|
HC APPLY LC SKIN SUB 1ST 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$2,520.30
|
|
|
Service Code
|
HCPCS 15273
|
| Hospital Charge Code |
76100051
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,587.79 |
| Max. Negotiated Rate |
$2,268.27 |
| Rate for Payer: Aetna Commercial |
$2,142.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,638.20
|
| Rate for Payer: Cash Price |
$2,016.24
|
| Rate for Payer: Cofinity Commercial |
$1,764.21
|
| Rate for Payer: Cofinity Commercial |
$2,167.46
|
| Rate for Payer: Healthscope Commercial |
$2,268.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,142.26
|
| Rate for Payer: PHP Commercial |
$2,142.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,764.21
|
| Rate for Payer: Priority Health SBD |
$1,587.79
|
|
|
HC APPLY LC SKIN SUB 1ST 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$2,553.43
|
|
|
Service Code
|
HCPCS 15275
|
| Hospital Charge Code |
76100053
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,608.66 |
| Max. Negotiated Rate |
$2,298.09 |
| Rate for Payer: Aetna Commercial |
$2,170.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,659.73
|
| Rate for Payer: Cash Price |
$2,042.74
|
| Rate for Payer: Cofinity Commercial |
$1,787.40
|
| Rate for Payer: Cofinity Commercial |
$2,195.95
|
| Rate for Payer: Healthscope Commercial |
$2,298.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,170.42
|
| Rate for Payer: PHP Commercial |
$2,170.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,787.40
|
| Rate for Payer: Priority Health SBD |
$1,608.66
|
|
|
HC APPLY LC SKIN SUB 1ST 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$2,553.43
|
|
|
Service Code
|
HCPCS 15275
|
| Hospital Charge Code |
76100053
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.70 |
| Max. Negotiated Rate |
$5,175.07 |
| Rate for Payer: Aetna Commercial |
$2,170.42
|
| Rate for Payer: Aetna Medicare |
$1,687.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,659.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,028.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,028.30
|
| Rate for Payer: BCBS Complete |
$932.04
|
| Rate for Payer: BCBS MAPPO |
$1,622.64
|
| Rate for Payer: BCBS Trust/PPO |
$922.68
|
| Rate for Payer: BCN Medicare Advantage |
$1,622.64
|
| Rate for Payer: Cash Price |
$2,042.74
|
| Rate for Payer: Cash Price |
$2,042.74
|
| Rate for Payer: Cofinity Commercial |
$1,787.40
|
| Rate for Payer: Cofinity Commercial |
$2,195.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,622.64
|
| Rate for Payer: Healthscope Commercial |
$2,298.09
|
| Rate for Payer: Mclaren Medicaid |
$887.58
|
| Rate for Payer: Mclaren Medicare |
$1,622.64
|
| Rate for Payer: Meridian Medicaid |
$932.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,703.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,866.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,170.42
|
| Rate for Payer: PACE Medicare |
$1,541.51
|
| Rate for Payer: PACE SWMI |
$1,622.64
|
| Rate for Payer: PHP Commercial |
$2,170.42
|
| Rate for Payer: PHP Medicare Advantage |
$1,622.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$887.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,787.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,175.07
|
| Rate for Payer: Priority Health Medicare |
$1,622.64
|
| Rate for Payer: Priority Health Narrow Network |
$4,140.06
|
| Rate for Payer: Priority Health SBD |
$1,608.66
|
| Rate for Payer: Railroad Medicare Medicare |
$1,622.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,622.64
|
| Rate for Payer: UHC Exchange |
$90.70
|
| Rate for Payer: UHC Medicare Advantage |
$1,671.32
|
| Rate for Payer: VA VA |
$1,622.64
|
|
|
HC APPLY LC SKIN SUB 1ST 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$2,340.63
|
|
|
Service Code
|
HCPCS 15271
|
| Hospital Charge Code |
76100049
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,474.60 |
| Max. Negotiated Rate |
$2,106.57 |
| Rate for Payer: Aetna Commercial |
$1,989.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,521.41
|
| Rate for Payer: Cash Price |
$1,872.50
|
| Rate for Payer: Cofinity Commercial |
$1,638.44
|
| Rate for Payer: Cofinity Commercial |
$2,012.94
|
| Rate for Payer: Healthscope Commercial |
$2,106.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,989.54
|
| Rate for Payer: PHP Commercial |
$1,989.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,638.44
|
| Rate for Payer: Priority Health SBD |
$1,474.60
|
|
|
HC APPLY LC SKIN SUB 1ST 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$2,340.63
