74 |
| Rate for Payer: Aetna Commercial |
$379.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.15
|
| Rate for Payer: Cash Price |
$357.10
|
| Rate for Payer: Cofinity Advantage |
$312.47
|
| Rate for Payer: Cofinity Commercial |
$383.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.10
|
| Rate for Payer: Healthscope Commercial |
$401.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.79
|
| Rate for Payer: PHP Commercial |
$379.42
|
| Rate for Payer: Priority Health SBD |
$281.22
|
|
|
HC TRANSCRAN LE MOTOR STIM
|
Facility
|
OP
|
$446.38
|
|
|
Service Code
|
CPT 95929
|
| Hospital Charge Code |
92200017
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$175.43 |
| Max. Negotiated Rate |
$1,202.41 |
| Rate for Payer: Aetna Commercial |
$379.42
|
| Rate for Payer: Aetna Medicare |
$386.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.15
|
| 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 |
$710.63
|
| Rate for Payer: BCN Commercial |
$710.63
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Cash Price |
$357.10
|
| Rate for Payer: Cash Price |
$357.10
|
| Rate for Payer: Cofinity Advantage |
$312.47
|
| Rate for Payer: Cofinity Commercial |
$383.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Healthscope Commercial |
$401.74
|
| 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 |
$379.42
|
| Rate for Payer: Nomi Health Commercial |
$1,115.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.79
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Commercial |
$379.42
|
| 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 |
$281.22
|
| 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) |
$290.15
|
| Rate for Payer: UHC Core |
$232.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$175.43
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: VA VA |
$371.82
|
|
|
HC TRANSCRAN UE MOTOR STIM
|
Facility
|
IP
|
$638.76
|
|
|
Service Code
|
CPT 95928
|
| Hospital Charge Code |
92200016
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$402.42 |
| Max. Negotiated Rate |
$574.88 |
| Rate for Payer: Aetna Commercial |
$542.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$415.19
|
| Rate for Payer: Cash Price |
$511.01
|
| Rate for Payer: Cofinity Advantage |
$447.13
|
| Rate for Payer: Cofinity Commercial |
$549.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$511.01
|
| Rate for Payer: Healthscope Commercial |
$574.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$542.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$479.07
|
| Rate for Payer: PHP Commercial |
$542.95
|
| Rate for Payer: Priority Health SBD |
$402.42
|
|
|
HC TRANSCRAN UE MOTOR STIM
|
Facility
|
OP
|
$638.76
|
|
|
Service Code
|
CPT 95928
|
| Hospital Charge Code |
92200016
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$251.03 |
| Max. Negotiated Rate |
$2,767.09 |
| Rate for Payer: Aetna Commercial |
$542.95
|
| Rate for Payer: Aetna Medicare |
$889.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$415.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,069.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,069.56
|
| Rate for Payer: BCBS Complete |
$469.92
|
| Rate for Payer: BCBS MAPPO |
$855.65
|
| Rate for Payer: BCBS Trust/PPO |
$706.18
|
| Rate for Payer: BCN Commercial |
$706.18
|
| Rate for Payer: BCN Medicare Advantage |
$855.65
|
| Rate for Payer: Cash Price |
$511.01
|
| Rate for Payer: Cash Price |
$511.01
|
| Rate for Payer: Cofinity Advantage |
$447.13
|
| Rate for Payer: Cofinity Commercial |
$549.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$511.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$855.65
|
| Rate for Payer: Healthscope Commercial |
$574.88
|
| Rate for Payer: Mclaren Medicaid |
$447.50
|
| Rate for Payer: Mclaren Medicare |
$855.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$898.43
|
| Rate for Payer: Meridian Medicaid |
$898.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$984.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$941.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$542.95
|
| Rate for Payer: Nomi Health Commercial |
$2,566.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$479.07
|
| Rate for Payer: PACE Medicare |
$812.87
|
| Rate for Payer: PACE SWMI |
$855.65
|
| Rate for Payer: PHP Commercial |
$542.95
|
| Rate for Payer: PHP Medicare Advantage |
