|
HC TROFILE
|
Facility
|
IP
|
$2,050.20
|
|
|
Service Code
|
CPT 87999
|
| Hospital Charge Code |
30600179
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1,291.63 |
| Max. Negotiated Rate |
$1,845.18 |
| Rate for Payer: Aetna Commercial |
$1,742.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,332.63
|
| Rate for Payer: Cash Price |
$1,640.16
|
| Rate for Payer: Cofinity Commercial |
$1,435.14
|
| Rate for Payer: Cofinity Commercial |
$1,763.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,435.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,640.16
|
| Rate for Payer: Healthscope Commercial |
$1,845.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,742.67
|
| Rate for Payer: PHP Commercial |
$1,742.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,332.63
|
| Rate for Payer: Priority Health SBD |
$1,291.63
|
|
|
HC TROPONIN QUANTITATIVE
|
Facility
|
IP
|
$107.51
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
30100449
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.73 |
| Max. Negotiated Rate |
$96.76 |
| Rate for Payer: Aetna Commercial |
$91.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.88
|
| Rate for Payer: Cash Price |
$86.01
|
| Rate for Payer: Cofinity Commercial |
$75.26
|
| Rate for Payer: Cofinity Commercial |
$92.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.01
|
| Rate for Payer: Healthscope Commercial |
$96.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.38
|
| Rate for Payer: PHP Commercial |
$91.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.88
|
| Rate for Payer: Priority Health SBD |
$67.73
|
|
|
HC TROPONIN QUANTITATIVE
|
Facility
|
OP
|
$107.51
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
30100449
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$96.76 |
| Rate for Payer: Aetna Commercial |
$91.38
|
| Rate for Payer: Aetna Medicare |
$12.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.59
|
| Rate for Payer: BCBS Complete |
$7.02
|
| Rate for Payer: BCBS MAPPO |
$12.47
|
| Rate for Payer: BCN Medicare Advantage |
$12.47
|
| Rate for Payer: Cash Price |
$86.01
|
| Rate for Payer: Cash Price |
$86.01
|
| Rate for Payer: Cofinity Commercial |
$92.46
|
| Rate for Payer: Cofinity Commercial |
$75.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.47
|
| Rate for Payer: Healthscope Commercial |
$96.76
|
| Rate for Payer: Mclaren Medicaid |
$6.68
|
| Rate for Payer: Mclaren Medicare |
$12.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.09
|
| Rate for Payer: Meridian Medicaid |
$7.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.38
|
| Rate for Payer: PACE Medicare |
$11.85
|
| Rate for Payer: PACE SWMI |
$12.47
|
| Rate for Payer: PHP Commercial |
$91.38
|
| Rate for Payer: PHP Medicare Advantage |
$12.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.88
|
| Rate for Payer: Priority Health Medicare |
$12.47
|
| Rate for Payer: Priority Health SBD |
$67.73
|
| Rate for Payer: Railroad Medicare Medicare |
$12.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.47
|
| Rate for Payer: UHC Medicare Advantage |
$12.47
|
| Rate for Payer: UHCCP Medicaid |
$7.02
|
| Rate for Payer: VA VA |
$12.47
|
|
|
HC TROUT IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200064
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| 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 |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| 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 |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC TROUT IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200064
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
|
|
HC TRYPTASE, S
|
Facility
|
IP
|
$66.59
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100602
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.95 |
| Max. Negotiated Rate |
$59.93 |
| Rate for Payer: Aetna Commercial |
$56.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.28
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cofinity Commercial |
$46.61
|
| Rate for Payer: Cofinity Commercial |
$57.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.27
|
| Rate for Payer: Healthscope Commercial |
$59.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.60
|
| Rate for Payer: PHP Commercial |
$56.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.28
|
| Rate for Payer: Priority Health SBD |
$41.95
|
|
|
HC TRYPTASE, S
|
Facility
|
OP
|
$66.59
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100602
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$59.93 |
| Rate for Payer: Aetna Commercial |
$56.60