|
|
|
Service Code
|
HCPCS 15271
|
| Hospital Charge Code |
76100049
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.86 |
| Max. Negotiated Rate |
$5,175.07 |
| Rate for Payer: Aetna Commercial |
$1,989.54
|
| Rate for Payer: Aetna Medicare |
$1,687.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,521.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,028.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,028.30
|
| Rate for Payer: BCBS Complete |
$932.04
|
| Rate for Payer: BCBS MAPPO |
$1,622.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,152.52
|
| Rate for Payer: BCN Medicare Advantage |
$1,622.64
|
| Rate for Payer: Cash Price |
$1,872.50
|
| Rate for Payer: Cash Price |
$1,872.50
|
| Rate for Payer: Cofinity Commercial |
$2,012.94
|
| Rate for Payer: Cofinity Commercial |
$1,638.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,622.64
|
| Rate for Payer: Healthscope Commercial |
$2,106.57
|
| Rate for Payer: Mclaren Medicaid |
$887.58
|
| Rate for Payer: Mclaren Medicare |
$1,622.64
|
| Rate for Payer: Meridian Medicaid |
$932.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,703.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,866.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,989.54
|
| Rate for Payer: PACE Medicare |
$1,541.51
|
| Rate for Payer: PACE SWMI |
$1,622.64
|
| Rate for Payer: PHP Commercial |
$1,989.54
|
| Rate for Payer: PHP Medicare Advantage |
$1,622.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$887.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,638.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,175.07
|
| Rate for Payer: Priority Health Medicare |
$1,622.64
|
| Rate for Payer: Priority Health Narrow Network |
$4,140.06
|
| Rate for Payer: Priority Health SBD |
$1,474.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,622.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,622.64
|
| Rate for Payer: UHC Exchange |
$81.86
|
| Rate for Payer: UHC Medicare Advantage |
$1,671.32
|
| Rate for Payer: VA VA |
$1,622.64
|
|
|
HC APPLY LC SKIN SUB ADDL 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$909.21
|
|
|
Service Code
|
HCPCS 15278
|
| Hospital Charge Code |
76100056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.03 |
| Max. Negotiated Rate |
$818.29 |
| Rate for Payer: Aetna Commercial |
$772.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$590.99
|
| Rate for Payer: BCBS Complete |
$363.68
|
| Rate for Payer: BCBS Trust/PPO |
$171.81
|
| Rate for Payer: Cash Price |
$727.37
|
| Rate for Payer: Cash Price |
$727.37
|
| Rate for Payer: Cofinity Commercial |
$636.45
|
| Rate for Payer: Cofinity Commercial |
$781.92
|
| Rate for Payer: Healthscope Commercial |
$818.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$772.83
|
| Rate for Payer: PHP Commercial |
$772.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$636.45
|
| Rate for Payer: Priority Health SBD |
$572.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.43
|
| Rate for Payer: UHC Exchange |
$54.03
|
|
|
HC APPLY LC SKIN SUB ADDL 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$909.21
|
|
|
Service Code
|
HCPCS 15278
|
| Hospital Charge Code |
76100056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$572.80 |
| Max. Negotiated Rate |
$818.29 |
| Rate for Payer: Aetna Commercial |
$772.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$590.99
|
| Rate for Payer: Cash Price |
$727.37
|
| Rate for Payer: Cofinity Commercial |
$636.45
|
| Rate for Payer: Cofinity Commercial |
$781.92
|
| Rate for Payer: Healthscope Commercial |
$818.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$772.83
|
| Rate for Payer: PHP Commercial |
$772.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$636.45
|
| Rate for Payer: Priority Health SBD |
$572.80
|
|
|
HC APPLY LC SKIN SUB ADDL 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$909.21
|
|
|
Service Code
|
HCPCS 15274
|
| Hospital Charge Code |
76100052
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.22 |
| Max. Negotiated Rate |
$818.29 |
| Rate for Payer: Aetna Commercial |
$772.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$590.99
|
| Rate for Payer: BCBS Complete |
$363.68
|
| Rate for Payer: BCBS Trust/PPO |
$143.65
|
| Rate for Payer: Cash Price |
$727.37
|
| Rate for Payer: Cash Price |
$727.37
|
| Rate for Payer: Cofinity Commercial |
$781.92
|
| Rate for Payer: Cofinity Commercial |
$636.45
|
| Rate for Payer: Healthscope Commercial |
$818.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$772.83
|
