|
HC TUBE CHANGE URETERO VIA ILEALO
|
Facility
|
OP
|
$2,116.00
|
|
|
Service Code
|
CPT 50688
|
| Hospital Charge Code |
36100248
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$998.78 |
| Max. Negotiated Rate |
$6,735.82 |
| Rate for Payer: Aetna Commercial |
$1,798.60
|
| Rate for Payer: Aetna Medicare |
$2,166.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,375.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$998.78
|
| Rate for Payer: BCN Commercial |
$998.78
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Cash Price |
$1,692.80
|
| Rate for Payer: Cash Price |
$1,692.80
|
| Rate for Payer: Cash Price |
$1,692.80
|
| Rate for Payer: Cofinity Advantage |
$1,481.20
|
| Rate for Payer: Cofinity Commercial |
$1,819.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,692.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Healthscope Commercial |
$1,904.40
|
| Rate for Payer: Mclaren Medicaid |
$1,089.34
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$2,187.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,798.60
|
| Rate for Payer: Nomi Health Commercial |
$6,248.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,587.00
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Commercial |
$1,798.60
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,735.82
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health SBD |
$1,333.08
|
| Rate for Payer: Priority Health Tiered Network |
$5,388.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: VA VA |
$2,082.87
|
|
|
HC TUBE CHANGE URETERO VIA ILEALO
|
Facility
|
IP
|
$2,116.00
|
|
|
Service Code
|
CPT 50688
|
| Hospital Charge Code |
36100248
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,333.08 |
| Max. Negotiated Rate |
$1,904.40 |
| Rate for Payer: Aetna Commercial |
$1,798.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,375.40
|
| Rate for Payer: Cash Price |
$1,692.80
|
| Rate for Payer: Cofinity Advantage |
$1,481.20
|
| Rate for Payer: Cofinity Commercial |
$1,819.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,692.80
|
| Rate for Payer: Healthscope Commercial |
$1,904.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,798.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,587.00
|
| Rate for Payer: PHP Commercial |
$1,798.60
|
| Rate for Payer: Priority Health SBD |
$1,333.08
|
|
|
HC TUBE CHECK WITH FLUORO
|
Facility
|
IP
|
$230.02
|
|
|
Service Code
|
CPT 49465
|
| Hospital Charge Code |
36100233
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$144.91 |
| Max. Negotiated Rate |
$207.02 |
| Rate for Payer: Aetna Commercial |
$195.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.51
|
| Rate for Payer: Cash Price |
$184.02
|
| Rate for Payer: Cofinity Advantage |
$161.01
|
| Rate for Payer: Cofinity Commercial |
$197.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.02
|
| Rate for Payer: Healthscope Commercial |
$207.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$172.51
|
| Rate for Payer: PHP Commercial |
$195.52
|
| Rate for Payer: Priority Health SBD |
$144.91
|
|
|
HC TUBE CHECK WITH FLUORO
|
Facility
|
OP
|
$230.02
|
|
|
Service Code
|
CPT 49465
|
| Hospital Charge Code |
36100233
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$768.83 |
| Rate for Payer: Aetna Commercial |
$195.52
|
| Rate for Payer: Aetna Medicare |
$247.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$192.54
|
| Rate for Payer: BCN Commercial |
$192.54
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$184.02
|
| Rate for Payer: Cash Price |
$184.02
|
| Rate for Payer: Cash Price |
$184.02
|
| Rate for Payer: Cofinity Advantage |
$161.01
|
| Rate for Payer: Cofinity Commercial |
$197.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$207.02
|
| Rate for Payer: Mclaren Medicaid |
$124.34
|
| Rate for Payer: Mclaren Medicare |
$237.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.63
|
| Rate for Payer: Meridian Medicaid |
$249.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.52
|
| Rate for Payer: Nomi Health Commercial |
$713.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$172.51
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$195.52
|
| Rate for Payer: PHP Medicare Advantage |
$237.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$768.83
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health SBD |
$144.91
|
| Rate for Payer: Priority Health Tiered Network |