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: BCBS Complete |
$9.72
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cofinity Commercial |
$57.27
|
| Rate for Payer: Cofinity Commercial |
$46.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$59.93
|
| Rate for Payer: Mclaren Medicaid |
$9.26
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: Meridian Medicaid |
$9.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.60
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$56.60
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.28
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health SBD |
$41.95
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Medicare Advantage |
$17.27
|
| Rate for Payer: UHCCP Medicaid |
$9.72
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC TSH RECEPTOR ANTIBODIES
|
Facility
|
OP
|
$67.63
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100256
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$60.87 |
| Rate for Payer: Aetna Commercial |
$57.49
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: BCBS Complete |
$9.72
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$58.16
|
| Rate for Payer: Cofinity Commercial |
$47.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$60.87
|
| Rate for Payer: Mclaren Medicaid |
$9.26
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: Meridian Medicaid |
$9.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$57.49
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.96
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health SBD |
$42.61
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Medicare Advantage |
$17.27
|
| Rate for Payer: UHCCP Medicaid |
$9.72
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC TSH RECEPTOR ANTIBODIES
|
Facility
|
IP
|
$67.63
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100256
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.61 |
| Max. Negotiated Rate |
$60.87 |
| Rate for Payer: Aetna Commercial |
$57.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.96
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$47.34
|
| Rate for Payer: Cofinity Commercial |
$58.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Healthscope Commercial |
$60.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: PHP Commercial |
$57.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.96
|
| Rate for Payer: Priority Health SBD |
$42.61
|
|
|
HC TSH THYROID STIMULATING HORMONE
|
Facility
|
IP
|
$46.82
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
30100438
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.50 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.43
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$32.77
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health SBD |
$29.50
|
|
|
HC TSH THYROID STIMULATING HORMONE
|
Facility
|
OP
|
$46.82
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
30100438
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$47.29 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna Medicare |
$17.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.00
|
| Rate for Payer: BCBS Complete |
$9.46
|
| Rate for Payer: BCBS MAPPO |
$16.80
|
| Rate for Payer: BCN Medicare Advantage |
$16.80
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Cofinity Commercial |
$32.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.80
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Mclaren Medicaid |
$9.00
|
| Rate for Payer: Mclaren Medicare |
$16.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.64
|
| Rate for Payer: Meridian Medicaid |
$9.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: PACE Medicare |
$15.96
|
| Rate for Payer: PACE SWMI |
$16.80
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: PHP Medicare Advantage |
$16.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health Medicare |
$16.80
|
| Rate for Payer: Priority Health SBD |
$29.50
|
| Rate for Payer: Railroad Medicare Medicare |
$16.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.80
|
| Rate for Payer: UHC Medicare Advantage |
$16.80
|
| Rate for Payer: UHCCP Medicaid |
$9.46
|
| Rate for Payer: VA VA |
$16.80
|
|
|
HC TUBE CHANGE OF CYSTOSTOMY SIMPLE
|
Facility
|
OP
|
$401.88
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
36100253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.14 |
| Max. Negotiated Rate |
$667.69 |
| Rate for Payer: Aetna Commercial |
$341.60
|
| Rate for Payer: Aetna Medicare |
$246.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.50
|
| Rate for Payer: BCBS Complete |
$133.50
