|
HC COGNITIVE EXAM
|
Facility
|
IP
|
$306.92
|
|
|
Service Code
|
CPT 96125
|
| Hospital Charge Code |
43400002
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$193.36 |
| Max. Negotiated Rate |
$276.23 |
| Rate for Payer: Aetna Commercial |
$260.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.50
|
| Rate for Payer: Cash Price |
$245.54
|
| Rate for Payer: Cofinity Advantage |
$214.84
|
| Rate for Payer: Cofinity Commercial |
$263.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.54
|
| Rate for Payer: Healthscope Commercial |
$276.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.19
|
| Rate for Payer: PHP Commercial |
$260.88
|
| Rate for Payer: Priority Health SBD |
$193.36
|
|
|
HC COGNITIVE EXAM
|
Facility
|
OP
|
$306.92
|
|
|
Service Code
|
CPT 96125
|
| Hospital Charge Code |
43400002
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$110.40 |
| Max. Negotiated Rate |
$276.23 |
| Rate for Payer: Aetna Commercial |
$260.88
|
| Rate for Payer: Aetna Medicare |
$153.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.50
|
| Rate for Payer: BCBS Complete |
$122.77
|
| Rate for Payer: BCBS Trust/PPO |
$139.96
|
| Rate for Payer: BCN Commercial |
$139.96
|
| Rate for Payer: Cash Price |
$245.54
|
| Rate for Payer: Cash Price |
$245.54
|
| Rate for Payer: Cash Price |
$245.54
|
| Rate for Payer: Cofinity Advantage |
$214.84
|
| Rate for Payer: Cofinity Commercial |
$263.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.54
|
| Rate for Payer: Healthscope Commercial |
$276.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$245.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.88
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.19
|
| Rate for Payer: PHP Commercial |
$260.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$138.00
|
| Rate for Payer: Priority Health SBD |
$193.36
|
| Rate for Payer: Priority Health Tiered Network |
$110.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.50
|
| Rate for Payer: UHC Core |
$159.91
|
| Rate for Payer: UHC Exchange |
$120.62
|
|
|
HC COGNITIVE FUNCTION, ADDL 15 MIN
|
Facility
|
OP
|
$115.76
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
43000023
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$18.77 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Aetna Commercial |
$98.40
|
| Rate for Payer: Aetna Medicare |
$57.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.24
|
| Rate for Payer: BCBS Complete |
$46.30
|
| Rate for Payer: BCBS Trust/PPO |
$29.09
|
| Rate for Payer: BCN Commercial |
$29.09
|
| Rate for Payer: Cash Price |
$92.61
|
| Rate for Payer: Cash Price |
$92.61
|
| Rate for Payer: Cash Price |
$92.61
|
| Rate for Payer: Cofinity Advantage |
$81.03
|
| Rate for Payer: Cofinity Commercial |
$99.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.61
|
| Rate for Payer: Healthscope Commercial |
$104.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.82
|
| Rate for Payer: PHP Commercial |
$98.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23.46
|
| Rate for Payer: Priority Health SBD |
$72.93
|
| Rate for Payer: Priority Health Tiered Network |
$18.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.24
|
| Rate for Payer: UHC Core |
$60.31
|
| Rate for Payer: UHC Exchange |
$45.49
|
|
|
HC COGNITIVE FUNCTION, ADDL 15 MIN
|
Facility
|
IP
|
$115.76
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
43000023
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$72.93 |
| Max. Negotiated Rate |
$104.18 |
| Rate for Payer: Aetna Commercial |
$98.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.24
|
| Rate for Payer: Cash Price |
$92.61
|
| Rate for Payer: Cofinity Advantage |
$81.03
|
| Rate for Payer: Cofinity Commercial |
$99.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.61
|
| Rate for Payer: Healthscope Commercial |
$104.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.82
|
| Rate for Payer: PHP Commercial |
$98.40
|
| Rate for Payer: Priority Health SBD |
$72.93
|
|
|
HC COGNITIVE FUNCTION, INITIAL 15 MIN
|
Facility
|
IP
|
$118.08
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
43000022
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$74.39 |
| Max. Negotiated Rate |
$106.27 |
| Rate for Payer: Aetna Commercial |
$100.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.75
|
| Rate for Payer: Cash Price |
$94.46
|
| Rate for Payer: Cofinity Advantage |