$855.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$447.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,767.09
|
| Rate for Payer: Priority Health Medicare |
$855.65
|
| Rate for Payer: Priority Health SBD |
$402.42
|
| Rate for Payer: Priority Health Tiered Network |
$2,213.67
|
| Rate for Payer: Railroad Medicare Medicare |
$855.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$415.19
|
| Rate for Payer: UHC Core |
$332.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$855.65
|
| Rate for Payer: UHC Exchange |
$251.03
|
| Rate for Payer: UHC Medicaid |
$447.50
|
| Rate for Payer: UHCCP Medicaid |
$447.50
|
| Rate for Payer: VA VA |
$855.65
|
|
|
HC TRANSFERRIN
|
Facility
|
IP
|
$53.06
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
30100443
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.43 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.49
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Advantage |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: Priority Health SBD |
$33.43
|
|
|
HC TRANSFERRIN
|
Facility
|
OP
|
$53.06
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
30100443
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.67 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna Medicare |
$13.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.95
|
| Rate for Payer: BCBS Complete |
$7.01
|
| Rate for Payer: BCBS MAPPO |
$12.76
|
| Rate for Payer: BCBS Trust/PPO |
$13.60
|
| Rate for Payer: BCN Commercial |
$13.60
|
| Rate for Payer: BCN Medicare Advantage |
$12.76
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Advantage |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.76
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Mclaren Medicaid |
$6.67
|
| Rate for Payer: Mclaren Medicare |
$12.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.40
|
| Rate for Payer: Meridian Medicaid |
$13.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$19.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PACE Medicare |
$12.12
|
| Rate for Payer: PACE SWMI |
$12.76
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: PHP Medicare Advantage |
$12.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.76
|
| Rate for Payer: Priority Health Medicare |
$12.76
|
| Rate for Payer: Priority Health SBD |
$33.43
|
| Rate for Payer: Priority Health Tiered Network |
$10.21
|
| Rate for Payer: Railroad Medicare Medicare |
$12.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.14
|
| Rate for Payer: UHC Core |
$19.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.76
|
| Rate for Payer: UHC Exchange |
$19.14
|
| Rate for Payer: UHC Medicaid |
$6.67
|
| Rate for Payer: UHCCP Medicaid |
$6.67
|
| Rate for Payer: VA VA |
$12.76
|
|
|
HC TRANSFUSION
|
Facility
|
IP
|
$1,220.39
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
39100000
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$768.85 |
| Max. Negotiated Rate |
$1,098.35 |
| Rate for Payer: Aetna Commercial |
$1,037.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$793.25
|
| Rate for Payer: Cash Price |
$976.31
|
| Rate for Payer: Cofinity Advantage |
$854.27
|
| Rate for Payer: Cofinity Commercial |
$1,049.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$976.31
|
| Rate for Payer: Healthscope Commercial |
$1,098.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,037.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$915.29
|
| Rate for Payer: PHP Commercial |
$1,037.33
|
| Rate for Payer: Priority Health SBD |
$768.85
|
|
|
HC TRANSFUSION
|
Facility
|
OP
|
$1,220.39
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
39100000
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$186.55 |
| Max. Negotiated Rate |
$1,421.59 |
| Rate for Payer: Aetna Commercial |
$1,037.33
|
| Rate for Payer: Aetna Medicare |
$457.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$793.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$549.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$549.49
|
| Rate for Payer: BCBS Complete |
$241.42
|
| Rate for Payer: BCBS MAPPO |
$439.59
|
| Rate for Payer: BCBS Trust/PPO |
$186.55
|
| Rate for Payer: BCN Commercial |
$186.55
|
| Rate for Payer: BCN Medicare Advantage |
$439.59
|
| Rate for Payer: Cash Price |
$976.31
|
| Rate for Payer: Cash Price |
$976.31
|
| Rate for Payer: Cofinity Advantage |
$854.27
|
| Rate for Payer: Cofinity Commercial |
