|
HC TRANSFERRIN
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
30100443
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health SBD |
$32.77
|
|
|
HC TRANSFUSION
|
Facility
|
IP
|
$1,196.46
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
39100000
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$753.77 |
| Max. Negotiated Rate |
$1,076.81 |
| Rate for Payer: Aetna Commercial |
$1,016.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$777.70
|
| Rate for Payer: Cash Price |
$957.17
|
| Rate for Payer: Cofinity Commercial |
$1,028.96
|
| Rate for Payer: Cofinity Commercial |
$837.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$837.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$957.17
|
| Rate for Payer: Healthscope Commercial |
$1,076.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,016.99
|
| Rate for Payer: PHP Commercial |
$1,016.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$777.70
|
| Rate for Payer: Priority Health SBD |
$753.77
|
|
|
HC TRANSFUSION
|
Facility
|
OP
|
$1,196.46
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
39100000
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$228.53 |
| Max. Negotiated Rate |
$1,200.19 |
| Rate for Payer: Aetna Commercial |
$1,016.99
|
| Rate for Payer: Aetna Medicare |
$443.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$777.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$532.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$532.96
|
| Rate for Payer: BCBS Complete |
$239.96
|
| Rate for Payer: BCBS MAPPO |
$426.37
|
| Rate for Payer: BCN Medicare Advantage |
$426.37
|
| Rate for Payer: Cash Price |
$957.17
|
| Rate for Payer: Cash Price |
$957.17
|
| Rate for Payer: Cofinity Commercial |
$837.52
|
| Rate for Payer: Cofinity Commercial |
$1,028.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$837.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$957.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$426.37
|
| Rate for Payer: Healthscope Commercial |
$1,076.81
|
| Rate for Payer: Mclaren Medicaid |
$228.53
|
| Rate for Payer: Mclaren Medicare |
$426.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$447.69
|
| Rate for Payer: Meridian Medicaid |
$239.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$490.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,016.99
|
| Rate for Payer: PACE Medicare |
$405.05
|
| Rate for Payer: PACE SWMI |
$426.37
|
| Rate for Payer: PHP Commercial |
$1,016.99
|
| Rate for Payer: PHP Medicare Advantage |
$426.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$228.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$777.70
|
| Rate for Payer: Priority Health Medicare |
$426.37
|
| Rate for Payer: Priority Health SBD |
$753.77
|
| Rate for Payer: Railroad Medicare Medicare |
$426.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,200.19
|
| Rate for Payer: UHC Core |
$885.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$426.37
|
| Rate for Payer: UHC Exchange |
$885.38
|
| Rate for Payer: UHC Medicare Advantage |
$426.37
|
| Rate for Payer: UHCCP Medicaid |
$240.05
|
| Rate for Payer: VA VA |
$426.37
|
|
|
HC TRANSFUSION INTRAUTERINE FETAL
|
Facility
|
IP
|
$632.04
|
|
|
Service Code
|
CPT 36460
|
| Hospital Charge Code |
36100115
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$398.19 |
| Max. Negotiated Rate |
$568.84 |
| Rate for Payer: Aetna Commercial |
$537.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$410.83
|
| Rate for Payer: Cash Price |
$505.63
|
| Rate for Payer: Cofinity Commercial |
$442.43
|
| Rate for Payer: Cofinity Commercial |
$543.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$442.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$505.63
|
| Rate for Payer: Healthscope Commercial |
$568.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$537.23
|
| Rate for Payer: PHP Commercial |
$537.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$410.83
|
| Rate for Payer: Priority Health SBD |
$398.19
|
|
|
HC TRANSFUSION INTRAUTERINE FETAL
|
Facility
|
OP
|
$632.04
|
|
|
Service Code
|
CPT 36460
|
| Hospital Charge Code |
36100115
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$228.53 |
| Max. Negotiated Rate |
$1,200.19 |
| Rate for Payer: Aetna Commercial |
$537.23
|
| Rate for Payer: Aetna Medicare |
$443.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$410.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$532.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$532.96
|
| Rate for Payer: BCBS Complete |
$239.96
|
| Rate for Payer: BCBS MAPPO |
$426.37
|
| Rate for Payer: BCN Medicare Advantage |
$426.37
|
| Rate for Payer: Cash Price |
