|
HC ATHERECT ILIAC ARTERY EA VE
|
Facility
|
IP
|
$11,848.47
|
|
|
Service Code
|
CPT 0238T
|
| Hospital Charge Code |
36100302
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,464.54 |
| Max. Negotiated Rate |
$10,663.62 |
| Rate for Payer: Aetna Commercial |
$10,071.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,701.51
|
| Rate for Payer: Cash Price |
$9,478.78
|
| Rate for Payer: Cofinity Commercial |
$8,293.93
|
| Rate for Payer: Cofinity Commercial |
$10,189.68
|
| Rate for Payer: Healthscope Commercial |
$10,663.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,071.20
|
| Rate for Payer: PHP Commercial |
$10,071.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,293.93
|
| Rate for Payer: Priority Health SBD |
$7,464.54
|
|
|
HC ATHERECTOMY RENAL ARTERY
|
Facility
|
IP
|
$12,716.17
|
|
|
Service Code
|
CPT 0234T
|
| Hospital Charge Code |
36100304
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,011.19 |
| Max. Negotiated Rate |
$11,444.55 |
| Rate for Payer: Aetna Commercial |
$10,808.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,265.51
|
| Rate for Payer: Cash Price |
$10,172.94
|
| Rate for Payer: Cofinity Commercial |
$8,901.32
|
| Rate for Payer: Cofinity Commercial |
$10,935.91
|
| Rate for Payer: Healthscope Commercial |
$11,444.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,808.74
|
| Rate for Payer: PHP Commercial |
$10,808.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,901.32
|
| Rate for Payer: Priority Health SBD |
$8,011.19
|
|
|
HC ATHERECTOMY RENAL ARTERY
|
Facility
|
OP
|
$12,716.17
|
|
|
Service Code
|
CPT 0234T
|
| Hospital Charge Code |
36100304
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,076.51 |
| Max. Negotiated Rate |
$31,275.01 |
| Rate for Payer: Aetna Commercial |
$10,808.74
|
| Rate for Payer: Aetna Medicare |
$10,180.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,265.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,235.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,235.94
|
| Rate for Payer: BCBS Complete |
$5,622.66
|
| Rate for Payer: BCBS MAPPO |
$9,788.75
|
| Rate for Payer: BCBS Trust/PPO |
$5,076.51
|
| Rate for Payer: BCN Medicare Advantage |
$9,788.75
|
| Rate for Payer: Cash Price |
$10,172.94
|
| Rate for Payer: Cash Price |
$10,172.94
|
| Rate for Payer: Cofinity Commercial |
$8,901.32
|
| Rate for Payer: Cofinity Commercial |
$10,935.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,788.75
|
| Rate for Payer: Healthscope Commercial |
$11,444.55
|
| Rate for Payer: Mclaren Medicaid |
$5,354.45
|
| Rate for Payer: Mclaren Medicare |
$9,788.75
|
| Rate for Payer: Meridian Medicaid |
$5,622.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,278.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,257.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,808.74
|
| Rate for Payer: PACE Medicare |
$9,299.31
|
| Rate for Payer: PACE SWMI |
$9,788.75
|
| Rate for Payer: PHP Commercial |
$10,808.74
|
| Rate for Payer: PHP Medicare Advantage |
$9,788.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,354.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,901.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31,275.01
|
| Rate for Payer: Priority Health Medicare |
$9,788.75
|
| Rate for Payer: Priority Health Narrow Network |
$25,020.01
|
| Rate for Payer: Priority Health SBD |
$8,011.19
|
| Rate for Payer: Railroad Medicare Medicare |
$9,788.75
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,788.75
|
| Rate for Payer: UHC Medicare Advantage |
$10,082.41
|
| Rate for Payer: VA VA |
$9,788.75
|
|
|
HC ATHERECT VISCERAL EACH VESS
|
Facility
|
OP
|
$12,716.17
|
|
|
Service Code
|
CPT 0235T
|
| Hospital Charge Code |
36100303
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$291.21 |
| Max. Negotiated Rate |
$11,444.55 |
| Rate for Payer: Aetna Commercial |
$10,808.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,265.51
|
| Rate for Payer: BCBS Complete |
$5,086.47
|
| Rate for Payer: BCBS Trust/PPO |
$291.21
|
| Rate for Payer: Cash Price |
$10,172.94
|
| Rate for Payer: Cash Price |
$10,172.94
|
