|
HC GROIN/PSEUDO IMAGING BILATERAL
|
Facility
|
IP
|
$1,415.42
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
92100027
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$891.71 |
| Max. Negotiated Rate |
$1,273.88 |
| Rate for Payer: Aetna Commercial |
$1,203.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$920.02
|
| Rate for Payer: Cash Price |
$1,132.34
|
| Rate for Payer: Cofinity Commercial |
$1,217.26
|
| Rate for Payer: Cofinity Commercial |
$990.79
|
| Rate for Payer: Healthscope Commercial |
$1,273.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,203.11
|
| Rate for Payer: PHP Commercial |
$1,203.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$990.79
|
| Rate for Payer: Priority Health SBD |
$891.71
|
|
|
HC GROIN/PSEUDO IMAGING (R OR L)
|
Facility
|
IP
|
$904.13
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
92100026
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$569.60 |
| Max. Negotiated Rate |
$813.72 |
| Rate for Payer: Aetna Commercial |
$768.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$587.68
|
| Rate for Payer: Cash Price |
$723.30
|
| Rate for Payer: Cofinity Commercial |
$632.89
|
| Rate for Payer: Cofinity Commercial |
$777.55
|
| Rate for Payer: Healthscope Commercial |
$813.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$768.51
|
| Rate for Payer: PHP Commercial |
$768.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$632.89
|
| Rate for Payer: Priority Health SBD |
$569.60
|
|
|
HC GROIN/PSEUDO IMAGING (R OR L)
|
Facility
|
OP
|
$904.13
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
92100026
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$813.72 |
| Rate for Payer: Aetna Commercial |
$768.51
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$587.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$554.18
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$723.30
|
| Rate for Payer: Cash Price |
$723.30
|
| Rate for Payer: Cofinity Commercial |
$632.89
|
| Rate for Payer: Cofinity Commercial |
$777.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$813.72
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$768.51
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$768.51
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$632.89
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health SBD |
$569.60
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$141.45
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC GROSHONG REPAIR KIT
|
Facility
|
IP
|
$455.08
|
|
| Hospital Charge Code |
27200125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$286.70 |
| Max. Negotiated Rate |
$409.57 |
| Rate for Payer: Aetna Commercial |
$386.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.80
|
| Rate for Payer: Cash Price |
$364.06
|
| Rate for Payer: Cofinity Commercial |
$318.56
|
| Rate for Payer: Cofinity Commercial |
$391.37
|
| Rate for Payer: Healthscope Commercial |
$409.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$386.82
|
| Rate for Payer: PHP Commercial |
$386.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.56
|
| Rate for Payer: Priority Health SBD |
$286.70
|
|
|
HC GROSHONG REPAIR KIT
|
Facility
|
OP
|
$455.08
|
|
| Hospital Charge Code |
27200125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$182.03 |
| Max. Negotiated Rate |
$409.57 |
| Rate for Payer: Aetna Commercial |
$386.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.80
|
| Rate for Payer: BCBS Complete |
$182.03
|
| Rate for Payer: Cash Price |
$364.06
|
| Rate for Payer: Cofinity Commercial |
$318.56
|
| Rate for Payer: Cofinity Commercial |
$391.37
|
| Rate for Payer: Healthscope Commercial |
$409.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$386.82
|
| Rate for Payer: PHP Commercial |
$386.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.56
|
| Rate for Payer: Priority Health SBD |
$286.70
|
|
|
HC GROUP B STREP, AMPLIFIED
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 87150
|
| Hospital Charge Code |
30600210
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$64.26 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$86.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.30
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$71.40
|
| Rate for Payer: Cofinity Commercial |
$87.72
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.70
|
| Rate for Payer: PHP Commercial |
$86.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.40
|
| Rate for Payer: Priority Health SBD |
$64.26
|
|
|
HC GROUP B STREP, AMPLIFIED
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 87150
|
| Hospital Charge Code |
30600210
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$86.70
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$27.48
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$71.40
|
| Rate for Payer: Cofinity Commercial |
$87.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.70
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$86.70
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.40
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$64.26