$505.63
|
| Rate for Payer: Cash Price |
$505.63
|
| Rate for Payer: Cofinity Commercial |
$543.55
|
| Rate for Payer: Cofinity Commercial |
$442.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$442.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$505.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$426.37
|
| Rate for Payer: Healthscope Commercial |
$568.84
|
| Rate for Payer: Mclaren Medicaid |
$228.53
|
| Rate for Payer: Mclaren Medicare |
$426.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$447.69
|
| Rate for Payer: Meridian Medicaid |
$239.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$490.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$537.23
|
| Rate for Payer: PACE Medicare |
$405.05
|
| Rate for Payer: PACE SWMI |
$426.37
|
| Rate for Payer: PHP Commercial |
$537.23
|
| Rate for Payer: PHP Medicare Advantage |
$426.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$228.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$410.83
|
| Rate for Payer: Priority Health Medicare |
$426.37
|
| Rate for Payer: Priority Health SBD |
$398.19
|
| Rate for Payer: Railroad Medicare Medicare |
$426.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,200.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$426.37
|
| Rate for Payer: UHC Medicare Advantage |
$426.37
|
| Rate for Payer: UHCCP Medicaid |
$240.05
|
| Rate for Payer: VA VA |
$426.37
|
|
|
HC TRANSHEPATIC PORTOGRAPHY
|
Facility
|
IP
|
$3,168.13
|
|
|
Service Code
|
CPT 75887
|
| Hospital Charge Code |
32000321
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,995.92 |
| Max. Negotiated Rate |
$2,851.32 |
| Rate for Payer: Aetna Commercial |
$2,692.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,059.28
|
| Rate for Payer: Cash Price |
$2,534.50
|
| Rate for Payer: Cofinity Commercial |
$2,217.69
|
| Rate for Payer: Cofinity Commercial |
$2,724.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,217.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,534.50
|
| Rate for Payer: Healthscope Commercial |
$2,851.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,692.91
|
| Rate for Payer: PHP Commercial |
$2,692.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,059.28
|
| Rate for Payer: Priority Health SBD |
$1,995.92
|
|
|
HC TRANSHEPATIC PORTOGRAPHY
|
Facility
|
OP
|
$3,168.13
|
|
|
Service Code
|
CPT 75887
|
| Hospital Charge Code |
32000321
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$8,640.87 |
| Rate for Payer: Aetna Commercial |
$2,692.91
|
| Rate for Payer: Aetna Medicare |
$3,192.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,059.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Cash Price |
$2,534.50
|
| Rate for Payer: Cash Price |
$2,534.50
|
| Rate for Payer: Cofinity Commercial |
$2,724.59
|
| Rate for Payer: Cofinity Commercial |
$2,217.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,217.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,534.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Healthscope Commercial |
$2,851.32
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,692.91
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Commercial |
$2,692.91
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,059.28
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Priority Health SBD |
$1,995.92
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,640.87
|
| Rate for Payer: UHC Core |
$2,344.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$2,344.42
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,728.24
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
HC TRANSPERINEAL PLMT BIODEGRADABLE MATRL
|
Facility
|
IP
|
$6,252.80
|
|
|
Service Code
|
CPT 55874
|
| Hospital Charge Code |
36100574
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,939.26 |
| Max. Negotiated Rate |
$5,627.52 |
| Rate for Payer: Aetna Commercial |
$5,314.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,064.32
|
| Rate for Payer: Cash Price |
$5,002.24
|
| Rate for Payer: Cofinity Commercial |
$4,376.96
|
| Rate for Payer: Cofinity Commercial |
$5,377.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,376.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,002.24
|
| Rate for Payer: Healthscope Commercial |
$5,627.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,314.88
|
| Rate for Payer: PHP Commercial |
$5,314.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,064.32
|
| Rate for Payer: Priority Health SBD |
$3,939.26
|
|
|
HC TRANSPERINEAL PLMT BIODEGRADABLE MATRL
|
Facility
|
OP
|
$6,252.80
|
|
|
Service Code
|
CPT 55874
|
| Hospital Charge Code |
36100574
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,657.46 |