| Rate for Payer: Cofinity Commercial |
$8,901.32
|
| Rate for Payer: Cofinity Commercial |
$10,935.91
|
| Rate for Payer: Healthscope Commercial |
$11,444.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,808.74
|
| Rate for Payer: PHP Commercial |
$10,808.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,901.32
|
| Rate for Payer: Priority Health SBD |
$8,011.19
|
| Rate for Payer: UHC Core |
$3,138.00
|
|
|
HC ATHERECT VISCERAL EACH VESS
|
Facility
|
IP
|
$12,716.17
|
|
|
Service Code
|
CPT 0235T
|
| Hospital Charge Code |
36100303
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,011.19 |
| Max. Negotiated Rate |
$11,444.55 |
| Rate for Payer: Aetna Commercial |
$10,808.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,265.51
|
| Rate for Payer: Cash Price |
$10,172.94
|
| Rate for Payer: Cofinity Commercial |
$10,935.91
|
| Rate for Payer: Cofinity Commercial |
$8,901.32
|
| Rate for Payer: Healthscope Commercial |
$11,444.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,808.74
|
| Rate for Payer: PHP Commercial |
$10,808.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,901.32
|
| Rate for Payer: Priority Health SBD |
$8,011.19
|
|
|
HC ATS NON OPEN HEART
|
Facility
|
IP
|
$2,206.32
|
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,389.98 |
| Max. Negotiated Rate |
$1,985.69 |
| Rate for Payer: Aetna Commercial |
$1,875.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,434.11
|
| Rate for Payer: Cash Price |
$1,765.06
|
| Rate for Payer: Cofinity Commercial |
$1,544.42
|
| Rate for Payer: Cofinity Commercial |
$1,897.44
|
| Rate for Payer: Healthscope Commercial |
$1,985.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,875.37
|
| Rate for Payer: PHP Commercial |
$1,875.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,544.42
|
| Rate for Payer: Priority Health SBD |
$1,389.98
|
|
|
HC ATS NON OPEN HEART
|
Facility
|
OP
|
$2,206.32
|
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$882.53 |
| Max. Negotiated Rate |
$1,985.69 |
| Rate for Payer: Aetna Commercial |
$1,875.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,434.11
|
| Rate for Payer: BCBS Complete |
$882.53
|
| Rate for Payer: Cash Price |
$1,765.06
|
| Rate for Payer: Cofinity Commercial |
$1,544.42
|
| Rate for Payer: Cofinity Commercial |
$1,897.44
|
| Rate for Payer: Healthscope Commercial |
$1,985.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,875.37
|
| Rate for Payer: PHP Commercial |
$1,875.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,544.42
|
| Rate for Payer: Priority Health SBD |
$1,389.98
|
|
|
HC ATS STAND BY HR
|
Facility
|
IP
|
$1,506.99
|
|
| Hospital Charge Code |
27000089
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$949.40 |
| Max. Negotiated Rate |
$1,356.29 |
| Rate for Payer: Aetna Commercial |
$1,280.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$979.54
|
| Rate for Payer: Cash Price |
$1,205.59
|
| Rate for Payer: Cofinity Commercial |
$1,054.89
|
| Rate for Payer: Cofinity Commercial |
$1,296.01
|
| Rate for Payer: Healthscope Commercial |
$1,356.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,280.94
|
| Rate for Payer: PHP Commercial |
$1,280.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,054.89
|
| Rate for Payer: Priority Health SBD |
$949.40
|
|
|
HC ATS STAND BY HR
|
Facility
|
OP
|
$1,506.99
|
|
| Hospital Charge Code |
27000089
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$602.80 |
| Max. Negotiated Rate |
$1,356.29 |
| Rate for Payer: Aetna Commercial |
$1,280.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$979.54
|
| Rate for Payer: BCBS Complete |
$602.80
|
| Rate for Payer: Cash Price |
$1,205.59
|
| Rate for Payer: Cofinity Commercial |
$1,054.89
|
| Rate for Payer: Cofinity Commercial |
$1,296.01
|
| Rate for Payer: Healthscope Commercial |
$1,356.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,280.94
|
| Rate for Payer: PHP Commercial |
$1,280.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,054.89
|
| Rate for Payer: Priority Health SBD |
$949.40
|
|
|
HC ATYPICAL PNEUMO EVAL C PNEUM
|
Facility
|
IP
|
$15.30