|
| Rate for Payer: BCBS MAPPO |
$237.20
|
| Rate for Payer: BCN Medicare Advantage |
$237.20
|
| Rate for Payer: Cash Price |
$321.50
|
| Rate for Payer: Cash Price |
$321.50
|
| Rate for Payer: Cofinity Commercial |
$345.62
|
| Rate for Payer: Cofinity Commercial |
$281.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$281.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.20
|
| Rate for Payer: Healthscope Commercial |
$361.69
|
| Rate for Payer: Mclaren Medicaid |
$127.14
|
| Rate for Payer: Mclaren Medicare |
$237.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.06
|
| Rate for Payer: Meridian Medicaid |
$133.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.60
|
| Rate for Payer: PACE Medicare |
$225.34
|
| Rate for Payer: PACE SWMI |
$237.20
|
| Rate for Payer: PHP Commercial |
$341.60
|
| Rate for Payer: PHP Medicare Advantage |
$237.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.22
|
| Rate for Payer: Priority Health Medicare |
$237.20
|
| Rate for Payer: Priority Health SBD |
$253.18
|
| Rate for Payer: Railroad Medicare Medicare |
$237.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$667.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$237.20
|
| Rate for Payer: UHC Medicare Advantage |
$237.20
|
| Rate for Payer: UHCCP Medicaid |
$133.54
|
| Rate for Payer: VA VA |
$237.20
|
|
|
HC TUBE CHANGE OF CYSTOSTOMY SIMPLE
|
Facility
|
IP
|
$401.88
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
36100253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.18 |
| Max. Negotiated Rate |
$361.69 |
| Rate for Payer: Aetna Commercial |
$341.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.22
|
| Rate for Payer: Cash Price |
$321.50
|
| Rate for Payer: Cofinity Commercial |
$281.32
|
| Rate for Payer: Cofinity Commercial |
$345.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$281.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.50
|
| Rate for Payer: Healthscope Commercial |
$361.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.60
|
| Rate for Payer: PHP Commercial |
$341.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.22
|
| Rate for Payer: Priority Health SBD |
$253.18
|
|
|
HC TUBE CHANGE URETERO VIA ILEALO
|
Facility
|
IP
|
$2,074.51
|
|
|
Service Code
|
CPT 50688
|
| Hospital Charge Code |
36100248
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,306.94 |
| Max. Negotiated Rate |
$1,867.06 |
| Rate for Payer: Aetna Commercial |
$1,763.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,348.43
|
| Rate for Payer: Cash Price |
$1,659.61
|
| Rate for Payer: Cofinity Commercial |
$1,452.16
|
| Rate for Payer: Cofinity Commercial |
$1,784.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,452.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,659.61
|
| Rate for Payer: Healthscope Commercial |
$1,867.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,763.33
|
| Rate for Payer: PHP Commercial |
$1,763.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,348.43
|
| Rate for Payer: Priority Health SBD |
$1,306.94
|
|
|
HC TUBE CHANGE URETERO VIA ILEALO
|
Facility
|
OP
|
$2,074.51
|
|
|
Service Code
|
CPT 50688
|
| Hospital Charge Code |
36100248
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,070.86 |
| Max. Negotiated Rate |
$5,623.80 |
| Rate for Payer: Aetna Commercial |
$1,763.33
|
| Rate for Payer: Aetna Medicare |
$2,077.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,348.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,497.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,497.34
|
| Rate for Payer: BCBS Complete |
$1,124.40
|
| Rate for Payer: BCBS MAPPO |
$1,997.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,997.87
|
| Rate for Payer: Cash Price |
$1,659.61
|
| Rate for Payer: Cash Price |
$1,659.61
|
| Rate for Payer: Cofinity Commercial |
$1,784.08
|
| Rate for Payer: Cofinity Commercial |
$1,452.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,452.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,659.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,997.87
|
| Rate for Payer: Healthscope Commercial |
$1,867.06
|
| Rate for Payer: Mclaren Medicaid |
$1,070.86
|
| Rate for Payer: Mclaren Medicare |
$1,997.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,097.76
|
| Rate for Payer: Meridian Medicaid |
$1,124.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,297.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,763.33
|
| Rate for Payer: PACE Medicare |
$1,897.98
|
| Rate for Payer: PACE SWMI |
$1,997.87
|
| Rate for Payer: PHP Commercial |