| Max. Negotiated Rate |
$13,956.13 |
| Rate for Payer: Aetna Commercial |
$5,314.88
|
| Rate for Payer: Aetna Medicare |
$5,156.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,064.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,197.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,197.44
|
| Rate for Payer: BCBS Complete |
$2,790.33
|
| Rate for Payer: BCBS MAPPO |
$4,957.95
|
| Rate for Payer: BCN Medicare Advantage |
$4,957.95
|
| Rate for Payer: Cash Price |
$5,002.24
|
| Rate for Payer: Cash Price |
$5,002.24
|
| Rate for Payer: Cofinity Commercial |
$5,377.41
|
| Rate for Payer: Cofinity Commercial |
$4,376.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,376.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,002.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,957.95
|
| Rate for Payer: Healthscope Commercial |
$5,627.52
|
| Rate for Payer: Mclaren Medicaid |
$2,657.46
|
| Rate for Payer: Mclaren Medicare |
$4,957.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,205.85
|
| Rate for Payer: Meridian Medicaid |
$2,790.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,701.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,314.88
|
| Rate for Payer: PACE Medicare |
$4,710.05
|
| Rate for Payer: PACE SWMI |
$4,957.95
|
| Rate for Payer: PHP Commercial |
$5,314.88
|
| Rate for Payer: PHP Medicare Advantage |
$4,957.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,657.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,064.32
|
| Rate for Payer: Priority Health Medicare |
$4,957.95
|
| Rate for Payer: Priority Health SBD |
$3,939.26
|
| Rate for Payer: Railroad Medicare Medicare |
$4,957.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,956.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,957.95
|
| Rate for Payer: UHC Medicare Advantage |
$4,957.95
|
| Rate for Payer: UHCCP Medicaid |
$2,791.33
|
| Rate for Payer: VA VA |
$4,957.95
|
|
|
HC TRANSSEP INTRO AGILIS
|
Facility
|
IP
|
$3,693.55
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
27200075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,326.94 |
| Max. Negotiated Rate |
$3,324.20 |
| Rate for Payer: Aetna Commercial |
$3,139.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,400.81
|
| Rate for Payer: Cash Price |
$2,954.84
|
| Rate for Payer: Cofinity Commercial |
$2,585.49
|
| Rate for Payer: Cofinity Commercial |
$3,176.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,585.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,954.84
|
| Rate for Payer: Healthscope Commercial |
$3,324.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,139.52
|
| Rate for Payer: PHP Commercial |
$3,139.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,400.81
|
| Rate for Payer: Priority Health SBD |
$2,326.94
|
|
|
HC TRANSSEP INTRO AGILIS
|
Facility
|
OP
|
$3,693.55
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
27200075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,477.42 |
| Max. Negotiated Rate |
$3,324.20 |
| Rate for Payer: Aetna Commercial |
$3,139.52
|
| Rate for Payer: Aetna Medicare |
$1,846.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,400.81
|
| Rate for Payer: BCBS Complete |
$1,477.42
|
| Rate for Payer: Cash Price |
$2,954.84
|
| Rate for Payer: Cofinity Commercial |
$2,585.49
|
| Rate for Payer: Cofinity Commercial |
$3,176.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,585.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,954.84
|
| Rate for Payer: Healthscope Commercial |
$3,324.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,139.52
|
| Rate for Payer: PHP Commercial |
$3,139.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,400.81
|
| Rate for Payer: Priority Health SBD |
$2,326.94
|
|
|
HC TRANSSEP PUNCTURE FOR PVI
|
Facility
|
OP
|
$4,922.93
|
|
|
Service Code
|
CPT 93462
|
| Hospital Charge Code |
48100021
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,969.17 |
| Max. Negotiated Rate |
$4,430.64 |
| Rate for Payer: Aetna Commercial |
$4,184.49
|
| Rate for Payer: Aetna Medicare |
$2,461.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,199.90
|
| Rate for Payer: BCBS Complete |
$1,969.17
|
| Rate for Payer: Cash Price |
$3,938.34
|
| Rate for Payer: Cofinity Commercial |
$3,446.05
|
| Rate for Payer: Cofinity Commercial |
$4,233.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,446.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,938.34
|
| Rate for Payer: Healthscope Commercial |
$4,430.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,184.49
|
| Rate for Payer: PHP Commercial |
$4,184.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,199.90