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
30200240
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.94
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$10.71
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health SBD |
$9.64
|
|
|
HC ATYPICAL PNEUMO EVAL C PNEUM
|
Facility
|
OP
|
$15.30
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
30200240
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$20.10 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: Aetna Medicare |
$12.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.78
|
| Rate for Payer: BCBS Complete |
$6.79
|
| Rate for Payer: BCBS MAPPO |
$11.82
|
| Rate for Payer: BCBS Trust/PPO |
$9.26
|
| Rate for Payer: BCN Medicare Advantage |
$11.82
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Cofinity Commercial |
$10.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.82
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Mclaren Medicaid |
$6.47
|
| Rate for Payer: Mclaren Medicare |
$11.82
|
| Rate for Payer: Meridian Medicaid |
$6.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PACE Medicare |
$11.23
|
| Rate for Payer: PACE SWMI |
$11.82
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: PHP Medicare Advantage |
$11.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health Medicare |
$11.82
|
| Rate for Payer: Priority Health SBD |
$9.64
|
| Rate for Payer: Railroad Medicare Medicare |
$11.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.18
|
| Rate for Payer: UHC Core |
$20.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.82
|
| Rate for Payer: UHC Exchange |
$11.82
|
| Rate for Payer: UHC Medicare Advantage |
$12.17
|
| Rate for Payer: VA VA |
$11.82
|
|
|
HC ATYPICAL PNEUMO EVAL C PNEUM IGM
|
Facility
|
IP
|
$15.30
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
30200243
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.94
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$10.71
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health SBD |
$9.64
|
|
|
HC ATYPICAL PNEUMO EVAL C PNEUM IGM
|
Facility
|
OP
|
$15.30
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
30200243
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$21.56 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: Aetna Medicare |
$13.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.85
|
| Rate for Payer: BCBS Complete |
$7.28
|
| Rate for Payer: BCBS MAPPO |
$12.68
|
| Rate for Payer: BCBS Trust/PPO |
$9.93
|
| Rate for Payer: BCN Medicare Advantage |
$12.68
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$10.71
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.68
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Mclaren Medicaid |
$6.94
|
| Rate for Payer: Mclaren Medicare |
$12.68
|
| Rate for Payer: Meridian Medicaid |
$7.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PACE Medicare |
$12.05
|
| Rate for Payer: PACE SWMI |
$12.68
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: PHP Medicare Advantage |
$12.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health Medicare |
$12.68
|
| Rate for Payer: Priority Health SBD |
$9.64
|
| Rate for Payer: Railroad Medicare Medicare |
$12.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.22
|
| Rate for Payer: UHC Core |
$21.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.68
|
| Rate for Payer: UHC Exchange |
$12.68
|
| Rate for Payer: UHC Medicare Advantage |
$13.06
|
| Rate for Payer: VA VA |
$12.68
|
|
|
HC ATYPICAL PNEUMO EVAL L PNEUM
|
Facility
|
OP
|
$21.42
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
30200302
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.37 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Aetna Commercial |
$18.21
|
| Rate for Payer: Aetna Medicare |
$15.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.12
|
| Rate for Payer: BCBS Complete |
$8.79
|
| Rate for Payer: BCBS MAPPO |
$15.30
|
| Rate for Payer: BCBS Trust/PPO |
$11.99
|
| Rate for Payer: BCN Medicare Advantage |
$15.30
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$18.42
|
| Rate for Payer: Cofinity Commercial |
$14.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.30