$1,049.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$976.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$439.59
|
| Rate for Payer: Healthscope Commercial |
$1,098.35
|
| Rate for Payer: Mclaren Medicaid |
$229.91
|
| Rate for Payer: Mclaren Medicare |
$439.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$461.57
|
| Rate for Payer: Meridian Medicaid |
$461.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$505.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$483.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,037.33
|
| Rate for Payer: Nomi Health Commercial |
$1,318.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$915.29
|
| Rate for Payer: PACE Medicare |
$417.61
|
| Rate for Payer: PACE SWMI |
$439.59
|
| Rate for Payer: PHP Commercial |
$1,037.33
|
| Rate for Payer: PHP Medicare Advantage |
$439.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$229.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,421.59
|
| Rate for Payer: Priority Health Medicare |
$439.59
|
| Rate for Payer: Priority Health SBD |
$768.85
|
| Rate for Payer: Priority Health Tiered Network |
$1,137.27
|
| Rate for Payer: Railroad Medicare Medicare |
$439.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$793.25
|
| Rate for Payer: UHC Core |
$635.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$439.59
|
| Rate for Payer: UHC Exchange |
$479.61
|
| Rate for Payer: UHC Medicaid |
$229.91
|
| Rate for Payer: UHCCP Medicaid |
$229.91
|
| Rate for Payer: VA VA |
$439.59
|
|
|
HC TRANSFUSION INTRAUTERINE FETAL
|
Facility
|
OP
|
$644.68
|
|
|
Service Code
|
CPT 36460
|
| Hospital Charge Code |
36100115
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$229.91 |
| Max. Negotiated Rate |
$1,421.59 |
| Rate for Payer: Aetna Commercial |
$547.98
|
| Rate for Payer: Aetna Medicare |
$457.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$419.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$549.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$549.49
|
| Rate for Payer: BCBS Complete |
$241.42
|
| Rate for Payer: BCBS MAPPO |
$439.59
|
| Rate for Payer: BCBS Trust/PPO |
$376.04
|
| Rate for Payer: BCN Commercial |
$376.04
|
| Rate for Payer: BCN Medicare Advantage |
$439.59
|
| Rate for Payer: Cash Price |
$515.74
|
| Rate for Payer: Cash Price |
$515.74
|
| Rate for Payer: Cofinity Advantage |
$451.28
|
| Rate for Payer: Cofinity Commercial |
$554.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$515.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$439.59
|
| Rate for Payer: Healthscope Commercial |
$580.21
|
| Rate for Payer: Mclaren Medicaid |
$229.91
|
| Rate for Payer: Mclaren Medicare |
$439.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$461.57
|
| Rate for Payer: Meridian Medicaid |
$461.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$505.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$483.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$547.98
|
| Rate for Payer: Nomi Health Commercial |
$1,318.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$483.51
|
| Rate for Payer: PACE Medicare |
$417.61
|
| Rate for Payer: PACE SWMI |
$439.59
|
| Rate for Payer: PHP Commercial |
$547.98
|
| Rate for Payer: PHP Medicare Advantage |
$439.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$229.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,421.59
|
| Rate for Payer: Priority Health Medicare |
$439.59
|
| Rate for Payer: Priority Health SBD |
$406.15
|
| Rate for Payer: Priority Health Tiered Network |
$1,137.27
|
| Rate for Payer: Railroad Medicare Medicare |
$439.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$439.59
|
| Rate for Payer: UHC Medicaid |
$229.91
|
| Rate for Payer: UHCCP Medicaid |
$229.91
|
| Rate for Payer: VA VA |
$439.59
|
|
|
HC TRANSFUSION INTRAUTERINE FETAL
|
Facility
|
IP
|
$644.68
|
|
|
Service Code
|
CPT 36460
|
| Hospital Charge Code |
36100115
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$406.15 |
| Max. Negotiated Rate |
$580.21 |
| Rate for Payer: Aetna Commercial |
$547.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$419.04
|
| Rate for Payer: Cash Price |
$515.74
|
| Rate for Payer: Cofinity Advantage |
$451.28
|
| Rate for Payer: Cofinity Commercial |
$554.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$515.74
|
| Rate for Payer: Healthscope Commercial |
$580.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$547.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$483.51