|
| Rate for Payer: Priority Health SBD |
$3,101.45
|
|
|
HC TRANSSEP PUNCTURE FOR PVI
|
Facility
|
IP
|
$4,922.93
|
|
|
Service Code
|
CPT 93462
|
| Hospital Charge Code |
48100021
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,101.45 |
| Max. Negotiated Rate |
$4,430.64 |
| Rate for Payer: Aetna Commercial |
$4,184.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,199.90
|
| Rate for Payer: Cash Price |
$3,938.34
|
| Rate for Payer: Cofinity Commercial |
$3,446.05
|
| Rate for Payer: Cofinity Commercial |
$4,233.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,446.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,938.34
|
| Rate for Payer: Healthscope Commercial |
$4,430.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,184.49
|
| Rate for Payer: PHP Commercial |
$4,184.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,199.90
|
| Rate for Payer: Priority Health SBD |
$3,101.45
|
|
|
HC TRANSSEPTAL INTRODUCER
|
Facility
|
OP
|
$904.39
|
|
| Hospital Charge Code |
27200154
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$361.76 |
| Max. Negotiated Rate |
$813.95 |
| Rate for Payer: Aetna Commercial |
$768.73
|
| Rate for Payer: Aetna Medicare |
$452.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$587.85
|
| Rate for Payer: BCBS Complete |
$361.76
|
| Rate for Payer: Cash Price |
$723.51
|
| Rate for Payer: Cofinity Commercial |
$633.07
|
| Rate for Payer: Cofinity Commercial |
$777.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$633.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$723.51
|
| Rate for Payer: Healthscope Commercial |
$813.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$768.73
|
| Rate for Payer: PHP Commercial |
$768.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$587.85
|
| Rate for Payer: Priority Health SBD |
$569.77
|
|
|
HC TRANSSEPTAL INTRODUCER
|
Facility
|
IP
|
$904.39
|
|
| Hospital Charge Code |
27200154
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$569.77 |
| Max. Negotiated Rate |
$813.95 |
| Rate for Payer: Aetna Commercial |
$768.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$587.85
|
| Rate for Payer: Cash Price |
$723.51
|
| Rate for Payer: Cofinity Commercial |
$633.07
|
| Rate for Payer: Cofinity Commercial |
$777.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$633.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$723.51
|
| Rate for Payer: Healthscope Commercial |
$813.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$768.73
|
| Rate for Payer: PHP Commercial |
$768.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$587.85
|
| Rate for Payer: Priority Health SBD |
$569.77
|
|
|
HC TRANSVERSUS ABDOMINIS PLANE (TAP) BIL
|
Facility
|
OP
|
$1,606.50
|
|
|
Service Code
|
CPT 64488
|
| Hospital Charge Code |
36100576
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$642.60 |
| Max. Negotiated Rate |
$1,445.85 |
| Rate for Payer: Aetna Commercial |
$1,365.53
|
| Rate for Payer: Aetna Medicare |
$803.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,044.22
|
| Rate for Payer: BCBS Complete |
$642.60
|
| Rate for Payer: Cash Price |
$1,285.20
|
| Rate for Payer: Cofinity Commercial |
$1,124.55
|
| Rate for Payer: Cofinity Commercial |
$1,381.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,124.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,285.20
|
| Rate for Payer: Healthscope Commercial |
$1,445.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,365.53
|
| Rate for Payer: PHP Commercial |
$1,365.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,044.22
|
| Rate for Payer: Priority Health SBD |
$1,012.10
|
|
|
HC TRANSVERSUS ABDOMINIS PLANE (TAP) BIL
|
Facility
|
IP
|
$1,606.50
|
|
|
Service Code
|
CPT 64488
|
| Hospital Charge Code |
36100576
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,012.10 |
| Max. Negotiated Rate |
$1,445.85 |
| Rate for Payer: Aetna Commercial |
$1,365.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,044.22
|
| Rate for Payer: Cash Price |
$1,285.20
|
| Rate for Payer: Cofinity Commercial |
$1,124.55
|
| Rate for Payer: Cofinity Commercial |
$1,381.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,124.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,285.20
|
| Rate for Payer: Healthscope Commercial |
$1,445.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,365.53
|
| Rate for Payer: PHP Commercial |
$1,365.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,044.22
|
| Rate for Payer: Priority Health SBD |
$1,012.10
|
|
|
HC TRANSVERSUS ABDOMINIS PLANE (TAP) UNI
|
Facility
|
OP
|
$1,194.38
|
|
|
Service Code
|
CPT 64486
|
| Hospital Charge Code |
36100575
