|
HC EGD W EUS EXAM ESOPH,STOM,DUO,
|
Facility
|
IP
|
$2,920.68
|
|
| Hospital Charge Code |
36000036
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,840.03 |
| Max. Negotiated Rate |
$2,628.61 |
| Rate for Payer: Aetna Commercial |
$2,482.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,898.44
|
| Rate for Payer: Cash Price |
$2,336.54
|
| Rate for Payer: Cofinity Commercial |
$2,044.48
|
| Rate for Payer: Cofinity Commercial |
$2,511.78
|
| Rate for Payer: Healthscope Commercial |
$2,628.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,482.58
|
| Rate for Payer: PHP Commercial |
$2,482.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,044.48
|
| Rate for Payer: Priority Health SBD |
$1,840.03
|
|
|
HC EGG WHITE IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200041
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.09
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC EGG WHITE IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200041
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
|
|
HC EGG YOLK, IGE
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200482
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.89
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$21.42
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.01
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.42
|
| Rate for Payer: Priority Health SBD |
$19.28
|
|
|
HC EGG YOLK, IGE
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200482
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.09
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Cofinity Commercial |
$21.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.01
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.42
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$19.28
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC EKG RHYTHM STRIP
|
Facility
|
IP
|
$72.41
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
73000002
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$45.62 |
| Max. Negotiated Rate |
$65.17 |
| Rate for Payer: Aetna Commercial |
$61.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.07
|
| Rate for Payer: Cash Price |
$57.93
|
| Rate for Payer: Cofinity Commercial |
$50.69
|
| Rate for Payer: Cofinity Commercial |
$62.27
|
| Rate for Payer: Healthscope Commercial |
$65.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.55
|
| Rate for Payer: PHP Commercial |
$61.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.69
|
| Rate for Payer: Priority Health SBD |
$45.62
|
|
|
HC EKG RHYTHM STRIP
|
Facility
|
OP
|
$72.41
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
73000002
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$6.22 |
| Max. Negotiated Rate |
$173.33 |
| Rate for Payer: Aetna Commercial |
$61.55
|
| Rate for Payer: Aetna Medicare |
$56.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.04
|
| Rate for Payer: BCBS Complete |
$31.26
|
| Rate for Payer: BCBS MAPPO |
$54.43
|
| Rate for Payer: BCBS Trust/PPO |
$26.09
|
| Rate for Payer: BCN Medicare Advantage |
$54.43
|
| Rate for Payer: Cash Price |
$57.93
|
| Rate for Payer: Cash Price |
$57.93
|
| Rate for Payer: Cofinity Commercial |
$62.27
|
| Rate for Payer: Cofinity Commercial |
$50.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.43
|
| Rate for Payer: Healthscope Commercial |
$65.17
|
| Rate for Payer: Mclaren Medicaid |
$29.77
|
| Rate for Payer: Mclaren Medicare |
$54.43
|
| Rate for Payer: Meridian Medicaid |
$31.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.55
|
| Rate for Payer: PACE Medicare |
$51.71
|
| Rate for Payer: PACE SWMI |
$54.43
|
| Rate for Payer: PHP Commercial |
$61.55
|
| Rate for Payer: PHP Medicare Advantage |
$54.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.33
|
| Rate for Payer: Priority Health Medicare |
$54.43
|
| Rate for Payer: Priority Health Narrow Network |
$138.66
|
| Rate for Payer: Priority Health SBD |
$45.62
|
| Rate for Payer: Railroad Medicare Medicare |
$54.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.43
|
| Rate for Payer: UHC Exchange |
$6.22
|
| Rate for Payer: UHC Medicare Advantage |
$56.06
|
| Rate for Payer: VA VA |
$54.43
|
|
|
HC EKG TRACING FOR INITIAL PREV
|
Facility
|
OP
|
$35.68
|
|
|
Service Code
|
HCPCS G0404
|
| Hospital Charge Code |
73000004