$615.06
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC TUBE PLACEMENT NASOG OR OROG W FLUO
|
Facility
|
OP
|
$490.49
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
36100191
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$232.80 |
| Max. Negotiated Rate |
$1,439.47 |
| Rate for Payer: Aetna Commercial |
$416.92
|
| Rate for Payer: Aetna Medicare |
$462.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$556.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$556.40
|
| Rate for Payer: BCBS Complete |
$244.46
|
| Rate for Payer: BCBS MAPPO |
$445.12
|
| Rate for Payer: BCBS Trust/PPO |
$311.31
|
| Rate for Payer: BCN Commercial |
$311.31
|
| Rate for Payer: BCN Medicare Advantage |
$445.12
|
| Rate for Payer: Cash Price |
$392.39
|
| Rate for Payer: Cash Price |
$392.39
|
| Rate for Payer: Cash Price |
$392.39
|
| Rate for Payer: Cofinity Advantage |
$343.34
|
| Rate for Payer: Cofinity Commercial |
$421.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$445.12
|
| Rate for Payer: Healthscope Commercial |
$441.44
|
| Rate for Payer: Mclaren Medicaid |
$232.80
|
| Rate for Payer: Mclaren Medicare |
$445.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$467.38
|
| Rate for Payer: Meridian Medicaid |
$467.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$511.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$489.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.92
|
| Rate for Payer: Nomi Health Commercial |
$1,335.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$367.87
|
| Rate for Payer: PACE Medicare |
$422.86
|
| Rate for Payer: PACE SWMI |
$445.12
|
| Rate for Payer: PHP Commercial |
$416.92
|
| Rate for Payer: PHP Medicare Advantage |
$445.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$232.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,439.47
|
| Rate for Payer: Priority Health Medicare |
$445.12
|
| Rate for Payer: Priority Health SBD |
$309.01
|
| Rate for Payer: Priority Health Tiered Network |
$1,151.58
|
| Rate for Payer: Railroad Medicare Medicare |
$445.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$445.12
|
| Rate for Payer: UHC Medicaid |
$232.80
|
| Rate for Payer: UHCCP Medicaid |
$232.80
|
| Rate for Payer: VA VA |
$445.12
|
|
|
HC TUBE PLACEMENT NASOG OR OROG W FLUO
|
Facility
|
IP
|
$490.49
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
36100191
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$309.01 |
| Max. Negotiated Rate |
$441.44 |
| Rate for Payer: Aetna Commercial |
$416.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.82
|
| Rate for Payer: Cash Price |
$392.39
|
| Rate for Payer: Cofinity Advantage |
$343.34
|
| Rate for Payer: Cofinity Commercial |
$421.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.39
|
| Rate for Payer: Healthscope Commercial |
$441.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$367.87
|
| Rate for Payer: PHP Commercial |
$416.92
|
| Rate for Payer: Priority Health SBD |
$309.01
|
|
|
HC TUBE REPLACEMENT BY PHYSICIAN
|
Facility
|
OP
|
$315.57
|
|
| Hospital Charge Code |
45000055
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$126.23 |
| Max. Negotiated Rate |
$284.01 |
| Rate for Payer: Aetna Commercial |
$268.23
|
| Rate for Payer: Aetna Medicare |
$157.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.12
|
| Rate for Payer: BCBS Complete |
$126.23
|
| Rate for Payer: Cash Price |
$252.46
|
| Rate for Payer: Cash Price |
$252.46
|
| Rate for Payer: Cofinity Advantage |
$220.90
|
| Rate for Payer: Cofinity Commercial |
$271.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.46
|
| Rate for Payer: Healthscope Commercial |
$284.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.68
|
| Rate for Payer: PHP Commercial |
$268.23
|
| Rate for Payer: Priority Health SBD |
$198.81
|
| Rate for Payer: UHCCP Medicaid |
$144.00
|
|
|
HC TUBE REPLACEMENT BY PHYSICIAN
|
Facility
|
IP
|
$315.57
|
|
| Hospital Charge Code |
45000055
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$198.81 |
| Max. Negotiated Rate |
$284.01 |
| Rate for Payer: Aetna Commercial |
$268.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.12
|
| Rate for Payer: Cash Price |
$252.46
|
| Rate for Payer: Cofinity Advantage |
$220.90
|
| Rate for Payer: Cofinity Commercial |
$271.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.46
|
| Rate for Payer: Healthscope Commercial |