|
| Rate for Payer: Healthscope Commercial |
$19.28
|
| Rate for Payer: Mclaren Medicaid |
$8.37
|
| Rate for Payer: Mclaren Medicare |
$15.30
|
| Rate for Payer: Meridian Medicaid |
$8.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.21
|
| Rate for Payer: PACE Medicare |
$14.54
|
| Rate for Payer: PACE SWMI |
$15.30
|
| Rate for Payer: PHP Commercial |
$18.21
|
| Rate for Payer: PHP Medicare Advantage |
$15.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.99
|
| Rate for Payer: Priority Health Medicare |
$15.30
|
| Rate for Payer: Priority Health SBD |
$13.49
|
| Rate for Payer: Railroad Medicare Medicare |
$15.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.36
|
| Rate for Payer: UHC Core |
$26.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.30
|
| Rate for Payer: UHC Exchange |
$15.30
|
| Rate for Payer: UHC Medicare Advantage |
$15.76
|
| Rate for Payer: VA VA |
$15.30
|
|
|
HC ATYPICAL PNEUMO EVAL L PNEUM
|
Facility
|
IP
|
$21.42
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
30200302
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.49 |
| Max. Negotiated Rate |
$19.28 |
| Rate for Payer: Aetna Commercial |
$18.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.92
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$14.99
|
| Rate for Payer: Cofinity Commercial |
$18.42
|
| Rate for Payer: Healthscope Commercial |
$19.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.21
|
| Rate for Payer: PHP Commercial |
$18.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.99
|
| Rate for Payer: Priority Health SBD |
$13.49
|
|
|
HC ATYPICAL PNEUMO EVAL M PNEUM
|
Facility
|
IP
|
$14.28
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
30200308
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$12.85 |
| Rate for Payer: Aetna Commercial |
$12.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.28
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cofinity Commercial |
$10.00
|
| Rate for Payer: Cofinity Commercial |
$12.28
|
| Rate for Payer: Healthscope Commercial |
$12.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.14
|
| Rate for Payer: PHP Commercial |
$12.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.00
|
| Rate for Payer: Priority Health SBD |
$9.00
|
|
|
HC ATYPICAL PNEUMO EVAL M PNEUM
|
Facility
|
OP
|
$14.28
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
30200308
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$22.51 |
| Rate for Payer: Aetna Commercial |
$12.14
|
| Rate for Payer: Aetna Medicare |
$13.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.55
|
| Rate for Payer: BCBS Complete |
$7.61
|
| Rate for Payer: BCBS MAPPO |
$13.24
|
| Rate for Payer: BCBS Trust/PPO |
$10.37
|
| Rate for Payer: BCN Medicare Advantage |
$13.24
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cofinity Commercial |
$12.28
|
| Rate for Payer: Cofinity Commercial |
$10.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.24
|
| Rate for Payer: Healthscope Commercial |
$12.85
|
| Rate for Payer: Mclaren Medicaid |
$7.24
|
| Rate for Payer: Mclaren Medicare |
$13.24
|
| Rate for Payer: Meridian Medicaid |
$7.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.14
|
| Rate for Payer: PACE Medicare |
$12.58
|
| Rate for Payer: PACE SWMI |
$13.24
|
| Rate for Payer: PHP Commercial |
$12.14
|
| Rate for Payer: PHP Medicare Advantage |
$13.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.00
|
| Rate for Payer: Priority Health Medicare |
$13.24
|
| Rate for Payer: Priority Health SBD |
$9.00
|
| Rate for Payer: Railroad Medicare Medicare |
$13.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.89
|
| Rate for Payer: UHC Core |
$22.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.24
|
| Rate for Payer: UHC Exchange |
$13.24
|
| Rate for Payer: UHC Medicare Advantage |
$13.64
|
| Rate for Payer: VA VA |
$13.24
|
|
|
HC ATYPICAL PNEUMO EVALUATION
|
Facility
|
OP
|
$15.30
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
30200241
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$20.10 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: Aetna Medicare |