|
| Rate for Payer: PHP Commercial |
$547.98
|
| Rate for Payer: Priority Health SBD |
$406.15
|
|
|
HC TRANSHEPATIC PORTOGRAPHY
|
Facility
|
IP
|
$3,231.49
|
|
|
Service Code
|
CPT 75887
|
| Hospital Charge Code |
32000321
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,035.84 |
| Max. Negotiated Rate |
$2,908.34 |
| Rate for Payer: Aetna Commercial |
$2,746.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,100.47
|
| Rate for Payer: Cash Price |
$2,585.19
|
| Rate for Payer: Cofinity Advantage |
$2,262.04
|
| Rate for Payer: Cofinity Commercial |
$2,779.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,585.19
|
| Rate for Payer: Healthscope Commercial |
$2,908.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,746.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,423.62
|
| Rate for Payer: PHP Commercial |
$2,746.77
|
| Rate for Payer: Priority Health SBD |
$2,035.84
|
|
|
HC TRANSHEPATIC PORTOGRAPHY
|
Facility
|
OP
|
$3,231.49
|
|
|
Service Code
|
CPT 75887
|
| Hospital Charge Code |
32000321
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$165.06 |
| Max. Negotiated Rate |
$10,174.29 |
| Rate for Payer: Aetna Commercial |
$2,746.77
|
| Rate for Payer: Aetna Medicare |
$3,271.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,100.47
|
| 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 |
$165.06
|
| Rate for Payer: BCN Commercial |
$165.06
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$2,585.19
|
| Rate for Payer: Cash Price |
$2,585.19
|
| Rate for Payer: Cofinity Advantage |
$2,262.04
|
| Rate for Payer: Cofinity Commercial |
$2,779.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,585.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$2,908.34
|
| 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 |
$2,746.77
|
| Rate for Payer: Nomi Health Commercial |
$9,438.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,423.62
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$2,746.77
|
| 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 |
$2,035.84
|
| Rate for Payer: Priority Health Tiered Network |
$8,139.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,100.47
|
| Rate for Payer: UHC Core |
$1,683.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Exchange |
$1,269.98
|
| 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 TRANSPERINEAL PLMT BIODEGRADABLE MATRL
|
Facility
|
OP
|
$6,377.86
|
|
|
Service Code
|
CPT 55874
|
| Hospital Charge Code |
36100574
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,506.50 |
| Max. Negotiated Rate |
$17,277.20 |
| Rate for Payer: Aetna Commercial |
$5,421.18
|
| Rate for Payer: Aetna Medicare |
$5,556.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,145.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,678.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,678.15
|
| Rate for Payer: BCBS Complete |
$2,934.11
|
| Rate for Payer: BCBS MAPPO |
$5,342.52
|
| Rate for Payer: BCBS Trust/PPO |
$3,796.82
|
| Rate for Payer: BCN Commercial |
$3,796.82
|
| Rate for Payer: BCN Medicare Advantage |
$5,342.52
|
| Rate for Payer: Cash Price |
$5,102.29
|
| Rate for Payer: Cash Price |
$5,102.29
|
| Rate for Payer: Cash Price |
$5,102.29
|
| Rate for Payer: Cofinity Advantage |
$4,464.50
|
| Rate for Payer: Cofinity Commercial |
$5,484.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,102.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,342.52
|
| Rate for Payer: Healthscope Commercial |
$5,740.07
|
| Rate for Payer: Mclaren Medicaid |
$2,794.14
|
| Rate for Payer: Mclaren Medicare |
$5,342.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,609.65
|
| Rate for Payer: Meridian Medicaid |
$5,609.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,143.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,876.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,421.18
|
| Rate for Payer: Nomi Health Commercial |
$16,027.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,783.40
|
| Rate for Payer: PACE Medicare |
$5,075.39
|
| Rate for Payer: PACE SWMI |
$5,342.52
|
| Rate for Payer: PHP Commercial |
$5,421.18
|
| Rate for Payer: PHP Medicare Advantage |
$5,342.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,794.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,277.20
|
| Rate for Payer: Priority Health Medicare |
$5,342.52
|
| Rate for Payer: Priority Health SBD |
$4,018.05
|