$284.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.68
|
| Rate for Payer: PHP Commercial |
$268.23
|
| Rate for Payer: Priority Health SBD |
$198.81
|
|
|
HC TUBING 1/2
|
Facility
|
IP
|
$18.73
|
|
| Hospital Charge Code |
27000663
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$16.86 |
| Rate for Payer: Aetna Commercial |
$15.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.17
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Advantage |
$13.11
|
| Rate for Payer: Cofinity Commercial |
$16.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$16.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.05
|
| Rate for Payer: PHP Commercial |
$15.92
|
| Rate for Payer: Priority Health SBD |
$11.80
|
|
|
HC TUBING 1/2
|
Facility
|
OP
|
$18.73
|
|
| Hospital Charge Code |
27000663
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$16.86 |
| Rate for Payer: Aetna Commercial |
$15.92
|
| Rate for Payer: Aetna Medicare |
$9.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.17
|
| Rate for Payer: BCBS Complete |
$7.49
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Advantage |
$13.11
|
| Rate for Payer: Cofinity Commercial |
$16.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$16.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.05
|
| Rate for Payer: PHP Commercial |
$15.92
|
| Rate for Payer: Priority Health SBD |
$11.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.17
|
| Rate for Payer: UHC Core |
$9.76
|
| Rate for Payer: UHC Exchange |
$7.36
|
|
|
HC TUBING 1/4
|
Facility
|
OP
|
$24.97
|
|
| Hospital Charge Code |
27000162
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Aetna Commercial |
$21.22
|
| Rate for Payer: Aetna Medicare |
$12.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.23
|
| Rate for Payer: BCBS Complete |
$9.99
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Advantage |
$17.48
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.73
|
| Rate for Payer: PHP Commercial |
$21.22
|
| Rate for Payer: Priority Health SBD |
$15.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.23
|
| Rate for Payer: UHC Core |
$13.01
|
| Rate for Payer: UHC Exchange |
$9.81
|
|
|
HC TUBING 1/4
|
Facility
|
IP
|
$24.97
|
|
| Hospital Charge Code |
27000162
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.73 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Aetna Commercial |
$21.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.23
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Advantage |
$17.48
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.73
|
| Rate for Payer: PHP Commercial |
$21.22
|
| Rate for Payer: Priority Health SBD |
$15.73
|
|
|
HC TUBING 3/8
|
Facility
|
IP
|
$29.65
|
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.68 |
| Max. Negotiated Rate |
$26.68 |
| Rate for Payer: Aetna Commercial |
$25.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.27
|
| Rate for Payer: Cash Price |
$23.72
|
| Rate for Payer: Cofinity Advantage |
$20.75
|
| Rate for Payer: Cofinity Commercial |
$25.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.72
|
| Rate for Payer: Healthscope Commercial |
$26.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.24
|
| Rate for Payer: PHP Commercial |
$25.20
|
| Rate for Payer: Priority Health SBD |
$18.68
|
|
|
HC TUBING 3/8
|
Facility
|
OP
|
$29.65
|
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$26.68 |
| Rate for Payer: Aetna Commercial |
$25.20
|
| Rate for Payer: Aetna Medicare |
$14.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.27
|
| Rate for Payer: BCBS Complete |
$11.86
|
| Rate for Payer: Cash Price |
$23.72
|
| Rate for Payer: Cofinity Advantage |
$20.75
|
| Rate for Payer: Cofinity Commercial |
$25.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.72
|
| Rate for Payer: Healthscope Commercial |
$26.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.24
|
| Rate for Payer: PHP Commercial |
$25.20
|
| Rate for Payer: Priority Health SBD |
$18.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.27
|
| Rate for Payer: UHC Core |
$15.45
|
| Rate for Payer: UHC Exchange |
$11.65
|
|
|
HC TUMOR IMMUNOHISTOCHEMISTRY
|
Facility
|
OP
|
$225.96
|
|
|
Service Code
|
CPT 88360
|
| Hospital Charge Code |
31200001
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$88.78 |
| Max. Negotiated Rate |
$548.99 |
| Rate for Payer: Aetna Commercial |
$192.07
|
| Rate for Payer: Aetna Medicare |
