|
HC AUTONOMIC FUNC CARDIO INNERVAT
|
Facility
|
IP
|
$370.31
|
|
|
Service Code
|
CPT 95921
|
| Hospital Charge Code |
92000006
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$233.30 |
| Max. Negotiated Rate |
$333.28 |
| Rate for Payer: Aetna Commercial |
$314.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.70
|
| Rate for Payer: Cash Price |
$296.25
|
| Rate for Payer: Cofinity Advantage |
$259.22
|
| Rate for Payer: Cofinity Commercial |
$318.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.25
|
| Rate for Payer: Healthscope Commercial |
$333.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.73
|
| Rate for Payer: PHP Commercial |
$314.76
|
| Rate for Payer: Priority Health SBD |
$233.30
|
|
|
HC AUTONOMIC FUNC QSART
|
Facility
|
OP
|
$370.31
|
|
|
Service Code
|
CPT 95923
|
| Hospital Charge Code |
92000008
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$428.73 |
| Rate for Payer: Aetna Commercial |
$314.76
|
| Rate for Payer: Aetna Medicare |
$137.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$328.67
|
| Rate for Payer: BCN Commercial |
$328.67
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$296.25
|
| Rate for Payer: Cash Price |
$296.25
|
| Rate for Payer: Cofinity Advantage |
$259.22
|
| Rate for Payer: Cofinity Commercial |
$318.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$333.28
|
| Rate for Payer: Mclaren Medicaid |
$69.33
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$139.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.76
|
| Rate for Payer: Nomi Health Commercial |
$397.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.73
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$314.76
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.73
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health SBD |
$233.30
|
| Rate for Payer: Priority Health Tiered Network |
$342.98
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.70
|
| Rate for Payer: UHC Core |
$192.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$145.53
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
HC AUTONOMIC FUNC QSART
|
Facility
|
IP
|
$370.31
|
|
|
Service Code
|
CPT 95923
|
| Hospital Charge Code |
92000008
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$233.30 |
| Max. Negotiated Rate |
$333.28 |
| Rate for Payer: Aetna Commercial |
$314.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.70
|
| Rate for Payer: Cash Price |
$296.25
|
| Rate for Payer: Cofinity Advantage |
$259.22
|
| Rate for Payer: Cofinity Commercial |
$318.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.25
|
| Rate for Payer: Healthscope Commercial |
$333.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.73
|
| Rate for Payer: PHP Commercial |
$314.76
|
| Rate for Payer: Priority Health SBD |
$233.30
|
|
|
HC AUTONOMIC W/O QSART
|
Facility
|
IP
|
$529.01
|
|
|
Service Code
|
CPT 95924
|
| Hospital Charge Code |
92000012
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$333.28 |
| Max. Negotiated Rate |
$476.11 |
| Rate for Payer: Aetna Commercial |
$449.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$343.86
|
| Rate for Payer: Cash Price |
$423.21
|
| Rate for Payer: Cofinity Advantage |
$370.31
|
| Rate for Payer: Cofinity Commercial |
$454.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$423.21
|
| Rate for Payer: Healthscope Commercial |
$476.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$449.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$396.76
|
| Rate for Payer: PHP Commercial |
$449.66
|
| Rate for Payer: Priority Health SBD |
$333.28
|
|
|
HC AUTONOMIC W/O QSART
|
Facility
|
OP
|
$529.01
|
|
|
Service Code
|
CPT 95924
|
| Hospital Charge Code |
92000012
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$695.77 |
| Rate for Payer: Aetna Commercial |
$449.66
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$343.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$278.33
|
| Rate for Payer: BCN Commercial |
$278.33
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$423.21
|
| Rate for Payer: Cash Price |
$423.21
|
| Rate for Payer: Cofinity Advantage |
$370.31
|
| Rate for Payer: Cofinity Commercial |
$454.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$423.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$476.11
|
| Rate for Payer: Mclaren Medicaid |
$112.52
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$449.66
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$396.76
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$449.66
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$333.28
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$343.86
|
| Rate for Payer: UHC Core |
$275.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$207.90
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC AVULSION OF NAIL PLATE
|
Facility
|
IP
|
$326.34
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
76100045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$205.59 |
| Max. Negotiated Rate |
$293.71 |
| Rate for Payer: Aetna Commercial |