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$6.22 |
| Max. Negotiated Rate |
$76.91 |
| Rate for Payer: Aetna Commercial |
$30.33
|
| Rate for Payer: Aetna Medicare |
$27.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.11
|
| Rate for Payer: BCBS Complete |
$15.22
|
| Rate for Payer: BCBS MAPPO |
$26.49
|
| Rate for Payer: BCN Medicare Advantage |
$26.49
|
| Rate for Payer: Cash Price |
$28.54
|
| Rate for Payer: Cash Price |
$28.54
|
| Rate for Payer: Cofinity Commercial |
$30.68
|
| Rate for Payer: Cofinity Commercial |
$24.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$32.11
|
| Rate for Payer: Mclaren Medicaid |
$14.49
|
| Rate for Payer: Mclaren Medicare |
$26.49
|
| Rate for Payer: Meridian Medicaid |
$15.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.33
|
| Rate for Payer: PACE Medicare |
$25.17
|
| Rate for Payer: PACE SWMI |
$26.49
|
| Rate for Payer: PHP Commercial |
$30.33
|
| Rate for Payer: PHP Medicare Advantage |
$26.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.91
|
| Rate for Payer: Priority Health Medicare |
$26.49
|
| Rate for Payer: Priority Health Narrow Network |
$61.53
|
| Rate for Payer: Priority Health SBD |
$22.48
|
| Rate for Payer: Railroad Medicare Medicare |
$26.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.49
|
| Rate for Payer: UHC Exchange |
$6.22
|
| Rate for Payer: UHC Medicare Advantage |
$27.28
|
| Rate for Payer: VA VA |
$26.49
|
|
|
HC EKG TRACING FOR INITIAL PREV
|
Facility
|
IP
|
$35.68
|
|
|
Service Code
|
HCPCS G0404
|
| Hospital Charge Code |
73000004
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$22.48 |
| Max. Negotiated Rate |
$32.11 |
| Rate for Payer: Aetna Commercial |
$30.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.19
|
| Rate for Payer: Cash Price |
$28.54
|
| Rate for Payer: Cofinity Commercial |
$24.98
|
| Rate for Payer: Cofinity Commercial |
$30.68
|
| Rate for Payer: Healthscope Commercial |
$32.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.33
|
| Rate for Payer: PHP Commercial |
$30.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.98
|
| Rate for Payer: Priority Health SBD |
$22.48
|
|
|
HC EKO INFUSION SYSTEM
|
Facility
|
IP
|
$7,545.17
|
|
| Hospital Charge Code |
27200279
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,753.46 |
| Max. Negotiated Rate |
$6,790.65 |
| Rate for Payer: Aetna Commercial |
$6,413.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,904.36
|
| Rate for Payer: Cash Price |
$6,036.14
|
| Rate for Payer: Cofinity Commercial |
$5,281.62
|
| Rate for Payer: Cofinity Commercial |
$6,488.85
|
| Rate for Payer: Healthscope Commercial |
$6,790.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,413.39
|
| Rate for Payer: PHP Commercial |
$6,413.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,281.62
|
| Rate for Payer: Priority Health SBD |
$4,753.46
|
|
|
HC EKO INFUSION SYSTEM
|
Facility
|
OP
|
$7,545.17
|
|
| Hospital Charge Code |
27200279
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,018.07 |
| Max. Negotiated Rate |
$6,790.65 |
| Rate for Payer: Aetna Commercial |
$6,413.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,904.36
|
| Rate for Payer: BCBS Complete |
$3,018.07
|
| Rate for Payer: Cash Price |
$6,036.14
|
| Rate for Payer: Cofinity Commercial |
$5,281.62
|
| Rate for Payer: Cofinity Commercial |
$6,488.85
|
| Rate for Payer: Healthscope Commercial |
$6,790.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,413.39
|
| Rate for Payer: PHP Commercial |
$6,413.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,281.62
|
| Rate for Payer: Priority Health SBD |
$4,753.46
|
|
|
HC ELEC ALYS IMPLT NPGT CPLX SP/PN PRGM
|
Facility
|
OP
|
$190.74
|
|
|
Service Code
|
CPT 95972
|
| Hospital Charge Code |
92000029
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$38.97 |
| Max. Negotiated Rate |
$312.58 |
| Rate for Payer: Aetna Commercial |
$162.13
|
| Rate for Payer: Aetna Medicare |
$89.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.66
|
| Rate for Payer: BCBS Complete |
$49.47
|
| Rate for Payer: BCBS MAPPO |
$86.13
|
| Rate for Payer: BCBS Trust/PPO |
$119.74
|
| Rate for Payer: BCN Medicare Advantage |
$86.13
|
| Rate for Payer: Cash Price |
$152.59
|
| Rate for Payer: Cash Price |
$152.59
|
| Rate for Payer: Cofinity Commercial |
$133.52
|