$176.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.87
|
| 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 |
$134.58
|
| Rate for Payer: BCCCP Commercial |
$110.97
|
| Rate for Payer: BCN Commercial |
$134.58
|
| Rate for Payer: BCN Medicare Advantage |
$169.76
|
| Rate for Payer: Cash Price |
$180.77
|
| Rate for Payer: Cash Price |
$180.77
|
| Rate for Payer: Cofinity Advantage |
$158.17
|
| Rate for Payer: Cofinity Commercial |
$194.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.76
|
| Rate for Payer: Healthscope Commercial |
$203.36
|
| 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 |
$192.07
|
| Rate for Payer: Nomi Health Commercial |
$509.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$169.47
|
| Rate for Payer: PACE Medicare |
$161.27
|
| Rate for Payer: PACE SWMI |
$169.76
|
| Rate for Payer: PHP Commercial |
$192.07
|
| 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 |
$142.35
|
| 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 TUMOR IMMUNOHISTOCHEMISTRY
|
Facility
|
IP
|
$225.96
|
|
|
Service Code
|
CPT 88360
|
| Hospital Charge Code |
31200001
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$142.35 |
| Max. Negotiated Rate |
$203.36 |
| Rate for Payer: Aetna Commercial |
$192.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.87
|
| Rate for Payer: Cash Price |
$180.77
|
| Rate for Payer: Cofinity Advantage |
$158.17
|
| Rate for Payer: Cofinity Commercial |
$194.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.77
|
| Rate for Payer: Healthscope Commercial |
$203.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$169.47
|
| Rate for Payer: PHP Commercial |
$192.07
|
| Rate for Payer: Priority Health SBD |
$142.35
|
|
|
HC TUNA IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200067
|
|
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 TUNA IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200067
|
|
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 TVT DEVICE KIT
|
Facility
|
IP
|
$4,251.56
|
|
|
Service Code
|
HCPCS C2631
|
| Hospital Charge Code |
27200076
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,678.48 |
| Max. Negotiated Rate |
$3,826.40 |
| Rate for Payer: Aetna Commercial |
$3,613.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,763.51
|
| Rate for Payer: Cash Price |
$3,401.25
|
| Rate for Payer: Cofinity Advantage |
$2,976.09
|
| Rate for Payer: Cofinity Commercial |
$3,656.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,401.25
|
| Rate for Payer: Healthscope Commercial |
$3,826.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,613.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,188.67
|
| Rate for Payer: PHP Commercial |
$3,613.83
|
| Rate for Payer: Priority Health SBD |
$2,678.48
|
|
|
HC TVT DEVICE KIT
|
Facility
|
OP
|
$4,251.56
|
|
|
Service Code
|
HCPCS C2631
|
| Hospital Charge Code |
27200076
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,670.86 |
| Max. Negotiated Rate |
$3,826.40 |
| Rate for Payer: Aetna Commercial |
$3,613.83
|
| Rate for Payer: Aetna Medicare |
$2,125.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,763.51
|
| Rate for Payer: BCBS Complete |
$1,700.62
|
| Rate for Payer: Cash Price |
$3,401.25
|
| Rate for Payer: Cofinity Advantage |
$2,976.09
|
| Rate for Payer: Cofinity Commercial |
$3,656.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,401.25
|
| Rate for Payer: Healthscope Commercial |
$3,826.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,401.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,613.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,188.67
|
| Rate for Payer: PHP Commercial |
$3,613.83
|
| Rate for Payer: Priority Health SBD |
$2,678.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,763.51
|
| Rate for Payer: UHC Core |
$2,215.06
|
| Rate for Payer: UHC Exchange |
$1,670.86
|
|
|
HC TWIST DRILL HOLE IMPLT VENTRICULAR CATH/DEVICE
|
Facility
|
IP
|
$3,745.44
|
|
|
Service Code
|
CPT 61107
|
| Hospital Charge Code |
36100620
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,359.63 |
| Max. Negotiated Rate |
$3,370.90 |
| Rate for Payer: Aetna Commercial |
$3,183.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,434.54
|
| Rate for Payer: Cash Price |
$2,996.35
|
| Rate for Payer: Cofinity Advantage |
$2,621.81
|
| Rate for Payer: Cofinity Commercial |
$3,221.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,996.35