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$477.75 |
| Max. Negotiated Rate |
$1,074.94 |
| Rate for Payer: Aetna Commercial |
$1,015.22
|
| Rate for Payer: Aetna Medicare |
$597.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$776.35
|
| Rate for Payer: BCBS Complete |
$477.75
|
| Rate for Payer: Cash Price |
$955.50
|
| Rate for Payer: Cofinity Commercial |
$1,027.17
|
| Rate for Payer: Cofinity Commercial |
$836.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$836.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$955.50
|
| Rate for Payer: Healthscope Commercial |
$1,074.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,015.22
|
| Rate for Payer: PHP Commercial |
$1,015.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$776.35
|
| Rate for Payer: Priority Health SBD |
$752.46
|
|
|
HC TRANSVERSUS ABDOMINIS PLANE (TAP) UNI
|
Facility
|
IP
|
$1,194.38
|
|
|
Service Code
|
CPT 64486
|
| Hospital Charge Code |
36100575
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$752.46 |
| Max. Negotiated Rate |
$1,074.94 |
| Rate for Payer: Aetna Commercial |
$1,015.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$776.35
|
| Rate for Payer: Cash Price |
$955.50
|
| Rate for Payer: Cofinity Commercial |
$1,027.17
|
| Rate for Payer: Cofinity Commercial |
$836.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$836.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$955.50
|
| Rate for Payer: Healthscope Commercial |
$1,074.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,015.22
|
| Rate for Payer: PHP Commercial |
$1,015.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$776.35
|
| Rate for Payer: Priority Health SBD |
$752.46
|
|
|
HC TRANURETH DESTR PROST TISS RF WVT
|
Facility
|
IP
|
$4,903.14
|
|
|
Service Code
|
CPT 53854
|
| Hospital Charge Code |
76100306
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,088.98 |
| Max. Negotiated Rate |
$4,412.83 |
| Rate for Payer: Aetna Commercial |
$4,167.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,187.04
|
| Rate for Payer: Cash Price |
$3,922.51
|
| Rate for Payer: Cofinity Commercial |
$3,432.20
|
| Rate for Payer: Cofinity Commercial |
$4,216.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,432.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,922.51
|
| Rate for Payer: Healthscope Commercial |
$4,412.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,167.67
|
| Rate for Payer: PHP Commercial |
$4,167.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,187.04
|
| Rate for Payer: Priority Health SBD |
$3,088.98
|
|
|
HC TRANURETH DESTR PROST TISS RF WVT
|
Facility
|
OP
|
$4,903.14
|
|
|
Service Code
|
CPT 53854
|
| Hospital Charge Code |
76100306
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,802.95 |
| Max. Negotiated Rate |
$9,468.51 |
| Rate for Payer: Aetna Commercial |
$4,167.67
|
| Rate for Payer: Aetna Medicare |
$3,498.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,187.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,204.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,204.64
|
| Rate for Payer: BCBS Complete |
$1,893.10
|
| Rate for Payer: BCBS MAPPO |
$3,363.71
|
| Rate for Payer: BCN Medicare Advantage |
$3,363.71
|
| Rate for Payer: Cash Price |
$3,922.51
|
| Rate for Payer: Cash Price |
$3,922.51
|
| Rate for Payer: Cofinity Commercial |
$4,216.70
|
| Rate for Payer: Cofinity Commercial |
$3,432.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,432.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,922.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,363.71
|
| Rate for Payer: Healthscope Commercial |
$4,412.83
|
| Rate for Payer: Mclaren Medicaid |
$1,802.95
|
| Rate for Payer: Mclaren Medicare |
$3,363.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,531.90
|
| Rate for Payer: Meridian Medicaid |
$1,893.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,868.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,167.67
|
| Rate for Payer: PACE Medicare |
$3,195.52
|
| Rate for Payer: PACE SWMI |
$3,363.71
|
| Rate for Payer: PHP Commercial |
$4,167.67
|
| Rate for Payer: PHP Medicare Advantage |
$3,363.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,802.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,187.04
|
| Rate for Payer: Priority Health Medicare |
$3,363.71
|
| Rate for Payer: Priority Health SBD |
$3,088.98
|
| Rate for Payer: Railroad Medicare Medicare |
$3,363.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,468.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,363.71
|
| Rate for Payer: UHC Medicare Advantage |
$3,363.71
|
| Rate for Payer: UHCCP Medicaid |
$1,893.77
|
