|
HC BDIAL VWAG
|
Facility
|
OP
|
$86.02
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
30500092
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$77.42 |
| Rate for Payer: Aetna Commercial |
$73.12
|
| Rate for Payer: Aetna Medicare |
$23.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.68
|
| Rate for Payer: BCBS Complete |
$12.60
|
| Rate for Payer: BCBS MAPPO |
$22.94
|
| Rate for Payer: BCBS Trust/PPO |
$24.47
|
| Rate for Payer: BCN Commercial |
$24.47
|
| Rate for Payer: BCN Medicare Advantage |
$22.94
|
| Rate for Payer: Cash Price |
$68.82
|
| Rate for Payer: Cash Price |
$68.82
|
| Rate for Payer: Cofinity Advantage |
$60.21
|
| Rate for Payer: Cofinity Commercial |
$73.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.94
|
| Rate for Payer: Healthscope Commercial |
$77.42
|
| Rate for Payer: Mclaren Medicaid |
$12.00
|
| Rate for Payer: Mclaren Medicare |
$22.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.09
|
| Rate for Payer: Meridian Medicaid |
$24.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.12
|
| Rate for Payer: Nomi Health Commercial |
$34.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.52
|
| Rate for Payer: PACE Medicare |
$21.79
|
| Rate for Payer: PACE SWMI |
$22.94
|
| Rate for Payer: PHP Commercial |
$73.12
|
| Rate for Payer: PHP Medicare Advantage |
$22.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22.94
|
| Rate for Payer: Priority Health Medicare |
$22.94
|
| Rate for Payer: Priority Health SBD |
$54.19
|
| Rate for Payer: Priority Health Tiered Network |
$18.35
|
| Rate for Payer: Railroad Medicare Medicare |
$22.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.41
|
| Rate for Payer: UHC Core |
$34.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22.94
|
| Rate for Payer: UHC Exchange |
$34.41
|
| Rate for Payer: UHC Medicaid |
$12.00
|
| Rate for Payer: UHCCP Medicaid |
$12.00
|
| Rate for Payer: VA VA |
$22.94
|
|
|
HC BDIAL VWAG
|
Facility
|
IP
|
$86.02
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
30500092
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$54.19 |
| Max. Negotiated Rate |
$77.42 |
| Rate for Payer: Aetna Commercial |
$73.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.91
|
| Rate for Payer: Cash Price |
$68.82
|
| Rate for Payer: Cofinity Advantage |
$60.21
|
| Rate for Payer: Cofinity Commercial |
$73.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.82
|
| Rate for Payer: Healthscope Commercial |
$77.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.52
|
| Rate for Payer: PHP Commercial |
$73.12
|
| Rate for Payer: Priority Health SBD |
$54.19
|
|
|
HC BDIAL VWFX
|
Facility
|
IP
|
$103.02
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
30500093
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$64.90 |
| Max. Negotiated Rate |
$92.72 |
| Rate for Payer: Aetna Commercial |
$87.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.96
|
| Rate for Payer: Cash Price |
$82.42
|
| Rate for Payer: Cofinity Advantage |
$72.11
|
| Rate for Payer: Cofinity Commercial |
$88.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.42
|
| Rate for Payer: Healthscope Commercial |
$92.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.27
|
| Rate for Payer: PHP Commercial |
$87.57
|
| Rate for Payer: Priority Health SBD |
$64.90
|
|
|
HC BDIAL VWFX
|
Facility
|
OP
|
$103.02
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
30500093
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.14 |
| Max. Negotiated Rate |
$92.72 |
| Rate for Payer: Aetna Commercial |
$87.57
|
| Rate for Payer: Aetna Medicare |
$32.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.58
|
| Rate for Payer: BCBS Complete |
$16.95
|
| Rate for Payer: BCBS MAPPO |
$30.86
|
| Rate for Payer: BCBS Trust/PPO |
$32.91
|
| Rate for Payer: BCN Commercial |
$32.91
|
| Rate for Payer: BCN Medicare Advantage |
$30.86
|
| Rate for Payer: Cash Price |
$82.42
|
| Rate for Payer: Cash Price |
$82.42
|
| Rate for Payer: Cofinity Advantage |
$72.11
|
| Rate for Payer: Cofinity Commercial |
$88.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.86
|
| Rate for Payer: Healthscope Commercial |
$92.72
|
| Rate for Payer: Mclaren Medicaid |
$16.14
|
| Rate for Payer: Mclaren Medicare |
$30.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.40
|
| Rate for Payer: Meridian Medicaid |
$32.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$33.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.57
|
| Rate for Payer: Nomi Health Commercial |
$46.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.27
|
| Rate for Payer: PACE Medicare |
$29.32
|
| Rate for Payer: PACE SWMI |
$30.86
|
| Rate for Payer: PHP Commercial |
$87.57
|
| Rate for Payer: PHP Medicare Advantage |
$30.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$30.86
|
| Rate for Payer: Priority Health Medicare |