|
| Rate for Payer: Healthscope Commercial |
$3,370.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,183.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,809.08
|
| Rate for Payer: PHP Commercial |
$3,183.62
|
| Rate for Payer: Priority Health SBD |
$2,359.63
|
|
|
HC TWIST DRILL HOLE IMPLT VENTRICULAR CATH/DEVICE
|
Facility
|
OP
|
$3,745.44
|
|
|
Service Code
|
CPT 61107
|
| Hospital Charge Code |
36100620
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$860.99 |
| Max. Negotiated Rate |
$3,370.90 |
| Rate for Payer: Aetna Commercial |
$3,183.62
|
| Rate for Payer: Aetna Medicare |
$1,872.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,434.54
|
| Rate for Payer: BCBS Complete |
$1,498.18
|
| Rate for Payer: BCBS Trust/PPO |
$860.99
|
| Rate for Payer: BCN Commercial |
$860.99
|
| Rate for Payer: Cash Price |
$2,996.35
|
| Rate for Payer: Cash Price |
$2,996.35
|
| Rate for Payer: Cofinity Advantage |
$2,621.81
|
| Rate for Payer: Cofinity Commercial |
$3,221.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,996.35
|
| Rate for Payer: Healthscope Commercial |
$3,370.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,996.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,183.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,809.08
|
| Rate for Payer: PHP Commercial |
$3,183.62
|
| Rate for Payer: Priority Health SBD |
$2,359.63
|
|
|
HC TX INCOMPLETE AB ANY TRI SURG
|
Facility
|
OP
|
$8,104.44
|
|
|
Service Code
|
CPT 59812
|
| Hospital Charge Code |
76100342
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,686.93 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Commercial |
$6,888.77
|
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,267.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,869.66
|
| Rate for Payer: BCN Commercial |
$1,869.66
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Cash Price |
$6,483.55
|
| Rate for Payer: Cash Price |
$6,483.55
|
| Rate for Payer: Cash Price |
$6,483.55
|
| Rate for Payer: Cofinity Advantage |
$5,673.11
|
| Rate for Payer: Cofinity Commercial |
$6,969.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,483.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Healthscope Commercial |
$7,294.00
|
| Rate for Payer: Mclaren Medicaid |
$1,686.93
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,888.77
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,078.33
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Commercial |
$6,888.77
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health SBD |
$5,105.80
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,267.89
|
| Rate for Payer: UHC Core |
$4,222.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Exchange |
$3,185.04
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
HC TX INCOMPLETE AB ANY TRI SURG
|
Facility
|
IP
|
$8,104.44
|
|
|
Service Code
|
CPT 59812
|
| Hospital Charge Code |
76100342
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,105.80 |
| Max. Negotiated Rate |
$7,294.00 |
| Rate for Payer: Aetna Commercial |
$6,888.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,267.89
|
| Rate for Payer: Cash Price |
$6,483.55
|
| Rate for Payer: Cofinity Advantage |
$5,673.11
|
| Rate for Payer: Cofinity Commercial |
$6,969.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,483.55
|
| Rate for Payer: Healthscope Commercial |
$7,294.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,888.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,078.33
|
| Rate for Payer: PHP Commercial |
$6,888.77
|
| Rate for Payer: Priority Health SBD |
$5,105.80
|
|
|
HC TX MISSED AB 1ST TRI SURG
|
Facility
|
IP
|
$8,104.44
|
|
|
Service Code
|
CPT 59820
|
| Hospital Charge Code |
76100343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,105.80 |
| Max. Negotiated Rate |
$7,294.00 |
| Rate for Payer: Aetna Commercial |
$6,888.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,267.89
|
| Rate for Payer: Cash Price |
$6,483.55
|
| Rate for Payer: Cofinity Advantage |
$5,673.11
|
| Rate for Payer: Cofinity Commercial |
$6,969.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,483.55
|
| Rate for Payer: Healthscope Commercial |
$7,294.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,888.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,078.33
|
| Rate for Payer: PHP Commercial |
$6,888.77
|
| Rate for Payer: Priority Health SBD |
$5,105.80
|
|