$82.66
|
| Rate for Payer: Cofinity Commercial |
$101.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.46
|
| Rate for Payer: Healthscope Commercial |
$106.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.56
|
| Rate for Payer: PHP Commercial |
$100.37
|
| Rate for Payer: Priority Health SBD |
$74.39
|
|
|
HC COGNITIVE FUNCTION, INITIAL 15 MIN
|
Facility
|
OP
|
$118.08
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
43000022
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.34 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$100.37
|
| Rate for Payer: Aetna Medicare |
$59.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.75
|
| Rate for Payer: BCBS Complete |
$47.23
|
| Rate for Payer: BCBS Trust/PPO |
$30.44
|
| Rate for Payer: BCN Commercial |
$30.44
|
| Rate for Payer: Cash Price |
$94.46
|
| Rate for Payer: Cash Price |
$94.46
|
| Rate for Payer: Cash Price |
$94.46
|
| Rate for Payer: Cofinity Advantage |
$82.66
|
| Rate for Payer: Cofinity Commercial |
$101.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.46
|
| Rate for Payer: Healthscope Commercial |
$106.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.37
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.56
|
| Rate for Payer: PHP Commercial |
$100.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24.18
|
| Rate for Payer: Priority Health SBD |
$74.39
|
| Rate for Payer: Priority Health Tiered Network |
$19.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.75
|
| Rate for Payer: UHC Core |
$61.52
|
| Rate for Payer: UHC Exchange |
$46.41
|
|
|
HC COLD AGGLUTININS
|
Facility
|
OP
|
$62.74
|
|
|
Service Code
|
CPT 86156
|
| Hospital Charge Code |
30200149
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$56.47 |
| Rate for Payer: Aetna Commercial |
$53.33
|
| Rate for Payer: Aetna Medicare |
$8.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.09
|
| Rate for Payer: BCBS Complete |
$4.43
|
| Rate for Payer: BCBS MAPPO |
$8.07
|
| Rate for Payer: BCBS Trust/PPO |
$8.60
|
| Rate for Payer: BCN Commercial |
$8.60
|
| Rate for Payer: BCN Medicare Advantage |
$8.07
|
| Rate for Payer: Cash Price |
$50.19
|
| Rate for Payer: Cash Price |
$50.19
|
| Rate for Payer: Cofinity Advantage |
$43.92
|
| Rate for Payer: Cofinity Commercial |
$53.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.07
|
| Rate for Payer: Healthscope Commercial |
$56.47
|
| Rate for Payer: Mclaren Medicaid |
$4.22
|
| Rate for Payer: Mclaren Medicare |
$8.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.47
|
| Rate for Payer: Meridian Medicaid |
$8.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.33
|
| Rate for Payer: Nomi Health Commercial |
$12.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.05
|
| Rate for Payer: PACE Medicare |
$7.67
|
| Rate for Payer: PACE SWMI |
$8.07
|
| Rate for Payer: PHP Commercial |
$53.33
|
| Rate for Payer: PHP Medicare Advantage |
$8.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8.07
|
| Rate for Payer: Priority Health Medicare |
$8.07
|
| Rate for Payer: Priority Health SBD |
$39.53
|
| Rate for Payer: Priority Health Tiered Network |
$6.46
|
| Rate for Payer: Railroad Medicare Medicare |
$8.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.11
|
| Rate for Payer: UHC Core |
$12.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.07
|
| Rate for Payer: UHC Exchange |
$12.11
|
| Rate for Payer: UHC Medicaid |
$4.22
|
| Rate for Payer: UHCCP Medicaid |
$4.22
|
| Rate for Payer: VA VA |
$8.07
|
|
|
HC COLD AGGLUTININS
|
Facility
|
IP
|
$62.74
|
|
|
Service Code
|
CPT 86156
|
| Hospital Charge Code |
30200149
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$39.53 |
| Max. Negotiated Rate |
$56.47 |
| Rate for Payer: Aetna Commercial |
$53.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.78
|
| Rate for Payer: Cash Price |
$50.19
|
| Rate for Payer: Cofinity Advantage |
$43.92
|
| Rate for Payer: Cofinity Commercial |
$53.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.19
|
| Rate for Payer: Healthscope Commercial |
$56.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.05
|
| Rate for Payer: PHP Commercial |
$53.33
|
| Rate for Payer: Priority Health SBD |
$39.53
|
|
|
HC COLD SNARE POLYPECTOMY
|
Facility
|
OP
|
$556.06
|
|
| Hospital Charge Code |
36000018
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$222.42 |
