|
HC CHROMOSOME CULTURE
|
Facility
|
IP
|
$310.94
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
31000015
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$195.89 |
| Max. Negotiated Rate |
$279.85 |
| Rate for Payer: Aetna Commercial |
$264.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.11
|
| Rate for Payer: Cash Price |
$248.75
|
| Rate for Payer: Cofinity Advantage |
$217.66
|
| Rate for Payer: Cofinity Commercial |
$267.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.75
|
| Rate for Payer: Healthscope Commercial |
$279.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.21
|
| Rate for Payer: PHP Commercial |
$264.30
|
| Rate for Payer: Priority Health SBD |
$195.89
|
|
|
HC CHRONIC CARE MGMT SVC PHYS 1ST 30 MIN CAL MO
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
CPT 99491
|
| Hospital Charge Code |
51000137
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.27 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna Commercial |
$136.85
|
| Rate for Payer: Aetna Medicare |
$80.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.65
|
| Rate for Payer: BCBS Complete |
$64.40
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cofinity Advantage |
$112.70
|
| Rate for Payer: Cofinity Commercial |
$138.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.80
|
| Rate for Payer: Healthscope Commercial |
$144.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.75
|
| Rate for Payer: PHP Commercial |
$136.85
|
| Rate for Payer: Priority Health SBD |
$101.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.65
|
| Rate for Payer: UHC Core |
$83.88
|
| Rate for Payer: UHC Exchange |
$63.27
|
|
|
HC CHRONIC CARE MGMT SVC PHYS 1ST 30 MIN CAL MO
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
CPT 99491
|
| Hospital Charge Code |
51000137
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$101.43 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna Commercial |
$136.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.65
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cofinity Advantage |
$112.70
|
| Rate for Payer: Cofinity Commercial |
$138.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.80
|
| Rate for Payer: Healthscope Commercial |
$144.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.75
|
| Rate for Payer: PHP Commercial |
$136.85
|
| Rate for Payer: Priority Health SBD |
$101.43
|
|
|
HC CHRONIC CARE MGMT SVCS STAFF 1ST 20 MIN CAL MO
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT 99490
|
| Hospital Charge Code |
51000136
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.94 |
| Max. Negotiated Rate |
$327.36 |
| Rate for Payer: Aetna Commercial |
$221.00
|
| Rate for Payer: Aetna Medicare |
$105.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.00
|
| 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: BCN Medicare Advantage |
$101.22
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cofinity Advantage |
$182.00
|
| Rate for Payer: Cofinity Commercial |
$223.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.22
|
| Rate for Payer: Healthscope Commercial |
$234.00
|
| 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 |
$221.00
|
| Rate for Payer: Nomi Health Commercial |
$303.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.00
|
| Rate for Payer: PACE Medicare |
$96.16
|
| Rate for Payer: PACE SWMI |
$101.22
|
| Rate for Payer: PHP Commercial |
$221.00
|
| 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 |
$163.80
|
| 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) |
$169.00
|
| Rate for Payer: UHC Core |
$135.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$101.22
|
| Rate for Payer: UHC Exchange |
$102.18
|
| Rate for Payer: UHC Medicaid |
$52.94
|
| Rate for Payer: UHCCP Medicaid |
$52.94
|
| Rate for Payer: VA VA |
$101.22
|
|
|
HC CHRONIC CARE MGMT SVCS STAFF 1ST 20 MIN CAL MO
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT 99490
|
| Hospital Charge Code |
51000136
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$163.80 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna Commercial |
$221.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cofinity Advantage |
$182.00
|
| Rate for Payer: Cofinity Commercial |
$223.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.00
|
| Rate for Payer: Healthscope Commercial |
$234.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.00
|
| Rate for Payer: PHP Commercial |
$221.00
|
| Rate for Payer: Priority Health SBD |
$163.80
|
|
|
HC CIRCUMCISION
|