| Rate for Payer: PHP Commercial |
$772.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$636.45
|
| Rate for Payer: Priority Health SBD |
$572.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.54
|
| Rate for Payer: UHC Exchange |
$43.22
|
|
|
HC APPLY LC SKIN SUB ADDL 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$909.21
|
|
|
Service Code
|
HCPCS 15274
|
| Hospital Charge Code |
76100052
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$572.80 |
| Max. Negotiated Rate |
$818.29 |
| Rate for Payer: Aetna Commercial |
$772.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$590.99
|
| Rate for Payer: Cash Price |
$727.37
|
| Rate for Payer: Cofinity Commercial |
$781.92
|
| Rate for Payer: Cofinity Commercial |
$636.45
|
| Rate for Payer: Healthscope Commercial |
$818.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$772.83
|
| Rate for Payer: PHP Commercial |
$772.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$636.45
|
| Rate for Payer: Priority Health SBD |
$572.80
|
|
|
HC APPLY LC SKIN SUB ADDL 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$696.66
|
|
|
Service Code
|
HCPCS 15276
|
| Hospital Charge Code |
76100054
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.23 |
| Max. Negotiated Rate |
$626.99 |
| Rate for Payer: Aetna Commercial |
$592.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$452.83
|
| Rate for Payer: BCBS Complete |
$278.66
|
| Rate for Payer: BCBS Trust/PPO |
$69.72
|
| Rate for Payer: Cash Price |
$557.33
|
| Rate for Payer: Cash Price |
$557.33
|
| Rate for Payer: Cofinity Commercial |
$599.13
|
| Rate for Payer: Cofinity Commercial |
$487.66
|
| Rate for Payer: Healthscope Commercial |
$626.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$592.16
|
| Rate for Payer: PHP Commercial |
$592.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.66
|
| Rate for Payer: Priority Health SBD |
$438.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.65
|
| Rate for Payer: UHC Exchange |
$24.23
|
|
|
HC APPLY LC SKIN SUB ADDL 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$696.66
|
|
|
Service Code
|
HCPCS 15276
|
| Hospital Charge Code |
76100054
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$438.90 |
| Max. Negotiated Rate |
$626.99 |
| Rate for Payer: Aetna Commercial |
$592.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$452.83
|
| Rate for Payer: Cash Price |
$557.33
|
| Rate for Payer: Cofinity Commercial |
$487.66
|
| Rate for Payer: Cofinity Commercial |
$599.13
|
| Rate for Payer: Healthscope Commercial |
$626.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$592.16
|
| Rate for Payer: PHP Commercial |
$592.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.66
|
| Rate for Payer: Priority Health SBD |
$438.90
|
|
|
HC APPLY LC SKIN SUB ADDL 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$696.66
|
|
|
Service Code
|
HCPCS 15272
|
| Hospital Charge Code |
76100050
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$438.90 |
| Max. Negotiated Rate |
$626.99 |
| Rate for Payer: Aetna Commercial |
$592.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$452.83
|
| Rate for Payer: Cash Price |
$557.33
|
| Rate for Payer: Cofinity Commercial |
$487.66
|
| Rate for Payer: Cofinity Commercial |
$599.13
|
| Rate for Payer: Healthscope Commercial |
$626.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$592.16
|
| Rate for Payer: PHP Commercial |
$592.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.66
|
| Rate for Payer: Priority Health SBD |
$438.90
|
|
|
HC APPLY LC SKIN SUB ADDL 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$696.66
|
|
|
Service Code
|
HCPCS 15272
|
| Hospital Charge Code |
76100050
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$16.37 |
| Max. Negotiated Rate |
$626.99 |
| Rate for Payer: Aetna Commercial |
$592.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$452.83
|
| Rate for Payer: BCBS Complete |
$278.66
|
| Rate for Payer: BCBS Trust/PPO |
$54.22
|
| Rate for Payer: Cash Price |
$557.33
|
| Rate for Payer: Cash Price |
$557.33
|
| Rate for Payer: Cofinity Commercial |
$599.13
|
| Rate for Payer: Cofinity Commercial |
$487.66
|
| Rate for Payer: Healthscope Commercial |
$626.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$592.16
|
| Rate for Payer: PHP Commercial |
$592.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.66
|
| Rate for Payer: Priority Health SBD |
$438.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.01
|
| Rate for Payer: UHC Exchange |
$16.37
|
|
|
HC APPLY SPLINT/CAST COMPLEX
|