$1,763.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,997.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,070.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,348.43
|
| Rate for Payer: Priority Health Medicare |
$1,997.87
|
| Rate for Payer: Priority Health SBD |
$1,306.94
|
| Rate for Payer: Railroad Medicare Medicare |
$1,997.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,623.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,997.87
|
| Rate for Payer: UHC Medicare Advantage |
$1,997.87
|
| Rate for Payer: UHCCP Medicaid |
$1,124.80
|
| Rate for Payer: VA VA |
$1,997.87
|
|
|
HC TUBE CHECK WITH FLUORO
|
Facility
|
OP
|
$219.07
|
|
|
Service Code
|
CPT 49465
|
| Hospital Charge Code |
36100233
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$663.58 |
| Rate for Payer: Aetna Commercial |
$186.21
|
| Rate for Payer: Aetna Medicare |
$245.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| Rate for Payer: Cash Price |
$175.26
|
| Rate for Payer: Cash Price |
$175.26
|
| Rate for Payer: Cofinity Commercial |
$188.40
|
| Rate for Payer: Cofinity Commercial |
$153.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$153.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$197.16
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.21
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$186.21
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.40
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health SBD |
$138.01
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$663.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$132.72
|
| Rate for Payer: VA VA |
$235.74
|
|
|
HC TUBE CHECK WITH FLUORO
|
Facility
|
IP
|
$219.07
|
|
|
Service Code
|
CPT 49465
|
| Hospital Charge Code |
36100233
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$138.01 |
| Max. Negotiated Rate |
$197.16 |
| Rate for Payer: Aetna Commercial |
$186.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.40
|
| Rate for Payer: Cash Price |
$175.26
|
| Rate for Payer: Cofinity Commercial |
$153.35
|
| Rate for Payer: Cofinity Commercial |
$188.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$153.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.26
|
| Rate for Payer: Healthscope Commercial |
$197.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.21
|
| Rate for Payer: PHP Commercial |
$186.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.40
|
| Rate for Payer: Priority Health SBD |
$138.01
|
|
|
HC TUBE PLACEMENT NASOG OR OROG W FLUO
|
Facility
|
OP
|
$480.87
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
36100191
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$208.60 |
| Max. Negotiated Rate |
$1,095.50 |
| Rate for Payer: Aetna Commercial |
$408.74
|
| Rate for Payer: Aetna Medicare |
$404.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$312.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$486.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$486.48
|
| Rate for Payer: BCBS Complete |
$219.03
|
| Rate for Payer: BCBS MAPPO |
$389.18
|
| Rate for Payer: BCN Medicare Advantage |
$389.18
|
| Rate for Payer: Cash Price |
$384.70
|
| Rate for Payer: Cash Price |
$384.70
|
| Rate for Payer: Cofinity Commercial |
$336.61
|
| Rate for Payer: Cofinity Commercial |
$413.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$336.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$384.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.18
|
| Rate for Payer: Healthscope Commercial |
$432.78
|
| Rate for Payer: Mclaren Medicaid |
$208.60
|
| Rate for Payer: Mclaren Medicare |
$389.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$408.64
|
| Rate for Payer: Meridian Medicaid |
$219.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$447.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$408.74
|
| Rate for Payer: PACE Medicare |
$369.72
|
| Rate for Payer: PACE SWMI |
$389.18
|
| Rate for Payer: PHP Commercial |
$408.74
|
| Rate for Payer: PHP Medicare Advantage |
$389.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.57
|
| Rate for Payer: Priority Health Medicare |
$389.18
|
| Rate for Payer: Priority Health SBD |
$302.95
|
| Rate for Payer: Railroad Medicare Medicare |
$389.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,095.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.18
|
| Rate for Payer: UHC Medicare Advantage |
$389.18
|
| Rate for Payer: UHCCP Medicaid |
$219.11
|
| Rate for Payer: VA VA |
$389.18
|
|
|
HC TUBE PLACEMENT NASOG OR OROG W FLUO
|
Facility
|
IP
|
$480.87
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
36100191