$12.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.78
|
| Rate for Payer: BCBS Complete |
$6.79
|
| Rate for Payer: BCBS MAPPO |
$11.82
|
| Rate for Payer: BCBS Trust/PPO |
$9.26
|
| Rate for Payer: BCN Medicare Advantage |
$11.82
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$10.71
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.82
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Mclaren Medicaid |
$6.47
|
| Rate for Payer: Mclaren Medicare |
$11.82
|
| Rate for Payer: Meridian Medicaid |
$6.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PACE Medicare |
$11.23
|
| Rate for Payer: PACE SWMI |
$11.82
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: PHP Medicare Advantage |
$11.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health Medicare |
$11.82
|
| Rate for Payer: Priority Health SBD |
$9.64
|
| Rate for Payer: Railroad Medicare Medicare |
$11.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.18
|
| Rate for Payer: UHC Core |
$20.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.82
|
| Rate for Payer: UHC Exchange |
$11.82
|
| Rate for Payer: UHC Medicare Advantage |
$12.17
|
| Rate for Payer: VA VA |
$11.82
|
|
|
HC ATYPICAL PNEUMO EVALUATION
|
Facility
|
IP
|
$15.30
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
30200241
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.94
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$10.71
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health SBD |
$9.64
|
|
|
HC AUDIOMETRY AIR AND BONE
|
Facility
|
OP
|
$208.01
|
|
|
Service Code
|
CPT 92553
|
| Hospital Charge Code |
47100010
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$45.19 |
| Max. Negotiated Rate |
$436.07 |
| Rate for Payer: Aetna Commercial |
$176.81
|
| Rate for Payer: Aetna Medicare |
$144.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.74
|
| Rate for Payer: BCBS Complete |
$79.84
|
| Rate for Payer: BCBS MAPPO |
$138.99
|
| Rate for Payer: BCBS Trust/PPO |
$198.02
|
| Rate for Payer: BCN Medicare Advantage |
$138.99
|
| Rate for Payer: Cash Price |
$166.41
|
| Rate for Payer: Cash Price |
$166.41
|
| Rate for Payer: Cofinity Commercial |
$178.89
|
| Rate for Payer: Cofinity Commercial |
$145.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.99
|
| Rate for Payer: Healthscope Commercial |
$187.21
|
| Rate for Payer: Mclaren Medicaid |
$76.03
|
| Rate for Payer: Mclaren Medicare |
$138.99
|
| Rate for Payer: Meridian Medicaid |
$79.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.81
|
| Rate for Payer: PACE Medicare |
$132.04
|
| Rate for Payer: PACE SWMI |
$138.99
|
| Rate for Payer: PHP Commercial |
$176.81
|
| Rate for Payer: PHP Medicare Advantage |
$138.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$436.07
|
| Rate for Payer: Priority Health Medicare |
$138.99
|
| Rate for Payer: Priority Health Narrow Network |
$348.85
|
| Rate for Payer: Priority Health SBD |
$131.05
|
| Rate for Payer: Railroad Medicare Medicare |
$138.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.99
|
| Rate for Payer: UHC Exchange |
$45.19
|
| Rate for Payer: UHC Medicare Advantage |
$143.16
|
| Rate for Payer: VA VA |
$138.99
|
|
|
HC AUDIOMETRY AIR AND BONE
|
Facility
|
IP
|
$208.01
|
|
|
Service Code
|
CPT 92553
|
| Hospital Charge Code |
47100010
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$131.05 |
| Max. Negotiated Rate |
$187.21 |
| Rate for Payer: Aetna Commercial |
$176.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.21
|
| Rate for Payer: Cash Price |
$166.41
|
| Rate for Payer: Cofinity Commercial |
$145.61
|
| Rate for Payer: Cofinity Commercial |
$178.89
|
| Rate for Payer: Healthscope Commercial |
$187.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.81
|
| Rate for Payer: PHP Commercial |
$176.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.61
|
| Rate for Payer: Priority Health SBD |
$131.05
|
|
|
HC AUDITORY EVOKED POTENTIAL SCREENING
|
Facility
|
OP
|
$251.11
|
|
|
Service Code
|
CPT 92650
|
| Hospital Charge Code |
47100015
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$226.00 |
| Rate for Payer: Aetna Commercial |