$30.86
|
| Rate for Payer: Priority Health SBD |
$64.90
|
| Rate for Payer: Priority Health Tiered Network |
$24.69
|
| Rate for Payer: Railroad Medicare Medicare |
$30.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.29
|
| Rate for Payer: UHC Core |
$46.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$30.86
|
| Rate for Payer: UHC Exchange |
$46.29
|
| Rate for Payer: UHC Medicaid |
$16.14
|
| Rate for Payer: UHCCP Medicaid |
$16.14
|
| Rate for Payer: VA VA |
$30.86
|
|
|
HC BEDSIDE/SIMPLE SPIROMETRY
|
Facility
|
OP
|
$244.04
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
46000001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$85.86 |
| Max. Negotiated Rate |
$695.77 |
| Rate for Payer: Aetna Commercial |
$207.43
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.63
|
| 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 |
$85.86
|
| Rate for Payer: BCN Commercial |
$85.86
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$195.23
|
| Rate for Payer: Cash Price |
$195.23
|
| Rate for Payer: Cofinity Advantage |
$170.83
|
| Rate for Payer: Cofinity Commercial |
$209.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$219.64
|
| 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 |
$207.43
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.03
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$207.43
|
| 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 |
$153.75
|
| 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) |
$158.63
|
| Rate for Payer: UHC Core |
$127.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$95.91
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC BEDSIDE/SIMPLE SPIROMETRY
|
Facility
|
IP
|
$244.04
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
46000001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$153.75 |
| Max. Negotiated Rate |
$219.64 |
| Rate for Payer: Aetna Commercial |
$207.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.63
|
| Rate for Payer: Cash Price |
$195.23
|
| Rate for Payer: Cofinity Advantage |
$170.83
|
| Rate for Payer: Cofinity Commercial |
$209.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.23
|
| Rate for Payer: Healthscope Commercial |
$219.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.03
|
| Rate for Payer: PHP Commercial |
$207.43
|
| Rate for Payer: Priority Health SBD |
$153.75
|
|
|
HC BEDSIDE URINE PREG TEST
|
Facility
|
OP
|
$29.71
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
30000000
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$26.74 |
| Rate for Payer: Aetna Commercial |
$25.25
|
| Rate for Payer: Aetna Medicare |
$8.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.76
|
| Rate for Payer: BCBS Complete |
$4.73
|
| Rate for Payer: BCBS MAPPO |
$8.61
|
| Rate for Payer: BCBS Trust/PPO |
$9.18
|
| Rate for Payer: BCCCP Commercial |
$8.61
|
| Rate for Payer: BCN Commercial |
$9.18
|
| Rate for Payer: BCN Medicare Advantage |
$8.61
|
| Rate for Payer: Cash Price |
$23.77
|
| Rate for Payer: Cash Price |
$23.77
|
| Rate for Payer: Cofinity Advantage |
$20.80
|
| Rate for Payer: Cofinity Commercial |
$25.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.61
|
| Rate for Payer: Healthscope Commercial |
$26.74
|
| Rate for Payer: Mclaren Medicaid |
$4.50
|
| Rate for Payer: Mclaren Medicare |
$8.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.04
|
| Rate for Payer: Meridian Medicaid |
$9.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.25
|
| Rate for Payer: Nomi Health Commercial |
$12.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.28
|
| Rate for Payer: PACE Medicare |
$8.18
|
| Rate for Payer: PACE SWMI |
$8.61
|
| Rate for Payer: PHP Commercial |
$25.25
|
| Rate for Payer: PHP Medicare Advantage |
$8.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8.61
|
| Rate for Payer: Priority Health Medicare |
$8.61
|
| Rate for Payer: Priority Health SBD |
$18.72
|
| Rate for Payer: Priority Health Tiered Network |
$6.89
|
| Rate for Payer: Railroad Medicare Medicare |
$8.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.92
|
| Rate for Payer: UHC Core |
$12.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.61
|
| Rate for Payer: UHC Exchange |
$12.92
|
| Rate for Payer: UHC Medicaid |
$4.50
|
| Rate for Payer: UHCCP Medicaid |
$4.50
|
| Rate for Payer: VA VA |
$8.61
|
|
|
HC BEDSIDE URINE PREG TEST
|
Facility
|
IP
|
$29.71
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
30000000
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$26.74 |
| Rate for Payer: Aetna Commercial |
$25.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.31
|
| Rate for Payer: Cash Price |
$23.77
|
| Rate for Payer: Cofinity Advantage |
$20.80
|
| Rate for Payer: Cofinity Commercial |
$25.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.77
|
| Rate for Payer: Healthscope Commercial |