| Rate for Payer: Priority Health Tiered Network |
$13,821.76
|
| Rate for Payer: Railroad Medicare Medicare |
$5,342.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,145.61
|
| Rate for Payer: UHC Core |
$3,322.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,342.52
|
| Rate for Payer: UHC Exchange |
$2,506.50
|
| Rate for Payer: UHC Medicaid |
$2,794.14
|
| Rate for Payer: UHCCP Medicaid |
$2,794.14
|
| Rate for Payer: VA VA |
$5,342.52
|
|
|
HC TRANSPERINEAL PLMT BIODEGRADABLE MATRL
|
Facility
|
IP
|
$6,377.86
|
|
|
Service Code
|
CPT 55874
|
| Hospital Charge Code |
36100574
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,018.05 |
| Max. Negotiated Rate |
$5,740.07 |
| Rate for Payer: Aetna Commercial |
$5,421.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,145.61
|
| Rate for Payer: Cash Price |
$5,102.29
|
| Rate for Payer: Cofinity Advantage |
$4,464.50
|
| Rate for Payer: Cofinity Commercial |
$5,484.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,102.29
|
| Rate for Payer: Healthscope Commercial |
$5,740.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,421.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,783.40
|
| Rate for Payer: PHP Commercial |
$5,421.18
|
| Rate for Payer: Priority Health SBD |
$4,018.05
|
|
|
HC TRANSSEP INTRO AGILIS
|
Facility
|
IP
|
$3,767.42
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
27200075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,373.47 |
| Max. Negotiated Rate |
$3,390.68 |
| Rate for Payer: Aetna Commercial |
$3,202.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,448.82
|
| Rate for Payer: Cash Price |
$3,013.94
|
| Rate for Payer: Cofinity Advantage |
$2,637.19
|
| Rate for Payer: Cofinity Commercial |
$3,239.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,013.94
|
| Rate for Payer: Healthscope Commercial |
$3,390.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,202.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,825.57
|
| Rate for Payer: PHP Commercial |
$3,202.31
|
| Rate for Payer: Priority Health SBD |
$2,373.47
|
|
|
HC TRANSSEP INTRO AGILIS
|
Facility
|
OP
|
$3,767.42
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
27200075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,480.60 |
| Max. Negotiated Rate |
$3,390.68 |
| Rate for Payer: Aetna Commercial |
$3,202.31
|
| Rate for Payer: Aetna Medicare |
$1,883.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,448.82
|
| Rate for Payer: BCBS Complete |
$1,506.97
|
| Rate for Payer: Cash Price |
$3,013.94
|
| Rate for Payer: Cofinity Advantage |
$2,637.19
|
| Rate for Payer: Cofinity Commercial |
$3,239.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,013.94
|
| Rate for Payer: Healthscope Commercial |
$3,390.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,013.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,202.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,825.57
|
| Rate for Payer: PHP Commercial |
$3,202.31
|
| Rate for Payer: Priority Health SBD |
$2,373.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,448.82
|
| Rate for Payer: UHC Core |
$1,962.83
|
| Rate for Payer: UHC Exchange |
$1,480.60
|
|
|
HC TRANSSEP PUNCTURE FOR PVI
|
Facility
|
IP
|
$5,021.39
|
|
|
Service Code
|
CPT 93462
|
| Hospital Charge Code |
48100021
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,163.48 |
| Max. Negotiated Rate |
$4,519.25 |
| Rate for Payer: Aetna Commercial |
$4,268.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,263.90
|
| Rate for Payer: Cash Price |
$4,017.11
|
| Rate for Payer: Cofinity Advantage |
$3,514.97
|
| Rate for Payer: Cofinity Commercial |
$4,318.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,017.11
|
| Rate for Payer: Healthscope Commercial |
$4,519.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,268.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,766.04
|
| Rate for Payer: PHP Commercial |
$4,268.18
|
| Rate for Payer: Priority Health SBD |
$3,163.48
|
|
|
HC TRANSSEP PUNCTURE FOR PVI
|
Facility
|
OP
|
$5,021.39
|
|
|
Service Code
|
CPT 93462
|
| Hospital Charge Code |
48100021
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$222.07 |
| Max. Negotiated Rate |
$4,519.25 |
| Rate for Payer: Aetna Commercial |
$4,268.18
|
| Rate for Payer: Aetna Medicare |
$2,510.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,263.90
|
| Rate for Payer: BCBS Complete |
$2,008.56
|