| Rate for Payer: VA VA |
$3,363.71
|
|
|
HC TREAT FINGER FRACTURE WITH MANIP EA
|
Facility
|
OP
|
$4,243.31
|
|
|
Service Code
|
CPT 26742
|
| Hospital Charge Code |
76100386
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$836.62 |
| Max. Negotiated Rate |
$4,393.64 |
| Rate for Payer: Aetna Commercial |
$3,606.81
|
| Rate for Payer: Aetna Medicare |
$1,623.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,758.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,951.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,951.06
|
| Rate for Payer: BCBS Complete |
$878.45
|
| Rate for Payer: BCBS MAPPO |
$1,560.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,560.85
|
| Rate for Payer: Cash Price |
$3,394.65
|
| Rate for Payer: Cash Price |
$3,394.65
|
| Rate for Payer: Cofinity Commercial |
$3,649.25
|
| Rate for Payer: Cofinity Commercial |
$2,970.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,970.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,394.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,560.85
|
| Rate for Payer: Healthscope Commercial |
$3,818.98
|
| Rate for Payer: Mclaren Medicaid |
$836.62
|
| Rate for Payer: Mclaren Medicare |
$1,560.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,638.89
|
| Rate for Payer: Meridian Medicaid |
$878.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,794.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,606.81
|
| Rate for Payer: PACE Medicare |
$1,482.81
|
| Rate for Payer: PACE SWMI |
$1,560.85
|
| Rate for Payer: PHP Commercial |
$3,606.81
|
| Rate for Payer: PHP Medicare Advantage |
$1,560.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$836.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,758.15
|
| Rate for Payer: Priority Health Medicare |
$1,560.85
|
| Rate for Payer: Priority Health SBD |
$2,673.29
|
| Rate for Payer: Railroad Medicare Medicare |
$1,560.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,393.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,560.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,560.85
|
| Rate for Payer: UHCCP Medicaid |
$878.76
|
| Rate for Payer: VA VA |
$1,560.85
|
|
|
HC TREAT FINGER FRACTURE WITH MANIP EA
|
Facility
|
IP
|
$4,243.31
|
|
|
Service Code
|
CPT 26742
|
| Hospital Charge Code |
76100386
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,673.29 |
| Max. Negotiated Rate |
$3,818.98 |
| Rate for Payer: Aetna Commercial |
$3,606.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,758.15
|
| Rate for Payer: Cash Price |
$3,394.65
|
| Rate for Payer: Cofinity Commercial |
$2,970.32
|
| Rate for Payer: Cofinity Commercial |
$3,649.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,970.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,394.65
|
| Rate for Payer: Healthscope Commercial |
$3,818.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,606.81
|
| Rate for Payer: PHP Commercial |
$3,606.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,758.15
|
| Rate for Payer: Priority Health SBD |
$2,673.29
|
|
|
HC TREPONEMA PALLIDUM AB TOTAL AND RPR
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 0064U
|
| Hospital Charge Code |
30200436
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$88.19 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$32.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.16
|
| Rate for Payer: BCBS Complete |
$17.63
|
| Rate for Payer: BCBS MAPPO |
$31.33
|
| Rate for Payer: BCN Medicare Advantage |
$31.33
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.33
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$16.79
|
| Rate for Payer: Mclaren Medicare |
$31.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.90
|
| Rate for Payer: Meridian Medicaid |
$17.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: PACE Medicare |
$29.76
|
| Rate for Payer: PACE SWMI |
$31.33
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: PHP Medicare Advantage |
$31.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.57
|
| Rate for Payer: Priority Health Medicare |
$31.33
|
| Rate for Payer: Priority Health SBD |
$16.07
|
| Rate for Payer: Railroad Medicare Medicare |
$31.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.33
|
| Rate for Payer: UHC Medicare Advantage |
$31.33
|
| Rate for Payer: UHCCP Medicaid |
$17.64
|
| Rate for Payer: VA VA |
$31.33
|
|
|
HC TREPONEMA PALLIDUM AB TOTAL AND RPR
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 0064U
|
| Hospital Charge Code |
30200436
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.57
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.57
|
| Rate for Payer: Priority Health SBD |
$16.07
|
|