Facility
|
IP
|
$322.41
|
|
| Hospital Charge Code |
45000027
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$203.12 |
| Max. Negotiated Rate |
$290.17 |
| Rate for Payer: Aetna Commercial |
$274.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.57
|
| Rate for Payer: Cash Price |
$257.93
|
| Rate for Payer: Cofinity Commercial |
$277.27
|
| Rate for Payer: Cofinity Commercial |
$225.69
|
| Rate for Payer: Healthscope Commercial |
$290.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.05
|
| Rate for Payer: PHP Commercial |
$274.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.69
|
| Rate for Payer: Priority Health SBD |
$203.12
|
|
|
HC APPLY SPLINT/CAST COMPLEX
|
Facility
|
OP
|
$322.41
|
|
| Hospital Charge Code |
45000027
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$128.96 |
| Max. Negotiated Rate |
$290.17 |
| Rate for Payer: Aetna Commercial |
$274.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.57
|
| Rate for Payer: BCBS Complete |
$128.96
|
| Rate for Payer: Cash Price |
$257.93
|
| Rate for Payer: Cofinity Commercial |
$225.69
|
| Rate for Payer: Cofinity Commercial |
$277.27
|
| Rate for Payer: Healthscope Commercial |
$290.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.05
|
| Rate for Payer: PHP Commercial |
$274.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.69
|
| Rate for Payer: Priority Health SBD |
$203.12
|
|
|
HC APPLY SPLINT/CAST SIMPLE
|
Facility
|
IP
|
$193.15
|
|
| Hospital Charge Code |
45000028
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$173.84 |
| Rate for Payer: Aetna Commercial |
$164.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.55
|
| Rate for Payer: Cash Price |
$154.52
|
| Rate for Payer: Cofinity Commercial |
$135.20
|
| Rate for Payer: Cofinity Commercial |
$166.11
|
| Rate for Payer: Healthscope Commercial |
$173.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$164.18
|
| Rate for Payer: PHP Commercial |
$164.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.20
|
| Rate for Payer: Priority Health SBD |
$121.68
|
|
|
HC APPLY SPLINT/CAST SIMPLE
|
Facility
|
OP
|
$193.15
|
|
| Hospital Charge Code |
45000028
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$77.26 |
| Max. Negotiated Rate |
$173.84 |
| Rate for Payer: Aetna Commercial |
$164.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.55
|
| Rate for Payer: BCBS Complete |
$77.26
|
| Rate for Payer: Cash Price |
$154.52
|
| Rate for Payer: Cofinity Commercial |
$135.20
|
| Rate for Payer: Cofinity Commercial |
$166.11
|
| Rate for Payer: Healthscope Commercial |
$173.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$164.18
|
| Rate for Payer: PHP Commercial |
$164.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.20
|
| Rate for Payer: Priority Health SBD |
$121.68
|
|
|
HC APT DOWNEY TEST
|
Facility
|
OP
|
$90.40
|
|
|
Service Code
|
CPT 83033
|
| Hospital Charge Code |
30100237
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$81.36 |
| Rate for Payer: Aetna Commercial |
$76.84
|
| Rate for Payer: Aetna Medicare |
$8.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.00
|
| Rate for Payer: BCBS Complete |
$4.60
|
| Rate for Payer: BCBS MAPPO |
$8.00
|
| Rate for Payer: BCBS Trust/PPO |
$6.26
|
| Rate for Payer: BCN Medicare Advantage |
$8.00
|
| Rate for Payer: Cash Price |
$72.32
|
| Rate for Payer: Cash Price |
$72.32
|
| Rate for Payer: Cofinity Commercial |
$77.74
|
| Rate for Payer: Cofinity Commercial |
$63.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.00
|
| Rate for Payer: Healthscope Commercial |
$81.36
|
| Rate for Payer: Mclaren Medicaid |
$4.38
|
| Rate for Payer: Mclaren Medicare |
$8.00
|
| Rate for Payer: Meridian Medicaid |
$4.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.84
|
| Rate for Payer: PACE Medicare |
$7.60
|
| Rate for Payer: PACE SWMI |
$8.00
|
| Rate for Payer: PHP Commercial |
$76.84
|
| Rate for Payer: PHP Medicare Advantage |
$8.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.28
|
| Rate for Payer: Priority Health Medicare |
$8.00
|
| Rate for Payer: Priority Health SBD |
$56.95
|
| Rate for Payer: Railroad Medicare Medicare |
$8.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.60
|
| Rate for Payer: UHC Core |
$10.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.00
|
| Rate for Payer: UHC Exchange |
$8.00
|
| Rate for Payer: UHC Medicare Advantage |
$8.24
|
| Rate for Payer: VA VA |
$8.00
|
|
|
HC APT DOWNEY TEST
|
Facility
|
IP
|
$90.40
|
|
|
Service Code
|
CPT 83033
|
| Hospital Charge Code |
30100237