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$59.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC GROUP CAREGIVER TRAINING
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 97552
|
| Hospital Charge Code |
42000067
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna Commercial |
$44.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.80
|
| Rate for Payer: BCBS Complete |
$20.80
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cofinity Commercial |
$44.72
|
| Rate for Payer: Cofinity Commercial |
$36.40
|
| Rate for Payer: Healthscope Commercial |
$46.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.20
|
| Rate for Payer: PHP Commercial |
$44.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
| Rate for Payer: Priority Health SBD |
$32.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.53
|
| Rate for Payer: UHC Exchange |
$10.48
|
|
|
HC GROUP CAREGIVER TRAINING
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 97552
|
| Hospital Charge Code |
42000067
|
| Min. Negotiated Rate |
$32.76 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna Commercial |
$44.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.80
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cofinity Commercial |
$36.40
|
| Rate for Payer: Cofinity Commercial |
$44.72
|
| Rate for Payer: Healthscope Commercial |
$46.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.20
|
| Rate for Payer: PHP Commercial |
$44.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
| Rate for Payer: Priority Health SBD |
$32.76
|
|
|
HC GROUP PSYCHOTHERAPY
|
Facility
|
OP
|
$96.90
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
91500001
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$22.20 |
| Max. Negotiated Rate |
$99.14 |
| Rate for Payer: Aetna Commercial |
$82.36
|
| Rate for Payer: Aetna Medicare |
$82.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.14
|
| Rate for Payer: BCBS Complete |
$45.56
|
| Rate for Payer: BCBS MAPPO |
$79.31
|
| Rate for Payer: BCBS Trust/PPO |
$22.20
|
| Rate for Payer: BCN Medicare Advantage |
$79.31
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cofinity Commercial |
$83.33
|
| Rate for Payer: Cofinity Commercial |
$67.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.31
|
| Rate for Payer: Healthscope Commercial |
$87.21
|
| Rate for Payer: Mclaren Medicaid |
$43.38
|
| Rate for Payer: Mclaren Medicare |
$79.31
|
| Rate for Payer: Meridian Medicaid |
$45.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$83.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.36
|
| Rate for Payer: PACE Medicare |
$75.34
|
| Rate for Payer: PACE SWMI |
$79.31
|
| Rate for Payer: PHP Commercial |
$82.36
|
| Rate for Payer: PHP Medicare Advantage |
$79.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.83
|
| Rate for Payer: Priority Health Medicare |
$79.31
|
| Rate for Payer: Priority Health SBD |
$61.05
|
| Rate for Payer: Railroad Medicare Medicare |
$79.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.31
|
| Rate for Payer: UHC Exchange |
$23.58
|
| Rate for Payer: UHC Medicare Advantage |
$81.69
|
| Rate for Payer: VA VA |
$79.31
|
|
|
HC GROUP PSYCHOTHERAPY
|
Facility
|
IP
|
$96.90
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
91500001
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$61.05 |
| Max. Negotiated Rate |
$87.21 |
| Rate for Payer: Aetna Commercial |
$82.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.98
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cofinity Commercial |
$67.83
|
| Rate for Payer: Cofinity Commercial |
$83.33
|
| Rate for Payer: Healthscope Commercial |
$87.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.36
|
| Rate for Payer: PHP Commercial |
$82.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.83
|
| Rate for Payer: Priority Health SBD |
$61.05
|
|
|
HC GROUP SESSION 30 MIN RD G0109
|
Facility
|
IP
|
$61.85
|
|
|
Service Code
|
HCPCS G0109
|
| Hospital Charge Code |
94200028
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$38.97 |
| Max. Negotiated Rate |
$55.66 |
| Rate for Payer: Aetna Commercial |
$52.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.20
|
| Rate for Payer: Cash Price |
$49.48
|
| Rate for Payer: Cofinity Commercial |
$43.30
|
| Rate for Payer: Cofinity Commercial |
$53.19
|
| Rate for Payer: Healthscope Commercial |
$55.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.57
|
| Rate for Payer: PHP Commercial |
$52.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.30
|
| Rate for Payer: Priority Health SBD |
$38.97
|
|
|
HC GROUP SESSION 30 MIN RD G0109
|
Facility
|
OP
|
$61.85
|
|
|
Service Code
|
HCPCS G0109
|
| Hospital Charge Code |
94200028
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$15.39 |
| Max. Negotiated Rate |
$55.66 |
| Rate for Payer: Aetna Commercial |
$52.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.20
|
| Rate for Payer: BCBS Complete |
$24.74
|
| Rate for Payer: BCBS Trust/PPO |
$30.71
|
| Rate for Payer: Cash Price |
$49.48
|
| Rate for Payer: Cash Price |
$49.48
|
| Rate for Payer: Cofinity Commercial |
$43.30
|
| Rate for Payer: Cofinity Commercial |