$26.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.28
|
| Rate for Payer: PHP Commercial |
$25.25
|
| Rate for Payer: Priority Health SBD |
$18.72
|
|
|
HC BEECH IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200074
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| 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 |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| 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 |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC BEECH IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200074
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
|
|
HC BEHAVIOR COUNSEL OBESITY 15M
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
HCPCS G0447
|
| Hospital Charge Code |
51000133
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$50.34 |
| Max. Negotiated Rate |
$327.36 |
| Rate for Payer: Aetna Commercial |
$242.25
|
| Rate for Payer: Aetna Medicare |
$105.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$126.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$126.53
|
| Rate for Payer: BCBS Complete |
$55.59
|
| Rate for Payer: BCBS MAPPO |
$101.22
|
| Rate for Payer: BCBS Trust/PPO |
$50.34
|
| Rate for Payer: BCN Commercial |
$50.34
|
| Rate for Payer: BCN Medicare Advantage |
$101.22
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cofinity Advantage |
$199.50
|
| Rate for Payer: Cofinity Commercial |
$245.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.22
|
| Rate for Payer: Healthscope Commercial |
$256.50
|
| Rate for Payer: Mclaren Medicaid |
$52.94
|
| Rate for Payer: Mclaren Medicare |
$101.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.28
|
| Rate for Payer: Meridian Medicaid |
$106.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.25
|
| Rate for Payer: Nomi Health Commercial |
$303.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.75
|
| Rate for Payer: PACE Medicare |
$96.16
|
| Rate for Payer: PACE SWMI |
$101.22
|
| Rate for Payer: PHP Commercial |
$242.25
|
| Rate for Payer: PHP Medicare Advantage |
$101.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$327.36
|
| Rate for Payer: Priority Health Medicare |
$101.22
|
| Rate for Payer: Priority Health SBD |
$179.55
|
| Rate for Payer: Priority Health Tiered Network |
$261.89
|
| Rate for Payer: Railroad Medicare Medicare |
$101.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.25
|
| Rate for Payer: UHC Core |
$148.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$101.22
|
| Rate for Payer: UHC Exchange |
$112.00
|
| Rate for Payer: UHC Medicaid |
$52.94
|
| Rate for Payer: UHCCP Medicaid |
$52.94
|
| Rate for Payer: VA VA |
$101.22
|
|
|
HC BEHAVIOR COUNSEL OBESITY 15M
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
HCPCS G0447
|
| Hospital Charge Code |
51000133
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$179.55 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Aetna Commercial |
$242.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.25
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cofinity Advantage |
$199.50
|
| Rate for Payer: Cofinity Commercial |
$245.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.00
|
| Rate for Payer: Healthscope Commercial |
$256.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.75
|
| Rate for Payer: PHP Commercial |
$242.25
|
| Rate for Payer: Priority Health SBD |
$179.55
|
|
|
HC BENCE JONES PROTEIN
|
Facility
|
OP
|
$172.50
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
30200197
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.35 |
| Max. Negotiated Rate |
$155.25 |
| Rate for Payer: Aetna Commercial |
$146.62
|
| Rate for Payer: Aetna Medicare |
$30.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.69
|
| Rate for Payer: BCBS Complete |
$16.12
|
| Rate for Payer: BCBS MAPPO |
$29.35
|
| Rate for Payer: BCBS Trust/PPO |
$23.47
|
| Rate for Payer: BCN Commercial |
$23.47
|
| Rate for Payer: BCN Medicare Advantage |
$29.35
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cofinity Advantage |
$120.75
|
| Rate for Payer: Cofinity Commercial |
$148.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.35
|
| Rate for Payer: Healthscope Commercial |
$155.25
|
| Rate for Payer: Mclaren Medicaid |
$15.35
|
| Rate for Payer: Mclaren Medicare |
$29.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.82
|
| Rate for Payer: Meridian Medicaid |
$30.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.62
|
| Rate for Payer: Nomi Health Commercial |
$44.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$129.38
|
| Rate for Payer: PACE Medicare |
$27.88
|
| Rate for Payer: PACE SWMI |
$29.35
|
| Rate for Payer: PHP Commercial |
$146.62
|
| Rate for Payer: PHP Medicare Advantage |
$29.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$29.35
|
| Rate for Payer: Priority Health Medicare |
$29.35
|