$277.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.12
|
| Rate for Payer: Cash Price |
$261.07
|
| Rate for Payer: Cofinity Advantage |
$228.44
|
| Rate for Payer: Cofinity Commercial |
$280.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.07
|
| Rate for Payer: Healthscope Commercial |
$293.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.75
|
| Rate for Payer: PHP Commercial |
$277.39
|
| Rate for Payer: Priority Health SBD |
$205.59
|
|
|
HC AVULSION OF NAIL PLATE
|
Facility
|
OP
|
$326.34
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
76100045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Commercial |
$277.39
|
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$127.65
|
| Rate for Payer: BCN Commercial |
$127.65
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$261.07
|
| Rate for Payer: Cash Price |
$261.07
|
| Rate for Payer: Cash Price |
$261.07
|
| Rate for Payer: Cofinity Advantage |
$228.44
|
| Rate for Payer: Cofinity Commercial |
$280.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$293.71
|
| Rate for Payer: Mclaren Medicaid |
$104.55
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.39
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.75
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$277.39
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health SBD |
$205.59
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.12
|
| Rate for Payer: UHC Core |
$170.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$128.25
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
HC BACITRACIN 1 OZ
|
Facility
|
IP
|
$8.29
|
|
| Hospital Charge Code |
27100006
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$7.46 |
| Rate for Payer: Aetna Commercial |
$7.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.39
|
| Rate for Payer: Cash Price |
$6.63
|
| Rate for Payer: Cofinity Advantage |
$5.80
|
| Rate for Payer: Cofinity Commercial |
$7.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.63
|
| Rate for Payer: Healthscope Commercial |
$7.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.22
|
| Rate for Payer: PHP Commercial |
$7.05
|
| Rate for Payer: Priority Health SBD |
$5.22
|
|
|
HC BACITRACIN 1 OZ
|
Facility
|
OP
|
$8.29
|
|
| Hospital Charge Code |
27100006
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$7.46 |
| Rate for Payer: Aetna Commercial |
$7.05
|
| Rate for Payer: Aetna Medicare |
$4.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.39
|
| Rate for Payer: BCBS Complete |
$3.32
|
| Rate for Payer: Cash Price |
$6.63
|
| Rate for Payer: Cofinity Advantage |
$5.80
|
| Rate for Payer: Cofinity Commercial |
$7.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.63
|
| Rate for Payer: Healthscope Commercial |
$7.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.22
|
| Rate for Payer: PHP Commercial |
$7.05
|
| Rate for Payer: Priority Health SBD |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.39
|
| Rate for Payer: UHC Core |
$4.32
|
| Rate for Payer: UHC Exchange |
$3.26
|
|
|
HC BACITRACIN 4 OZ
|
Facility
|
OP
|
$31.60
|
|
| Hospital Charge Code |
27100007
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.42 |
| Max. Negotiated Rate |
$28.44 |
| Rate for Payer: Aetna Commercial |
$26.86
|
| Rate for Payer: Aetna Medicare |
$15.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.54
|
| Rate for Payer: BCBS Complete |
$12.64
|
| Rate for Payer: Cash Price |
$25.28
|
| Rate for Payer: Cofinity Advantage |
$22.12
|
| Rate for Payer: Cofinity Commercial |
$27.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.28
|
| Rate for Payer: Healthscope Commercial |
$28.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.70
|
| Rate for Payer: PHP Commercial |
$26.86
|
| Rate for Payer: Priority Health SBD |
$19.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.54
|
| Rate for Payer: UHC Core |
$16.46
|
| Rate for Payer: UHC Exchange |
$12.42
|
|
|
HC BACITRACIN 4 OZ
|
Facility
|
IP
|
$31.60
|
|
| Hospital Charge Code |
27100007
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$28.44 |
| Rate for Payer: Aetna Commercial |
$26.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.54
|
| Rate for Payer: Cash Price |
$25.28
|
| Rate for Payer: Cofinity Advantage |
$22.12
|
| Rate for Payer: Cofinity Commercial |
$27.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.28
|
| Rate for Payer: Healthscope Commercial |
$28.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.70
|
| Rate for Payer: PHP Commercial |
$26.86
|
| Rate for Payer: Priority Health SBD |
$19.91
|
|
|
HC BACK SCREEN
|
Facility
|
OP
|
$53.06
|
|
| Hospital Charge Code |
42000047
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.85 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna Medicare |
$26.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.49
|
| Rate for Payer: BCBS Complete |
$21.22
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Advantage |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: Priority Health SBD |