Facility
|
IP
|
$2,819.98
|
|
| Hospital Charge Code |
72300001
|
|
Hospital Revenue Code
|
723
|
| Min. Negotiated Rate |
$1,776.59 |
| Max. Negotiated Rate |
$2,537.98 |
| Rate for Payer: Aetna Commercial |
$2,396.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,832.99
|
| Rate for Payer: Cash Price |
$2,255.98
|
| Rate for Payer: Cofinity Advantage |
$1,973.99
|
| Rate for Payer: Cofinity Commercial |
$2,425.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,255.98
|
| Rate for Payer: Healthscope Commercial |
$2,537.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,396.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,114.99
|
| Rate for Payer: PHP Commercial |
$2,396.98
|
| Rate for Payer: Priority Health SBD |
$1,776.59
|
|
|
HC CIRCUMCISION
|
Facility
|
OP
|
$2,819.98
|
|
| Hospital Charge Code |
72300001
|
|
Hospital Revenue Code
|
723
|
| Min. Negotiated Rate |
$1,108.25 |
| Max. Negotiated Rate |
$2,537.98 |
| Rate for Payer: Aetna Commercial |
$2,396.98
|
| Rate for Payer: Aetna Medicare |
$1,409.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,832.99
|
| Rate for Payer: BCBS Complete |
$1,127.99
|
| Rate for Payer: Cash Price |
$2,255.98
|
| Rate for Payer: Cofinity Advantage |
$1,973.99
|
| Rate for Payer: Cofinity Commercial |
$2,425.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,255.98
|
| Rate for Payer: Healthscope Commercial |
$2,537.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,255.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,396.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,114.99
|
| Rate for Payer: PHP Commercial |
$2,396.98
|
| Rate for Payer: Priority Health SBD |
$1,776.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,832.99
|
| Rate for Payer: UHC Core |
$1,469.21
|
| Rate for Payer: UHC Exchange |
$1,108.25
|
|
|
HC CIRCUMCISION CLAMP NEWBORN
|
Facility
|
IP
|
$2,769.36
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
76100198
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,744.70 |
| Max. Negotiated Rate |
$2,492.42 |
| Rate for Payer: Aetna Commercial |
$2,353.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,800.08
|
| Rate for Payer: Cash Price |
$2,215.49
|
| Rate for Payer: Cofinity Advantage |
$1,938.55
|
| Rate for Payer: Cofinity Commercial |
$2,381.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,215.49
|
| Rate for Payer: Healthscope Commercial |
$2,492.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,353.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,077.02
|
| Rate for Payer: PHP Commercial |
$2,353.96
|
| Rate for Payer: Priority Health SBD |
$1,744.70
|
|
|
HC CIRCUMCISION CLAMP NEWBORN
|
Facility
|
OP
|
$2,769.36
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
76100198
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$794.81 |
| Max. Negotiated Rate |
$6,735.82 |
| Rate for Payer: Aetna Commercial |
$2,353.96
|
| Rate for Payer: Aetna Medicare |
$2,166.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,800.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$794.81
|
| Rate for Payer: BCN Commercial |
$794.81
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Cash Price |
$2,215.49
|
| Rate for Payer: Cash Price |
$2,215.49
|
| Rate for Payer: Cash Price |
$2,215.49
|
| Rate for Payer: Cofinity Advantage |
$1,938.55
|
| Rate for Payer: Cofinity Commercial |
$2,381.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,215.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Healthscope Commercial |
$2,492.42
|
| Rate for Payer: Mclaren Medicaid |
$1,089.34
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$2,187.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,353.96
|
| Rate for Payer: Nomi Health Commercial |
$6,248.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,077.02
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Commercial |
$2,353.96
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,735.82
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health SBD |
$1,744.70
|
| Rate for Payer: Priority Health Tiered Network |
$5,388.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,800.08
|
| Rate for Payer: UHC Core |
$1,442.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Exchange |
$1,088.36
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: VA VA |
$2,082.87
|
|
|
HC CIRCUMCISION, SURG OTHER THAN CLAMP >28 DAYS OLD
|
Facility
|
IP
|
$2,819.98
|
|
|
Service Code
|
CPT 54161
|
| Hospital Charge Code |
76100256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,776.59 |