| Rate for Payer: Priority Health SBD |
$108.67
|
| Rate for Payer: Priority Health Tiered Network |
$23.48
|
| Rate for Payer: Railroad Medicare Medicare |
$29.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.03
|
| Rate for Payer: UHC Core |
$44.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$29.35
|
| Rate for Payer: UHC Exchange |
$44.03
|
| Rate for Payer: UHC Medicaid |
$15.35
|
| Rate for Payer: UHCCP Medicaid |
$15.35
|
| Rate for Payer: VA VA |
$29.35
|
|
|
HC BENCE JONES PROTEIN
|
Facility
|
IP
|
$172.50
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
30200197
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$155.25 |
| Rate for Payer: Aetna Commercial |
$146.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.12
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cofinity Advantage |
$120.75
|
| Rate for Payer: Cofinity Commercial |
$148.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.00
|
| Rate for Payer: Healthscope Commercial |
$155.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$129.38
|
| Rate for Payer: PHP Commercial |
$146.62
|
| Rate for Payer: Priority Health SBD |
$108.67
|
|
|
HC BENIGN HYPERKERATOTIC 2-4 LESIONS
|
Facility
|
IP
|
$283.50
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
76100039
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$178.60 |
| Max. Negotiated Rate |
$255.15 |
| Rate for Payer: Aetna Commercial |
$240.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.28
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cofinity Advantage |
$198.45
|
| Rate for Payer: Cofinity Commercial |
$243.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.80
|
| Rate for Payer: Healthscope Commercial |
$255.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.62
|
| Rate for Payer: PHP Commercial |
$240.97
|
| Rate for Payer: Priority Health SBD |
$178.60
|
|
|
HC BENIGN HYPERKERATOTIC 2-4 LESIONS
|
Facility
|
OP
|
$283.50
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
76100039
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.36 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Commercial |
$240.97
|
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.28
|
| 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 |
$58.36
|
| Rate for Payer: BCN Commercial |
$58.36
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cofinity Advantage |
$198.45
|
| Rate for Payer: Cofinity Commercial |
$243.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$255.15
|
| 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 |
$240.97
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.62
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$240.97
|
| 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 |
$178.60
|
| 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) |
$184.28
|
| Rate for Payer: UHC Core |
$147.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$111.42
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
HC BENIGN HYPERKERATOTIC >4 LESIONS
|
Facility
|
IP
|
$283.50
|
|
|
Service Code
|
CPT 11057
|
| Hospital Charge Code |
76100040
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$178.60 |
| Max. Negotiated Rate |
$255.15 |
| Rate for Payer: Aetna Commercial |
$240.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.28
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cofinity Advantage |
$198.45
|
| Rate for Payer: Cofinity Commercial |
$243.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.80
|
| Rate for Payer: Healthscope Commercial |
$255.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.62
|
| Rate for Payer: PHP Commercial |
$240.97
|
| Rate for Payer: Priority Health SBD |
$178.60
|
|
|
HC BENIGN HYPERKERATOTIC >4 LESIONS
|
Facility
|
OP
|
$283.50
|
|
|
Service Code
|
CPT 11057
|
| Hospital Charge Code |
76100040
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$68.20 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Commercial |
$240.97
|
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.28
|
| 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 |
$68.20
|
| Rate for Payer: BCN Commercial |
$68.20
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cofinity Advantage |
$198.45
|
| Rate for Payer: Cofinity Commercial |
$243.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$255.15
|
| 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 |
$240.97
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.62
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$240.97
|
| 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 |
$178.60
|
| 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) |
$184.28
|
| Rate for Payer: UHC Core |
$147.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$111.42
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
HC BENIGN HYPERKERATOTIC LESION
|
Facility
|
OP
|
$283.50
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