| Rate for Payer: Cofinity Commercial |
$164.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.13
|
| Rate for Payer: Healthscope Commercial |
$171.67
|
| Rate for Payer: Mclaren Medicaid |
$47.11
|
| Rate for Payer: Mclaren Medicare |
$86.13
|
| Rate for Payer: Meridian Medicaid |
$49.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$90.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$162.13
|
| Rate for Payer: PACE Medicare |
$81.82
|
| Rate for Payer: PACE SWMI |
$86.13
|
| Rate for Payer: PHP Commercial |
$162.13
|
| Rate for Payer: PHP Medicare Advantage |
$86.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$312.58
|
| Rate for Payer: Priority Health Medicare |
$86.13
|
| Rate for Payer: Priority Health Narrow Network |
$250.06
|
| Rate for Payer: Priority Health SBD |
$120.17
|
| Rate for Payer: Railroad Medicare Medicare |
$86.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.13
|
| Rate for Payer: UHC Exchange |
$38.97
|
| Rate for Payer: UHC Medicare Advantage |
$88.71
|
| Rate for Payer: VA VA |
$86.13
|
|
|
HC ELEC ALYS IMPLT NPGT CPLX SP/PN PRGM
|
Facility
|
IP
|
$190.74
|
|
|
Service Code
|
CPT 95972
|
| Hospital Charge Code |
92000029
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$120.17 |
| Max. Negotiated Rate |
$171.67 |
| Rate for Payer: Aetna Commercial |
$162.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.98
|
| Rate for Payer: Cash Price |
$152.59
|
| Rate for Payer: Cofinity Commercial |
$133.52
|
| Rate for Payer: Cofinity Commercial |
$164.04
|
| Rate for Payer: Healthscope Commercial |
$171.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$162.13
|
| Rate for Payer: PHP Commercial |
$162.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.52
|
| Rate for Payer: Priority Health SBD |
$120.17
|
|
|
HC ELEC ALYS IMPLT NPGT PHYS/QHP W/O PRGM
|
Facility
|
IP
|
$166.80
|
|
|
Service Code
|
CPT 95970
|
| Hospital Charge Code |
92000030
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$105.08 |
| Max. Negotiated Rate |
$150.12 |
| Rate for Payer: Aetna Commercial |
$141.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.42
|
| Rate for Payer: Cash Price |
$133.44
|
| Rate for Payer: Cofinity Commercial |
$116.76
|
| Rate for Payer: Cofinity Commercial |
$143.45
|
| Rate for Payer: Healthscope Commercial |
$150.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$141.78
|
| Rate for Payer: PHP Commercial |
$141.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.76
|
| Rate for Payer: Priority Health SBD |
$105.08
|
|
|
HC ELEC ALYS IMPLT NPGT PHYS/QHP W/O PRGM
|
Facility
|
OP
|
$166.80
|
|
|
Service Code
|
CPT 95970
|
| Hospital Charge Code |
92000030
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$351.10 |
| Rate for Payer: Aetna Commercial |
$141.78
|
| Rate for Payer: Aetna Medicare |
$118.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$142.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$142.08
|
| Rate for Payer: BCBS Complete |
$65.29
|
| Rate for Payer: BCBS MAPPO |
$113.66
|
| Rate for Payer: BCBS Trust/PPO |
$26.09
|
| Rate for Payer: BCN Medicare Advantage |
$113.66
|
| Rate for Payer: Cash Price |
$133.44
|
| Rate for Payer: Cash Price |
$133.44
|
| Rate for Payer: Cofinity Commercial |
$116.76
|
| Rate for Payer: Cofinity Commercial |
$143.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.66
|
| Rate for Payer: Healthscope Commercial |
$150.12
|
| Rate for Payer: Mclaren Medicaid |
$62.17
|
| Rate for Payer: Mclaren Medicare |
$113.66
|
| Rate for Payer: Meridian Medicaid |
$65.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$141.78
|
| Rate for Payer: PACE Medicare |
$107.98
|
| Rate for Payer: PACE SWMI |
$113.66
|
| Rate for Payer: PHP Commercial |
$141.78
|
| Rate for Payer: PHP Medicare Advantage |
$113.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$351.10
|
| Rate for Payer: Priority Health Medicare |
$113.66
|
| Rate for Payer: Priority Health Narrow Network |
$280.88
|
| Rate for Payer: Priority Health SBD |
$105.08
|
| Rate for Payer: Railroad Medicare Medicare |
$113.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.66
|
| Rate for Payer: UHC Exchange |
$17.68
|
| Rate for Payer: UHC Medicare Advantage |
$117.07
|
| Rate for Payer: VA VA |
$113.66
|
|
|
HC ELEC ALYS IMPLT NPGT SMPL SP/PN NPGT PRGM
|
Facility
|
OP