$213.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.22
|
| Rate for Payer: BCBS Complete |
$100.44
|
| Rate for Payer: BCBS Trust/PPO |
$85.95
|
| Rate for Payer: Cash Price |
$200.89
|
| Rate for Payer: Cash Price |
$200.89
|
| Rate for Payer: Cofinity Commercial |
$215.95
|
| Rate for Payer: Cofinity Commercial |
$175.78
|
| Rate for Payer: Healthscope Commercial |
$226.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$213.44
|
| Rate for Payer: PHP Commercial |
$213.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.78
|
| Rate for Payer: Priority Health SBD |
$158.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.17
|
| Rate for Payer: UHC Exchange |
$26.52
|
|
|
HC AUDITORY EVOKED POTENTIAL SCREENING
|
Facility
|
IP
|
$251.11
|
|
|
Service Code
|
CPT 92650
|
| Hospital Charge Code |
47100015
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$158.20 |
| Max. Negotiated Rate |
$226.00 |
| Rate for Payer: Aetna Commercial |
$213.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.22
|
| Rate for Payer: Cash Price |
$200.89
|
| Rate for Payer: Cofinity Commercial |
$175.78
|
| Rate for Payer: Cofinity Commercial |
$215.95
|
| Rate for Payer: Healthscope Commercial |
$226.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$213.44
|
| Rate for Payer: PHP Commercial |
$213.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.78
|
| Rate for Payer: Priority Health SBD |
$158.20
|
|
|
HC AUDITORY EVOK POT NEURODIAGNOSTIC W I&R
|
Facility
|
OP
|
$674.35
|
|
|
Service Code
|
CPT 92653
|
| Hospital Charge Code |
47000001
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$81.53 |
| Max. Negotiated Rate |
$824.04 |
| Rate for Payer: Aetna Commercial |
$573.20
|
| Rate for Payer: Aetna Medicare |
$290.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$438.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$349.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$349.11
|
| Rate for Payer: BCBS Complete |
$160.42
|
| Rate for Payer: BCBS MAPPO |
$279.29
|
| Rate for Payer: BCBS Trust/PPO |
$216.45
|
| Rate for Payer: BCN Medicare Advantage |
$279.29
|
| Rate for Payer: Cash Price |
$539.48
|
| Rate for Payer: Cash Price |
$539.48
|
| Rate for Payer: Cofinity Commercial |
$579.94
|
| Rate for Payer: Cofinity Commercial |
$472.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.29
|
| Rate for Payer: Healthscope Commercial |
$606.92
|
| Rate for Payer: Mclaren Medicaid |
$152.77
|
| Rate for Payer: Mclaren Medicare |
$279.29
|
| Rate for Payer: Meridian Medicaid |
$160.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$293.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$321.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$573.20
|
| Rate for Payer: PACE Medicare |
$265.33
|
| Rate for Payer: PACE SWMI |
$279.29
|
| Rate for Payer: PHP Commercial |
$573.20
|
| Rate for Payer: PHP Medicare Advantage |
$279.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$824.04
|
| Rate for Payer: Priority Health Medicare |
$279.29
|
| Rate for Payer: Priority Health Narrow Network |
$659.23
|
| Rate for Payer: Priority Health SBD |
$424.84
|
| Rate for Payer: Railroad Medicare Medicare |
$279.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.29
|
| Rate for Payer: UHC Exchange |
$81.53
|
| Rate for Payer: UHC Medicare Advantage |
$287.67
|
| Rate for Payer: VA VA |
$279.29
|
|
|
HC AUDITORY EVOK POT NEURODIAGNOSTIC W I&R
|
Facility
|
IP
|
$674.35
|
|
|
Service Code
|
CPT 92653
|
| Hospital Charge Code |
47000001
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$424.84 |
| Max. Negotiated Rate |
$606.92 |
| Rate for Payer: Aetna Commercial |
$573.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$438.33
|
| Rate for Payer: Cash Price |
$539.48
|
| Rate for Payer: Cofinity Commercial |
$579.94
|
| Rate for Payer: Cofinity Commercial |
$472.04
|
| Rate for Payer: Healthscope Commercial |
$606.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$573.20
|
| Rate for Payer: PHP Commercial |
$573.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.04
|
| Rate for Payer: Priority Health SBD |
$424.84
|
|