$53.19
|
| Rate for Payer: Healthscope Commercial |
$55.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.57
|
| Rate for Payer: PHP Commercial |
$52.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.30
|
| Rate for Payer: Priority Health SBD |
$38.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.93
|
| Rate for Payer: UHC Exchange |
$15.39
|
|
|
HC GROUP THERAPEUTIC PROCEDURES
|
Facility
|
OP
|
$105.11
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
42000027
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$11.83 |
| Max. Negotiated Rate |
$94.60 |
| Rate for Payer: Aetna Commercial |
$89.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.32
|
| Rate for Payer: BCBS Complete |
$42.04
|
| Rate for Payer: BCBS Trust/PPO |
$11.83
|
| Rate for Payer: Cash Price |
$84.09
|
| Rate for Payer: Cash Price |
$84.09
|
| Rate for Payer: Cofinity Commercial |
$90.39
|
| Rate for Payer: Cofinity Commercial |
$73.58
|
| Rate for Payer: Healthscope Commercial |
$94.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.34
|
| Rate for Payer: PHP Commercial |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.58
|
| Rate for Payer: Priority Health SBD |
$66.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.45
|
| Rate for Payer: UHC Exchange |
$17.68
|
|
|
HC GROUP THERAPEUTIC PROCEDURES
|
Facility
|
IP
|
$105.11
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
42000027
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$66.22 |
| Max. Negotiated Rate |
$94.60 |
| Rate for Payer: Aetna Commercial |
$89.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.32
|
| Rate for Payer: Cash Price |
$84.09
|
| Rate for Payer: Cofinity Commercial |
$73.58
|
| Rate for Payer: Cofinity Commercial |
$90.39
|
| Rate for Payer: Healthscope Commercial |
$94.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.34
|
| Rate for Payer: PHP Commercial |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.58
|
| Rate for Payer: Priority Health SBD |
$66.22
|
|
|
HC GROWTH HORMONE HGH
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
30100752
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna Commercial |
$55.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.25
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$45.50
|
| Rate for Payer: Cofinity Commercial |
$55.90
|
| Rate for Payer: Healthscope Commercial |
$58.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.25
|
| Rate for Payer: PHP Commercial |
$55.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health SBD |
$40.95
|
|
|
HC GROWTH HORMONE HGH
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
30100752
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna Commercial |
$55.25
|
| Rate for Payer: Aetna Medicare |
$17.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.84
|
| Rate for Payer: BCBS Complete |
$9.58
|
| Rate for Payer: BCBS MAPPO |
$16.67
|
| Rate for Payer: BCBS Trust/PPO |
$13.05
|
| Rate for Payer: BCN Medicare Advantage |
$16.67
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$45.50
|
| Rate for Payer: Cofinity Commercial |
$55.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.67
|
| Rate for Payer: Healthscope Commercial |
$58.50
|
| Rate for Payer: Mclaren Medicaid |
$9.12
|
| Rate for Payer: Mclaren Medicare |
$16.67
|
| Rate for Payer: Meridian Medicaid |
$9.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.25
|
| Rate for Payer: PACE Medicare |
$15.84
|
| Rate for Payer: PACE SWMI |
$16.67
|
| Rate for Payer: PHP Commercial |
$55.25
|
| Rate for Payer: PHP Medicare Advantage |
$16.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health Medicare |
$16.67
|
| Rate for Payer: Priority Health SBD |
$40.95
|
| Rate for Payer: Railroad Medicare Medicare |
$16.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.00
|
| Rate for Payer: UHC Core |
$28.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.67
|
| Rate for Payer: UHC Exchange |
$16.67
|
| Rate for Payer: UHC Medicare Advantage |
$17.17
|
| Rate for Payer: VA VA |
$16.67
|
|
|
HC GROWTH HORMONE STIMULATION TEST
|
Facility
|
OP
|
$663.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
76100362
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.56 |
| Max. Negotiated Rate |
$636.96 |
| Rate for Payer: Aetna Commercial |
$563.55
|
| Rate for Payer: Aetna Medicare |
$198.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$238.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$238.40
|
| Rate for Payer: BCBS Complete |
$109.55
|
| Rate for Payer: BCBS MAPPO |
$190.72
|
| Rate for Payer: BCBS Trust/PPO |
$260.99
|
| Rate for Payer: BCN Medicare Advantage |
$190.72
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cofinity Commercial |
$570.18
|
| Rate for Payer: Cofinity Commercial |
$464.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.72
|
| Rate for Payer: Healthscope Commercial |
$596.70
|
| Rate for Payer: Mclaren Medicaid |
$104.32
|
| Rate for Payer: Mclaren Medicare |
$190.72
|
| Rate for Payer: Meridian Medicaid |
$109.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$200.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$563.55