| Max. Negotiated Rate |
$2,537.98 |
| Rate for Payer: Aetna Commercial |
$2,396.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,832.99
|
| Rate for Payer: Cash Price |
$2,255.98
|
| Rate for Payer: Cofinity Advantage |
$1,973.99
|
| Rate for Payer: Cofinity Commercial |
$2,425.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,255.98
|
| Rate for Payer: Healthscope Commercial |
$2,537.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,396.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,114.99
|
| Rate for Payer: PHP Commercial |
$2,396.98
|
| Rate for Payer: Priority Health SBD |
$1,776.59
|
|
|
HC CIRCUMCISION, SURG OTHER THAN CLAMP >28 DAYS OLD
|
Facility
|
OP
|
$2,819.98
|
|
|
Service Code
|
CPT 54161
|
| Hospital Charge Code |
76100256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,089.34 |
| Max. Negotiated Rate |
$6,735.82 |
| Rate for Payer: Aetna Commercial |
$2,396.98
|
| Rate for Payer: Aetna Medicare |
$2,166.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,832.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,190.20
|
| Rate for Payer: BCN Commercial |
$2,190.20
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Cash Price |
$2,255.98
|
| Rate for Payer: Cash Price |
$2,255.98
|
| Rate for Payer: Cash Price |
$2,255.98
|
| Rate for Payer: Cofinity Advantage |
$1,973.99
|
| Rate for Payer: Cofinity Commercial |
$2,425.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,255.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Healthscope Commercial |
$2,537.98
|
| Rate for Payer: Mclaren Medicaid |
$1,089.34
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$2,187.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,396.98
|
| Rate for Payer: Nomi Health Commercial |
$6,248.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,114.99
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Commercial |
$2,396.98
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,735.82
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health SBD |
$1,776.59
|
| Rate for Payer: Priority Health Tiered Network |
$5,388.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,832.99
|
| Rate for Payer: UHC Core |
$1,469.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Exchange |
$1,108.25
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: VA VA |
$2,082.87
|
|
|
HC CITRIC ACID URINE
|
Facility
|
IP
|
$54.12
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
30100166
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.10 |
| Max. Negotiated Rate |
$48.71 |
| Rate for Payer: Aetna Commercial |
$46.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.18
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cofinity Advantage |
$37.88
|
| Rate for Payer: Cofinity Commercial |
$46.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.30
|
| Rate for Payer: Healthscope Commercial |
$48.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.59
|
| Rate for Payer: PHP Commercial |
$46.00
|
| Rate for Payer: Priority Health SBD |
$34.10
|
|
|
HC CITRIC ACID URINE
|
Facility
|
OP
|
$54.12
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
30100166
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.54 |
| Max. Negotiated Rate |
$48.71 |
| Rate for Payer: Aetna Commercial |
$46.00
|
| Rate for Payer: Aetna Medicare |
$28.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.75
|
| Rate for Payer: BCBS Complete |
$15.27
|
| Rate for Payer: BCBS MAPPO |
$27.80
|
| Rate for Payer: BCBS Trust/PPO |
$29.64
|
| Rate for Payer: BCN Commercial |
$29.64
|
| Rate for Payer: BCN Medicare Advantage |
$27.80
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cofinity Advantage |
$37.88
|
| Rate for Payer: Cofinity Commercial |
$46.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.80
|
| Rate for Payer: Healthscope Commercial |
$48.71
|
| Rate for Payer: Mclaren Medicaid |
$14.54
|
| Rate for Payer: Mclaren Medicare |
$27.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.19
|
| Rate for Payer: Meridian Medicaid |
$29.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.00
|
| Rate for Payer: Nomi Health Commercial |
$41.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.59
|
| Rate for Payer: PACE Medicare |
$26.41
|
| Rate for Payer: PACE SWMI |
$27.80
|
| Rate for Payer: PHP Commercial |
$46.00
|
| Rate for Payer: PHP Medicare Advantage |
$27.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$27.80
|
| Rate for Payer: Priority Health Medicare |
$27.80
|
| Rate for Payer: Priority Health SBD |