|
$173.52
|
|
|
Service Code
|
CPT 95971
|
| Hospital Charge Code |
92000031
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$37.66 |
| Max. Negotiated Rate |
$312.58 |
| Rate for Payer: Aetna Commercial |
$147.49
|
| Rate for Payer: Aetna Medicare |
$89.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.66
|
| Rate for Payer: BCBS Complete |
$49.47
|
| Rate for Payer: BCBS MAPPO |
$86.13
|
| Rate for Payer: BCBS Trust/PPO |
$87.49
|
| Rate for Payer: BCN Medicare Advantage |
$86.13
|
| Rate for Payer: Cash Price |
$138.82
|
| Rate for Payer: Cash Price |
$138.82
|
| Rate for Payer: Cofinity Commercial |
$121.46
|
| Rate for Payer: Cofinity Commercial |
$149.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.13
|
| Rate for Payer: Healthscope Commercial |
$156.17
|
| Rate for Payer: Mclaren Medicaid |
$47.11
|
| Rate for Payer: Mclaren Medicare |
$86.13
|
| Rate for Payer: Meridian Medicaid |
$49.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$90.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.49
|
| Rate for Payer: PACE Medicare |
$81.82
|
| Rate for Payer: PACE SWMI |
$86.13
|
| Rate for Payer: PHP Commercial |
$147.49
|
| Rate for Payer: PHP Medicare Advantage |
$86.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$312.58
|
| Rate for Payer: Priority Health Medicare |
$86.13
|
| Rate for Payer: Priority Health Narrow Network |
$250.06
|
| Rate for Payer: Priority Health SBD |
$109.32
|
| Rate for Payer: Railroad Medicare Medicare |
$86.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.13
|
| Rate for Payer: UHC Exchange |
$37.66
|
| Rate for Payer: UHC Medicare Advantage |
$88.71
|
| Rate for Payer: VA VA |
$86.13
|
|
|
HC ELEC ALYS IMPLT NPGT SMPL SP/PN NPGT PRGM
|
Facility
|
IP
|
$173.52
|
|
|
Service Code
|
CPT 95971
|
| Hospital Charge Code |
92000031
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$109.32 |
| Max. Negotiated Rate |
$156.17 |
| Rate for Payer: Aetna Commercial |
$147.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.79
|
| Rate for Payer: Cash Price |
$138.82
|
| Rate for Payer: Cofinity Commercial |
$121.46
|
| Rate for Payer: Cofinity Commercial |
$149.23
|
| Rate for Payer: Healthscope Commercial |
$156.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.49
|
| Rate for Payer: PHP Commercial |
$147.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.46
|
| Rate for Payer: Priority Health SBD |
$109.32
|
|
|
HC ELEC BREAST PUMP KI (OB)
|
Facility
|
IP
|
$202.50
|
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.58 |
| Max. Negotiated Rate |
$182.25 |
| Rate for Payer: Aetna Commercial |
$172.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.62
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cofinity Commercial |
$141.75
|
| Rate for Payer: Cofinity Commercial |
$174.15
|
| Rate for Payer: Healthscope Commercial |
$182.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.12
|
| Rate for Payer: PHP Commercial |
$172.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.75
|
| Rate for Payer: Priority Health SBD |
$127.58
|
|
|
HC ELEC BREAST PUMP KI (OB)
|
Facility
|
OP
|
$202.50
|
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$182.25 |
| Rate for Payer: Aetna Commercial |
$172.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.62
|
| Rate for Payer: BCBS Complete |
$81.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cofinity Commercial |
$141.75
|
| Rate for Payer: Cofinity Commercial |
$174.15
|
| Rate for Payer: Healthscope Commercial |
$182.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.12
|
| Rate for Payer: PHP Commercial |
$172.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.75
|
| Rate for Payer: Priority Health SBD |
$127.58
|
|
|
HC ELECTRICAL STIM UNATTENDED
|
Facility
|
IP
|
$90.78
|
|
|
Service Code
|
CPT 97014
|
| Hospital Charge Code |
42000010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$57.19 |
| Max. Negotiated Rate |
$81.70 |
| Rate for Payer: Aetna Commercial |
$77.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.01
|
| Rate for Payer: Cash Price |
$72.62
|
| Rate for Payer: Cofinity Commercial |
$63.55
|
| Rate for Payer: Cofinity Commercial |
$78.07
|
| Rate for Payer: Healthscope Commercial |
$81.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$77.16
|
| Rate for Payer: PHP Commercial |