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$302.95 |
| Max. Negotiated Rate |
$432.78 |
| Rate for Payer: Aetna Commercial |
$408.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$312.57
|
| Rate for Payer: Cash Price |
$384.70
|
| Rate for Payer: Cofinity Commercial |
$336.61
|
| Rate for Payer: Cofinity Commercial |
$413.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$336.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$384.70
|
| Rate for Payer: Healthscope Commercial |
$432.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$408.74
|
| Rate for Payer: PHP Commercial |
$408.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.57
|
| Rate for Payer: Priority Health SBD |
$302.95
|
|
|
HC TUBE REPLACEMENT BY PHYSICIAN
|
Facility
|
IP
|
$309.38
|
|
| Hospital Charge Code |
45000055
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$194.91 |
| Max. Negotiated Rate |
$278.44 |
| Rate for Payer: Aetna Commercial |
$262.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.10
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cofinity Commercial |
$216.57
|
| Rate for Payer: Cofinity Commercial |
$266.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.50
|
| Rate for Payer: Healthscope Commercial |
$278.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.97
|
| Rate for Payer: PHP Commercial |
$262.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.10
|
| Rate for Payer: Priority Health SBD |
$194.91
|
|
|
HC TUBE REPLACEMENT BY PHYSICIAN
|
Facility
|
OP
|
$309.38
|
|
| Hospital Charge Code |
45000055
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$278.44 |
| Rate for Payer: Aetna Commercial |
$262.97
|
| Rate for Payer: Aetna Medicare |
$154.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.10
|
| Rate for Payer: BCBS Complete |
$123.75
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cofinity Commercial |
$216.57
|
| Rate for Payer: Cofinity Commercial |
$266.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.50
|
| Rate for Payer: Healthscope Commercial |
$278.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.97
|
| Rate for Payer: PHP Commercial |
$262.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.10
|
| Rate for Payer: Priority Health SBD |
$194.91
|
|
|
HC TUBING 1/2
|
Facility
|
IP
|
$18.36
|
|
| Hospital Charge Code |
27000663
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$16.52 |
| Rate for Payer: Aetna Commercial |
$15.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.93
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Cofinity Commercial |
$12.85
|
| Rate for Payer: Cofinity Commercial |
$15.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.69
|
| Rate for Payer: Healthscope Commercial |
$16.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.61
|
| Rate for Payer: PHP Commercial |
$15.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.93
|
| Rate for Payer: Priority Health SBD |
$11.57
|
|
|
HC TUBING 1/2
|
Facility
|
OP
|
$18.36
|
|
| Hospital Charge Code |
27000663
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.34 |
| Max. Negotiated Rate |
$16.52 |
| Rate for Payer: Aetna Commercial |
$15.61
|
| Rate for Payer: Aetna Medicare |
$9.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.93
|
| Rate for Payer: BCBS Complete |
$7.34
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Cofinity Commercial |
$12.85
|
| Rate for Payer: Cofinity Commercial |
$15.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.69
|
| Rate for Payer: Healthscope Commercial |
$16.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.61
|
| Rate for Payer: PHP Commercial |
$15.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.93
|
| Rate for Payer: Priority Health SBD |
$11.57
|
|
|
HC TUBING 1/4
|
Facility
|
OP
|
$24.48
|
|
| Hospital Charge Code |
27000162
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: Aetna Medicare |
$12.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.91
|
| Rate for Payer: BCBS Complete |
$9.79
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.81
|
| Rate for Payer: PHP Commercial |
$20.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.91
|
| Rate for Payer: Priority Health SBD |
$15.42
|
|
|
HC TUBING 1/4
|
Facility
|
IP
|
$24.48
|
|
| Hospital Charge Code |
27000162
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.42 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.91
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.81
|
| Rate for Payer: PHP Commercial |
$20.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.91
|
| Rate for Payer: Priority Health SBD |
$15.42
|
|