$34.10
|
| Rate for Payer: Priority Health Tiered Network |
$22.24
|
| Rate for Payer: Railroad Medicare Medicare |
$27.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.70
|
| Rate for Payer: UHC Core |
$41.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27.80
|
| Rate for Payer: UHC Exchange |
$41.70
|
| Rate for Payer: UHC Medicaid |
$14.54
|
| Rate for Payer: UHCCP Medicaid |
$14.54
|
| Rate for Payer: VA VA |
$27.80
|
|
|
HC CK-MB FRACTION
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
30100179
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$65.52 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna Commercial |
$88.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.60
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cofinity Advantage |
$72.80
|
| Rate for Payer: Cofinity Commercial |
$89.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.20
|
| Rate for Payer: Healthscope Commercial |
$93.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.00
|
| Rate for Payer: PHP Commercial |
$88.40
|
| Rate for Payer: Priority Health SBD |
$65.52
|
|
|
HC CK-MB FRACTION
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
30100179
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna Commercial |
$88.40
|
| Rate for Payer: Aetna Medicare |
$12.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.44
|
| Rate for Payer: BCBS Complete |
$6.34
|
| Rate for Payer: BCBS MAPPO |
$11.55
|
| Rate for Payer: BCBS Trust/PPO |
$12.31
|
| Rate for Payer: BCN Commercial |
$12.31
|
| Rate for Payer: BCN Medicare Advantage |
$11.55
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cofinity Advantage |
$72.80
|
| Rate for Payer: Cofinity Commercial |
$89.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.55
|
| Rate for Payer: Healthscope Commercial |
$93.60
|
| Rate for Payer: Mclaren Medicaid |
$6.04
|
| Rate for Payer: Mclaren Medicare |
$11.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.13
|
| Rate for Payer: Meridian Medicaid |
$12.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.40
|
| Rate for Payer: Nomi Health Commercial |
$17.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.00
|
| Rate for Payer: PACE Medicare |
$10.97
|
| Rate for Payer: PACE SWMI |
$11.55
|
| Rate for Payer: PHP Commercial |
$88.40
|
| Rate for Payer: PHP Medicare Advantage |
$11.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11.55
|
| Rate for Payer: Priority Health Medicare |
$11.55
|
| Rate for Payer: Priority Health SBD |
$65.52
|
| Rate for Payer: Priority Health Tiered Network |
$9.24
|
| Rate for Payer: Railroad Medicare Medicare |
$11.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.33
|
| Rate for Payer: UHC Core |
$17.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.55
|
| Rate for Payer: UHC Exchange |
$17.33
|
| Rate for Payer: UHC Medicaid |
$6.04
|
| Rate for Payer: UHCCP Medicaid |
$6.04
|
| Rate for Payer: VA VA |
$11.55
|
|
|
HC CLADOSPORIUM IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200032
|
|
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 CLADOSPORIUM IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200032
|
|
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 CLAM IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200033
|
|
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 CLAM IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200033
|
|
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 CLIP FIX DEVICE ROTATABLE
|
Facility
|
OP
|
$807.12
|
|
| Hospital Charge Code |
27200290
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$317.20 |
| Max. Negotiated Rate |
$726.41 |
| Rate for Payer: Aetna Commercial |
$686.05
|
| Rate for Payer: Aetna Medicare |
$403.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$524.63
|
| Rate for Payer: BCBS Complete |
$322.85
|
| Rate for Payer: Cash Price |
$645.70
|
| Rate for Payer: Cofinity Advantage |
$564.98
|
| Rate for Payer: Cofinity Commercial |
$694.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$645.70
|
| Rate for Payer: Healthscope Commercial |
$726.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$645.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$686.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$605.34
|
| Rate for Payer: PHP Commercial |
$686.05
|
| Rate for Payer: Priority Health SBD |
$508.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$524.63
|
| Rate for Payer: UHC Core |
$420.51
|
| Rate for Payer: UHC Exchange |
$317.20
|
|
|