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.95 |
| Max. Negotiated Rate |
$81.36 |
| Rate for Payer: Aetna Commercial |
$76.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.76
|
| Rate for Payer: Cash Price |
$72.32
|
| Rate for Payer: Cofinity Commercial |
$63.28
|
| Rate for Payer: Cofinity Commercial |
$77.74
|
| Rate for Payer: Healthscope Commercial |
$81.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.84
|
| Rate for Payer: PHP Commercial |
$76.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.28
|
| Rate for Payer: Priority Health SBD |
$56.95
|
|
|
HC APTT
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
30500063
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health SBD |
$16.06
|
|
|
HC APTT
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
30500063
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.29 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$6.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.51
|
| Rate for Payer: BCBS Complete |
$3.45
|
| Rate for Payer: BCBS MAPPO |
$6.01
|
| Rate for Payer: BCBS Trust/PPO |
$4.71
|
| Rate for Payer: BCN Medicare Advantage |
$6.01
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.01
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$3.29
|
| Rate for Payer: Mclaren Medicare |
$6.01
|
| Rate for Payer: Meridian Medicaid |
$3.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PACE Medicare |
$5.71
|
| Rate for Payer: PACE SWMI |
$6.01
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: PHP Medicare Advantage |
$6.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health Medicare |
$6.01
|
| Rate for Payer: Priority Health SBD |
$16.06
|
| Rate for Payer: Railroad Medicare Medicare |
$6.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.21
|
| Rate for Payer: UHC Core |
$10.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.01
|
| Rate for Payer: UHC Exchange |
$6.01
|
| Rate for Payer: UHC Medicare Advantage |
$6.19
|
| Rate for Payer: VA VA |
$6.01
|
|
|
HC APTT MIXING STUDY
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
30500064
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$3.72
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$5.06
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cofinity Commercial |
$68.60
|
| Rate for Payer: Cofinity Commercial |
$84.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$88.20
|
| Rate for Payer: Mclaren Medicaid |
$3.54
|
| Rate for Payer: Mclaren Medicare |
$6.47
|
| Rate for Payer: Meridian Medicaid |
$3.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.30
|
| Rate for Payer: PACE Medicare |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$83.30
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.60
|
| Rate for Payer: Priority Health Medicare |
$6.47
|
| Rate for Payer: Priority Health SBD |
$61.74
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.76
|
| Rate for Payer: UHC Core |
$11.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.47
|
| Rate for Payer: UHC Exchange |
$6.47
|
| Rate for Payer: UHC Medicare Advantage |
$6.66
|
| Rate for Payer: VA VA |
$6.47
|
|
|
HC APTT MIXING STUDY
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
30500064
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$61.74 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.70
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cofinity Commercial |
$68.60
|
| Rate for Payer: Cofinity Commercial |
$84.28
|
| Rate for Payer: Healthscope Commercial |
$88.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.30
|
| Rate for Payer: PHP Commercial |
$83.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.60
|
| Rate for Payer: Priority Health SBD |
$61.74
|
|
|
HC AQUATIC THERAPY EA 15 MIN
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
42000022
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.56 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: BCBS Complete |
$36.72
|
| Rate for Payer: BCBS Trust/PPO |
$24.56
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.03
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.26
|
| Rate for Payer: Priority Health SBD |
$57.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.62
|
| Rate for Payer: UHC Exchange |
$36.02
|
|
|
HC AQUATIC THERAPY EA 15 MIN
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
42000022
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$57.83 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.03
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.26
|
| Rate for Payer: Priority Health SBD |
$57.83
|
|