$77.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.55
|
| Rate for Payer: Priority Health SBD |
$57.19
|
|
|
HC ELECTRICAL STIM UNATTENDED
|
Facility
|
OP
|
$90.78
|
|
|
Service Code
|
CPT 97014
|
| Hospital Charge Code |
42000010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$81.70 |
| Rate for Payer: Aetna Commercial |
$77.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.01
|
| Rate for Payer: BCBS Complete |
$36.31
|
| Rate for Payer: BCBS Trust/PPO |
$8.26
|
| Rate for Payer: Cash Price |
$72.62
|
| Rate for Payer: Cash Price |
$72.62
|
| Rate for Payer: Cofinity Commercial |
$63.55
|
| Rate for Payer: Cofinity Commercial |
$78.07
|
| Rate for Payer: Healthscope Commercial |
$81.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$77.16
|
| Rate for Payer: PHP Commercial |
$77.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.55
|
| Rate for Payer: Priority Health SBD |
$57.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.33
|
| Rate for Payer: UHC Exchange |
$12.12
|
|
|
HC ELECTRICAL STIM UNATTENDED FOR PRESSURE
|
Facility
|
IP
|
$100.43
|
|
|
Service Code
|
HCPCS G0281
|
| Hospital Charge Code |
42000057
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$63.27 |
| Max. Negotiated Rate |
$90.39 |
| Rate for Payer: Aetna Commercial |
$85.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.28
|
| Rate for Payer: Cash Price |
$80.34
|
| Rate for Payer: Cofinity Commercial |
$70.30
|
| Rate for Payer: Cofinity Commercial |
$86.37
|
| Rate for Payer: Healthscope Commercial |
$90.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.37
|
| Rate for Payer: PHP Commercial |
$85.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.30
|
| Rate for Payer: Priority Health SBD |
$63.27
|
|
|
HC ELECTRICAL STIM UNATTENDED FOR PRESSURE
|
Facility
|
OP
|
$100.43
|
|
|
Service Code
|
HCPCS G0281
|
| Hospital Charge Code |
42000057
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$90.39 |
| Rate for Payer: Aetna Commercial |
$85.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.28
|
| Rate for Payer: BCBS Complete |
$40.17
|
| Rate for Payer: BCBS Trust/PPO |
$8.04
|
| Rate for Payer: Cash Price |
$80.34
|
| Rate for Payer: Cash Price |
$80.34
|
| Rate for Payer: Cofinity Commercial |
$70.30
|
| Rate for Payer: Cofinity Commercial |
$86.37
|
| Rate for Payer: Healthscope Commercial |
$90.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.37
|
| Rate for Payer: PHP Commercial |
$85.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.30
|
| Rate for Payer: Priority Health SBD |
$63.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.61
|
| Rate for Payer: UHC Exchange |
$11.46
|
|
|
HC ELECTRICAL STIM UNATTENDED NOT PRESSURE
|
Facility
|
IP
|
$130.16
|
|
|
Service Code
|
HCPCS G0283
|
| Hospital Charge Code |
42000058
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$82.00 |
| Max. Negotiated Rate |
$117.14 |
| Rate for Payer: Aetna Commercial |
$110.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.60
|
| Rate for Payer: Cash Price |
$104.13
|
| Rate for Payer: Cofinity Commercial |
$111.94
|
| Rate for Payer: Cofinity Commercial |
$91.11
|
| Rate for Payer: Healthscope Commercial |
$117.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.64
|
| Rate for Payer: PHP Commercial |
$110.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.11
|
| Rate for Payer: Priority Health SBD |
$82.00
|
|
|
HC ELECTRICAL STIM UNATTENDED NOT PRESSURE
|
Facility
|
OP
|
$130.16
|
|
|
Service Code
|
HCPCS G0283
|
| Hospital Charge Code |
42000058
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$117.14 |
| Rate for Payer: Aetna Commercial |
$110.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.60
|
| Rate for Payer: BCBS Complete |
$52.06
|
| Rate for Payer: BCBS Trust/PPO |
$8.04
|
| Rate for Payer: Cash Price |
$104.13
|
| Rate for Payer: Cash Price |
$104.13
|
| Rate for Payer: Cofinity Commercial |
$91.11
|
| Rate for Payer: Cofinity Commercial |
$111.94
|
| Rate for Payer: Healthscope Commercial |
$117.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.64
|
| Rate for Payer: PHP Commercial |
$110.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.11
|
| Rate for Payer: Priority Health SBD |
$82.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.61
|
| Rate for Payer: UHC Exchange |
$11.46
|
|