HC CLIP FIX DEVICE ROTATABLE
|
Facility
|
IP
|
$807.12
|
|
| Hospital Charge Code |
27200290
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$508.49 |
| Max. Negotiated Rate |
$726.41 |
| Rate for Payer: Aetna Commercial |
$686.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$524.63
|
| Rate for Payer: Cash Price |
$645.70
|
| Rate for Payer: Cofinity Advantage |
$564.98
|
| Rate for Payer: Cofinity Commercial |
$694.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$645.70
|
| Rate for Payer: Healthscope Commercial |
$726.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$686.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$605.34
|
| Rate for Payer: PHP Commercial |
$686.05
|
| Rate for Payer: Priority Health SBD |
$508.49
|
|
|
HC CLOSED RX CARPAL FX
|
Facility
|
OP
|
$358.31
|
|
|
Service Code
|
CPT 25630
|
| Hospital Charge Code |
76100165
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna Commercial |
$304.56
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$149.14
|
| Rate for Payer: BCN Commercial |
$149.14
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cofinity Advantage |
$250.82
|
| Rate for Payer: Cofinity Commercial |
$308.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$322.48
|
| Rate for Payer: Mclaren Medicaid |
$128.54
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$258.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.56
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.73
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$304.56
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$794.84
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health SBD |
$225.74
|
| Rate for Payer: Priority Health Tiered Network |
$635.87
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$232.90
|
| Rate for Payer: UHC Core |
$186.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$140.82
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC CLOSED RX CARPAL FX
|
Facility
|
IP
|
$358.31
|
|
|
Service Code
|
CPT 25630
|
| Hospital Charge Code |
76100165
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.74 |
| Max. Negotiated Rate |
$322.48 |
| Rate for Payer: Aetna Commercial |
$304.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.90
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cofinity Advantage |
$250.82
|
| Rate for Payer: Cofinity Commercial |
$308.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.65
|
| Rate for Payer: Healthscope Commercial |
$322.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.73
|
| Rate for Payer: PHP Commercial |
$304.56
|
| Rate for Payer: Priority Health SBD |
$225.74
|
|
|
HC CLOSED RX DIST FIBULA FX
|
Facility
|
OP
|
$358.31
|
|
|
Service Code
|
CPT 27786
|
| Hospital Charge Code |
76100174
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna Commercial |
$304.56
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$192.01
|
| Rate for Payer: BCN Commercial |
$192.01
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cofinity Advantage |
$250.82
|
| Rate for Payer: Cofinity Commercial |
$308.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$322.48
|
| Rate for Payer: Mclaren Medicaid |
$128.54
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$258.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.56
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.73
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$304.56
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$794.84
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health SBD |
$225.74
|
| Rate for Payer: Priority Health Tiered Network |
$635.87
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$232.90
|
| Rate for Payer: UHC Core |
$186.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$140.82
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC CLOSED RX DIST FIBULA FX
|
Facility
|
IP
|
$358.31
|
|
|
Service Code
|
CPT 27786
|
| Hospital Charge Code |
76100174
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.74 |
| Max. Negotiated Rate |
$322.48 |
| Rate for Payer: Aetna Commercial |
$304.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.90
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cofinity Advantage |
$250.82
|
| Rate for Payer: Cofinity Commercial |
$308.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.65
|
| Rate for Payer: Healthscope Commercial |
$322.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.73
|
| Rate for Payer: PHP Commercial |
$304.56
|
| Rate for Payer: Priority Health SBD |
$225.74
|
|