|
| Rate for Payer: PACE Medicare |
$181.18
|
| Rate for Payer: PACE SWMI |
$190.72
|
| Rate for Payer: PHP Commercial |
$563.55
|
| Rate for Payer: PHP Medicare Advantage |
$190.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$636.96
|
| Rate for Payer: Priority Health Medicare |
$190.72
|
| Rate for Payer: Priority Health Narrow Network |
$509.57
|
| Rate for Payer: Priority Health SBD |
$417.69
|
| Rate for Payer: Railroad Medicare Medicare |
$190.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$190.72
|
| Rate for Payer: UHC Exchange |
$61.56
|
| Rate for Payer: UHC Medicare Advantage |
$196.44
|
| Rate for Payer: VA VA |
$190.72
|
|
|
HC GROWTH HORMONE STIMULATION TEST
|
Facility
|
IP
|
$663.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
76100362
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$417.69 |
| Max. Negotiated Rate |
$596.70 |
| Rate for Payer: Aetna Commercial |
$563.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.95
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cofinity Commercial |
$464.10
|
| Rate for Payer: Cofinity Commercial |
$570.18
|
| Rate for Payer: Healthscope Commercial |
$596.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$563.55
|
| Rate for Payer: PHP Commercial |
$563.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: Priority Health SBD |
$417.69
|
|
|
HC GSU OBSERVATION PER HOUR
|
Facility
|
IP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200011
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$84.63 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.31
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Cofinity Commercial |
$94.03
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health SBD |
$84.63
|
|
|
HC GSU OBSERVATION PER HOUR
|
Facility
|
OP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200011
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$53.73 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.31
|
| Rate for Payer: BCBS Complete |
$53.73
|
| Rate for Payer: BCBS Trust/PPO |
$108.91
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$94.03
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Meridian Medicaid |
$1,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health SBD |
$84.63
|
|
|
HC G TUBE REPLACEMENT
|
Facility
|
IP
|
$565.20
|
|
| Hospital Charge Code |
36000046
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$356.08 |
| Max. Negotiated Rate |
$508.68 |
| Rate for Payer: Aetna Commercial |
$480.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.38
|
| Rate for Payer: Cash Price |
$452.16
|
| Rate for Payer: Cofinity Commercial |
$395.64
|
| Rate for Payer: Cofinity Commercial |
$486.07
|
| Rate for Payer: Healthscope Commercial |
$508.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$480.42
|
| Rate for Payer: PHP Commercial |
$480.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.64
|
| Rate for Payer: Priority Health SBD |
$356.08
|
|
|
HC G TUBE REPLACEMENT
|
Facility
|
OP
|
$565.20
|
|
| Hospital Charge Code |
36000046
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$226.08 |
| Max. Negotiated Rate |
$508.68 |
| Rate for Payer: Aetna Commercial |
$480.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.38
|
| Rate for Payer: BCBS Complete |
$226.08
|
| Rate for Payer: Cash Price |
$452.16
|
| Rate for Payer: Cofinity Commercial |
$395.64
|
| Rate for Payer: Cofinity Commercial |
$486.07
|
| Rate for Payer: Healthscope Commercial |
$508.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$480.42
|
| Rate for Payer: PHP Commercial |
$480.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.64
|
| Rate for Payer: Priority Health SBD |
$356.08
|
|
|
HC GUIDANT / ABBOTT PERIPHERAL ST
|
Facility
|
IP
|
$2,989.24
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,883.22 |
| Max. Negotiated Rate |
$2,690.32 |
| Rate for Payer: Aetna Commercial |
$2,540.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,943.01
|
| Rate for Payer: Cash Price |
$2,391.39
|
| Rate for Payer: Cofinity Commercial |
$2,092.47
|
| Rate for Payer: Cofinity Commercial |
$2,570.75
|
| Rate for Payer: Healthscope Commercial |
$2,690.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,540.85
|
| Rate for Payer: PHP Commercial |
$2,540.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,092.47
|
| Rate for Payer: Priority Health SBD |
$1,883.22
|
|
|
HC GUIDANT / ABBOTT PERIPHERAL ST
|
Facility
|
OP
|
$2,989.24
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,195.70 |
| Max. Negotiated Rate |
$2,690.32 |
| Rate for Payer: Aetna Commercial |
$2,540.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,943.01
|
| Rate for Payer: BCBS Complete |
$1,195.70
|
| Rate for Payer: Cash Price |
$2,391.39
|
| Rate for Payer: Cofinity Commercial |
$2,092.47
|
| Rate for Payer: Cofinity Commercial |
$2,570.75
|
| Rate for Payer: Healthscope Commercial |
$2,690.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,540.85
|
| Rate for Payer: PHP Commercial |
$2,540.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,092.47
|
| Rate for Payer: Priority Health SBD |
$1,883.22
|
|