76100041
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.58 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Commercial |
$240.97
|
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.28
|
| 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 |
$49.58
|
| Rate for Payer: BCN Commercial |
$49.58
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cofinity Advantage |
$198.45
|
| Rate for Payer: Cofinity Commercial |
$243.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$255.15
|
| 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 |
$240.97
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.62
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$240.97
|
| 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 |
$178.60
|
| 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) |
$184.28
|
| Rate for Payer: UHC Core |
$147.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$111.42
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
HC BENIGN HYPERKERATOTIC LESION
|
Facility
|
IP
|
$283.50
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
76100041
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$178.60 |
| Max. Negotiated Rate |
$255.15 |
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.80
|
| Rate for Payer: Aetna Commercial |
$240.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.28
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cofinity Advantage |
$198.45
|
| Rate for Payer: Cofinity Commercial |
$243.81
|
| Rate for Payer: Healthscope Commercial |
$255.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.62
|
| Rate for Payer: PHP Commercial |
$240.97
|
| Rate for Payer: Priority Health SBD |
$178.60
|
|
|
HC BENZO CONFIRMATION CMPT 1
|
Facility
|
OP
|
$36.41
|
|
|
Service Code
|
CPT 80347
|
| Hospital Charge Code |
30000164
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: Aetna Medicare |
$18.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.67
|
| Rate for Payer: BCBS Complete |
$14.56
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Advantage |
$25.49
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.31
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: Priority Health SBD |
$22.94
|
|
|
HC BENZO CONFIRMATION CMPT 1
|
Facility
|
IP
|
$36.41
|
|
|
Service Code
|
CPT 80347
|
| Hospital Charge Code |
30000164
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.67
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Advantage |
$25.49
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.31
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: Priority Health SBD |
$22.94
|
|
|
HC BENZO CONFIRMATION CMPT 2
|
Facility
|
OP
|
$33.29
|
|
|
Service Code
|
CPT 80368
|
| Hospital Charge Code |
30000165
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$29.96 |
| Rate for Payer: Aetna Commercial |
$28.30
|
| Rate for Payer: Aetna Medicare |
$16.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.64
|
| Rate for Payer: BCBS Complete |
$13.32
|
| Rate for Payer: Cash Price |
$26.63
|
| Rate for Payer: Cofinity Advantage |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$28.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.63
|
| Rate for Payer: Healthscope Commercial |
$29.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.97
|
| Rate for Payer: PHP Commercial |
$28.30
|
| Rate for Payer: Priority Health SBD |
$20.97
|
|
|
HC BENZO CONFIRMATION CMPT 2
|
Facility
|
IP
|
$33.29
|
|
|
Service Code
|
CPT 80368
|
| Hospital Charge Code |
30000165
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.97 |
| Max. Negotiated Rate |
$29.96 |
| Rate for Payer: Aetna Commercial |
$28.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.64
|
| Rate for Payer: Cash Price |
$26.63
|
| Rate for Payer: Cofinity Advantage |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$28.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.63
|
| Rate for Payer: Healthscope Commercial |
$29.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.97
|
| Rate for Payer: PHP Commercial |
$28.30
|
| Rate for Payer: Priority Health SBD |
$20.97
|
|
|
HC BENZO CONFIRMATION, U
|
Facility
|
OP
|
$31.25
|
|
|
Service Code
|
CPT 80339
|
| Hospital Charge Code |
30000163
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$28.12 |
| Rate for Payer: Aetna Commercial |
$26.56
|
| Rate for Payer: Aetna Medicare |
$15.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.31
|
| Rate for Payer: BCBS Complete |
$12.50
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cofinity Advantage |
$21.88
|
| Rate for Payer: Cofinity Commercial |
$26.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.00
|
| Rate for Payer: Healthscope Commercial |
$28.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.44
|
| Rate for Payer: PHP Commercial |
$26.56
|
| Rate for Payer: Priority Health SBD |
$19.69
|
|