$33.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.49
|
| Rate for Payer: UHC Core |
$27.64
|
| Rate for Payer: UHC Exchange |
$20.85
|
|
|
HC BACK SCREEN
|
Facility
|
IP
|
$53.06
|
|
| Hospital Charge Code |
42000047
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.43 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.49
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Advantage |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: Priority Health SBD |
$33.43
|
|
|
HC BACK SCREEN, VBISD
|
Facility
|
IP
|
$69.71
|
|
| Hospital Charge Code |
43000014
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$43.92 |
| Max. Negotiated Rate |
$62.74 |
| Rate for Payer: Aetna Commercial |
$59.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.31
|
| Rate for Payer: Cash Price |
$55.77
|
| Rate for Payer: Cofinity Advantage |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$59.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.77
|
| Rate for Payer: Healthscope Commercial |
$62.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.28
|
| Rate for Payer: PHP Commercial |
$59.25
|
| Rate for Payer: Priority Health SBD |
$43.92
|
|
|
HC BACK SCREEN, VBISD
|
Facility
|
OP
|
$69.71
|
|
| Hospital Charge Code |
43000014
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$27.40 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$59.25
|
| Rate for Payer: Aetna Medicare |
$34.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.31
|
| Rate for Payer: BCBS Complete |
$27.88
|
| Rate for Payer: Cash Price |
$55.77
|
| Rate for Payer: Cash Price |
$55.77
|
| Rate for Payer: Cofinity Advantage |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$59.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.77
|
| Rate for Payer: Healthscope Commercial |
$62.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.25
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.28
|
| Rate for Payer: PHP Commercial |
$59.25
|
| Rate for Payer: Priority Health SBD |
$43.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.31
|
| Rate for Payer: UHC Core |
$36.32
|
| Rate for Payer: UHC Exchange |
$27.40
|
|
|
HC BACTERIAL VAGINOSIS PANEL
|
Facility
|
OP
|
$156.06
|
|
|
Service Code
|
CPT 0352U
|
| Hospital Charge Code |
30600337
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$62.42 |
| Max. Negotiated Rate |
$140.45 |
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: Aetna Medicare |
$78.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.44
|
| Rate for Payer: BCBS Complete |
$62.42
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Advantage |
$109.24
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$140.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.05
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: Priority Health SBD |
$98.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.03
|
| Rate for Payer: UHC Core |
$78.03
|
| Rate for Payer: UHC Exchange |
$78.03
|
|
|
HC BACTERIAL VAGINOSIS PANEL
|
Facility
|
IP
|
$156.06
|
|
|
Service Code
|
CPT 0352U
|
| Hospital Charge Code |
30600337
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$98.32 |
| Max. Negotiated Rate |
$140.45 |
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.44
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Advantage |
$109.24
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$140.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.05
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: Priority Health SBD |
$98.32
|
|
|
HC BAG BLOOD TRANSFER
|
Facility
|
IP
|
$9.05
|
|
| Hospital Charge Code |
27000161
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.70 |
| Max. Negotiated Rate |
$8.14 |
| Rate for Payer: Aetna Commercial |
$7.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.88
|
| Rate for Payer: Cash Price |
$7.24
|
| Rate for Payer: Cofinity Advantage |
$6.33
|
| Rate for Payer: Cofinity Commercial |
$7.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.24
|
| Rate for Payer: Healthscope Commercial |
$8.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.79
|
| Rate for Payer: PHP Commercial |
$7.69
|
| Rate for Payer: Priority Health SBD |
$5.70
|
|
|
HC BAG BLOOD TRANSFER
|
Facility
|
OP
|
$9.05
|
|
| Hospital Charge Code |
27000161
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$8.14 |
| Rate for Payer: Aetna Commercial |
$7.69
|
| Rate for Payer: Aetna Medicare |
$4.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.88
|
| Rate for Payer: BCBS Complete |
$3.62
|
| Rate for Payer: Cash Price |
$7.24
|
| Rate for Payer: Cofinity Advantage |
$6.33
|
| Rate for Payer: Cofinity Commercial |
$7.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.24
|
| Rate for Payer: Healthscope Commercial |
$8.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.79
|
| Rate for Payer: PHP Commercial |
$7.69
|
| Rate for Payer: Priority Health SBD |
$5.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.88
|
| Rate for Payer: UHC Core |
$4.72
|
| Rate for Payer: UHC Exchange |
$3.56
|
|
|
HC BAG WASTE