| Rate for Payer: BCBS Trust/PPO |
$222.07
|
| Rate for Payer: BCN Commercial |
$222.07
|
| Rate for Payer: Cash Price |
$4,017.11
|
| Rate for Payer: Cash Price |
$4,017.11
|
| Rate for Payer: Cofinity Advantage |
$3,514.97
|
| Rate for Payer: Cofinity Commercial |
$4,318.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,017.11
|
| Rate for Payer: Healthscope Commercial |
$4,519.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,017.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,268.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,766.04
|
| Rate for Payer: PHP Commercial |
$4,268.18
|
| Rate for Payer: Priority Health SBD |
$3,163.48
|
|
|
HC TRANSSEPTAL INTRODUCER
|
Facility
|
OP
|
$922.48
|
|
| Hospital Charge Code |
27200154
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$362.53 |
| Max. Negotiated Rate |
$830.23 |
| Rate for Payer: Aetna Commercial |
$784.11
|
| Rate for Payer: Aetna Medicare |
$461.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$599.61
|
| Rate for Payer: BCBS Complete |
$368.99
|
| Rate for Payer: Cash Price |
$737.98
|
| Rate for Payer: Cofinity Advantage |
$645.74
|
| Rate for Payer: Cofinity Commercial |
$793.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$737.98
|
| Rate for Payer: Healthscope Commercial |
$830.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$737.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$784.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$691.86
|
| Rate for Payer: PHP Commercial |
$784.11
|
| Rate for Payer: Priority Health SBD |
$581.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$599.61
|
| Rate for Payer: UHC Core |
$480.61
|
| Rate for Payer: UHC Exchange |
$362.53
|
|
|
HC TRANSSEPTAL INTRODUCER
|
Facility
|
IP
|
$922.48
|
|
| Hospital Charge Code |
27200154
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$581.16 |
| Max. Negotiated Rate |
$830.23 |
| Rate for Payer: Aetna Commercial |
$784.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$599.61
|
| Rate for Payer: Cash Price |
$737.98
|
| Rate for Payer: Cofinity Advantage |
$645.74
|
| Rate for Payer: Cofinity Commercial |
$793.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$737.98
|
| Rate for Payer: Healthscope Commercial |
$830.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$784.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$691.86
|
| Rate for Payer: PHP Commercial |
$784.11
|
| Rate for Payer: Priority Health SBD |
$581.16
|
|
|
HC TRANSVERSUS ABDOMINIS PLANE (TAP) BIL
|
Facility
|
IP
|
$1,686.83
|
|
|
Service Code
|
CPT 64488
|
| Hospital Charge Code |
36100576
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,062.70 |
| Max. Negotiated Rate |
$1,518.15 |
| Rate for Payer: Aetna Commercial |
$1,433.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,096.44
|
| Rate for Payer: Cash Price |
$1,349.46
|
| Rate for Payer: Cofinity Advantage |
$1,180.78
|
| Rate for Payer: Cofinity Commercial |
$1,450.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,349.46
|
| Rate for Payer: Healthscope Commercial |
$1,518.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,433.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,265.12
|
| Rate for Payer: PHP Commercial |
$1,433.81
|
| Rate for Payer: Priority Health SBD |
$1,062.70
|
|
|
HC TRANSVERSUS ABDOMINIS PLANE (TAP) BIL
|
Facility
|
OP
|
$1,686.83
|
|
|
Service Code
|
CPT 64488
|
| Hospital Charge Code |
36100576
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$674.73 |
| Max. Negotiated Rate |
$1,518.15 |
| Rate for Payer: Aetna Commercial |
$1,433.81
|
| Rate for Payer: Aetna Medicare |
$843.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,096.44
|
| Rate for Payer: BCBS Complete |
$674.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,071.25
|
| Rate for Payer: BCN Commercial |
$1,071.25
|
| Rate for Payer: Cash Price |
$1,349.46
|
| Rate for Payer: Cash Price |
$1,349.46
|
| Rate for Payer: Cofinity Advantage |
$1,180.78
|
| Rate for Payer: Cofinity Commercial |
$1,450.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,349.46
|
| Rate for Payer: Healthscope Commercial |
$1,518.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,349.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,433.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,265.12
|
| Rate for Payer: PHP Commercial |
$1,433.81
|
| Rate for Payer: Priority Health SBD |
$1,062.70
|
|