|
Facility
|
OP
|
$65.55
|
|
| Hospital Charge Code |
27000670
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.76 |
| Max. Negotiated Rate |
$58.99 |
| Rate for Payer: Aetna Commercial |
$55.72
|
| Rate for Payer: Aetna Medicare |
$32.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.61
|
| Rate for Payer: BCBS Complete |
$26.22
|
| Rate for Payer: Cash Price |
$52.44
|
| Rate for Payer: Cofinity Advantage |
$45.88
|
| Rate for Payer: Cofinity Commercial |
$56.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.44
|
| Rate for Payer: Healthscope Commercial |
$58.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.16
|
| Rate for Payer: PHP Commercial |
$55.72
|
| Rate for Payer: Priority Health SBD |
$41.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.61
|
| Rate for Payer: UHC Core |
$34.15
|
| Rate for Payer: UHC Exchange |
$25.76
|
|
|
HC BAG WASTE
|
Facility
|
IP
|
$65.55
|
|
| Hospital Charge Code |
27000670
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$58.99 |
| Rate for Payer: Aetna Commercial |
$55.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.61
|
| Rate for Payer: Cash Price |
$52.44
|
| Rate for Payer: Cofinity Advantage |
$45.88
|
| Rate for Payer: Cofinity Commercial |
$56.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.44
|
| Rate for Payer: Healthscope Commercial |
$58.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.16
|
| Rate for Payer: PHP Commercial |
$55.72
|
| Rate for Payer: Priority Health SBD |
$41.30
|
|
|
HC BAKRI BALLOON CATHETER
|
Facility
|
OP
|
$1,209.83
|
|
| Hospital Charge Code |
27200112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$475.46 |
| Max. Negotiated Rate |
$1,088.85 |
| Rate for Payer: Aetna Commercial |
$1,028.36
|
| Rate for Payer: Aetna Medicare |
$604.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$786.39
|
| Rate for Payer: BCBS Complete |
$483.93
|
| Rate for Payer: Cash Price |
$967.86
|
| Rate for Payer: Cofinity Advantage |
$846.88
|
| Rate for Payer: Cofinity Commercial |
$1,040.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$967.86
|
| Rate for Payer: Healthscope Commercial |
$1,088.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$967.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,028.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$907.37
|
| Rate for Payer: PHP Commercial |
$1,028.36
|
| Rate for Payer: Priority Health SBD |
$762.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$786.39
|
| Rate for Payer: UHC Core |
$630.32
|
| Rate for Payer: UHC Exchange |
$475.46
|
|
|
HC BAKRI BALLOON CATHETER
|
Facility
|
IP
|
$1,209.83
|
|
| Hospital Charge Code |
27200112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$762.19 |
| Max. Negotiated Rate |
$1,088.85 |
| Rate for Payer: Aetna Commercial |
$1,028.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$786.39
|
| Rate for Payer: Cash Price |
$967.86
|
| Rate for Payer: Cofinity Advantage |
$846.88
|
| Rate for Payer: Cofinity Commercial |
$1,040.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$967.86
|
| Rate for Payer: Healthscope Commercial |
$1,088.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,028.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$907.37
|
| Rate for Payer: PHP Commercial |
$1,028.36
|
| Rate for Payer: Priority Health SBD |
$762.19
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 10
|
Facility
|
IP
|
$1,041.42
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$656.09 |
| Max. Negotiated Rate |
$937.28 |
| Rate for Payer: Aetna Commercial |
$885.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$676.92
|
| Rate for Payer: Cash Price |
$833.14
|
| Rate for Payer: Cofinity Advantage |
$728.99
|
| Rate for Payer: Cofinity Commercial |
$895.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$833.14
|
| Rate for Payer: Healthscope Commercial |
$937.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$781.07
|
| Rate for Payer: PHP Commercial |
$885.21
|
| Rate for Payer: Priority Health SBD |
$656.09
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 10
|
Facility
|
OP
|
$1,041.42
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$937.28 |
| Rate for Payer: Aetna Commercial |
$885.21
|
| Rate for Payer: Aetna Medicare |
$520.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$676.92
|
| Rate for Payer: BCBS Complete |
$416.57
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$833.14
|
| Rate for Payer: Cash Price |
$833.14
|
| Rate for Payer: Cofinity Advantage |
$728.99
|
| Rate for Payer: Cofinity Commercial |
$895.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$833.14
|
| Rate for Payer: Healthscope Commercial |
$937.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$833.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$781.07
|
| Rate for Payer: PHP Commercial |
$885.21
|
| Rate for Payer: Priority Health SBD |
$656.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$676.92
|
| Rate for Payer: UHC Core |
$542.58
|
| Rate for Payer: UHC Exchange |
$409.28
|
|