| Max. Negotiated Rate |
$500.45 |
| Rate for Payer: Aetna Commercial |
$472.65
|
| Rate for Payer: Aetna Medicare |
$278.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$361.44
|
| Rate for Payer: BCBS Complete |
$222.42
|
| Rate for Payer: Cash Price |
$444.85
|
| Rate for Payer: Cofinity Advantage |
$389.24
|
| Rate for Payer: Cofinity Commercial |
$478.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$444.85
|
| Rate for Payer: Healthscope Commercial |
$500.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$444.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$472.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$417.05
|
| Rate for Payer: PHP Commercial |
$472.65
|
| Rate for Payer: Priority Health SBD |
$350.32
|
|
|
HC COLD SNARE POLYPECTOMY
|
Facility
|
IP
|
$556.06
|
|
| Hospital Charge Code |
36000018
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$350.32 |
| Max. Negotiated Rate |
$500.45 |
| Rate for Payer: Aetna Commercial |
$472.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$361.44
|
| Rate for Payer: Cash Price |
$444.85
|
| Rate for Payer: Cofinity Advantage |
$389.24
|
| Rate for Payer: Cofinity Commercial |
$478.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$444.85
|
| Rate for Payer: Healthscope Commercial |
$500.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$472.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$417.05
|
| Rate for Payer: PHP Commercial |
$472.65
|
| Rate for Payer: Priority Health SBD |
$350.32
|
|
|
HC COLLAGEN IMPLANT
|
Facility
|
IP
|
$1,918.60
|
|
|
Service Code
|
HCPCS L8603
|
| Hospital Charge Code |
27800005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,208.72 |
| Max. Negotiated Rate |
$1,726.74 |
| Rate for Payer: Aetna Commercial |
$1,630.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,247.09
|
| Rate for Payer: Cash Price |
$1,534.88
|
| Rate for Payer: Cofinity Advantage |
$1,343.02
|
| Rate for Payer: Cofinity Commercial |
$1,650.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,534.88
|
| Rate for Payer: Healthscope Commercial |
$1,726.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,630.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,438.95
|
| Rate for Payer: PHP Commercial |
$1,630.81
|
| Rate for Payer: Priority Health SBD |
$1,208.72
|
|
|
HC COLLAGEN IMPLANT
|
Facility
|
OP
|
$1,918.60
|
|
|
Service Code
|
HCPCS L8603
|
| Hospital Charge Code |
27800005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.32 |
| Max. Negotiated Rate |
$1,726.74 |
| Rate for Payer: Aetna Commercial |
$1,630.81
|
| Rate for Payer: Aetna Medicare |
$959.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,247.09
|
| Rate for Payer: BCBS Complete |
$767.44
|
| Rate for Payer: BCBS Trust/PPO |
$91.32
|
| Rate for Payer: BCN Commercial |
$91.32
|
| Rate for Payer: Cash Price |
$1,534.88
|
| Rate for Payer: Cash Price |
$1,534.88
|
| Rate for Payer: Cofinity Advantage |
$1,343.02
|
| Rate for Payer: Cofinity Commercial |
$1,650.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,534.88
|
| Rate for Payer: Healthscope Commercial |
$1,726.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,534.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,630.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,438.95
|
| Rate for Payer: PHP Commercial |
$1,630.81
|
| Rate for Payer: Priority Health SBD |
$1,208.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,247.09
|
| Rate for Payer: UHC Core |
$999.59
|
| Rate for Payer: UHC Exchange |
$754.01
|
|
|
HC COLL CAPILLARY BLOOD SPECIMEN
|
Facility
|
IP
|
$8.91
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
30000077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$8.02 |
| Rate for Payer: Aetna Commercial |
$7.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.79
|
| Rate for Payer: Cash Price |
$7.13
|
| Rate for Payer: Cofinity Advantage |
$6.24
|
| Rate for Payer: Cofinity Commercial |
$7.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.13
|
| Rate for Payer: Healthscope Commercial |
$8.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.68
|
| Rate for Payer: PHP Commercial |
$7.57
|
| Rate for Payer: Priority Health SBD |
$5.61
|
|
|
HC COLL CAPILLARY BLOOD SPECIMEN
|
Facility
|
OP
|
$8.91
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
30000077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$13.59 |
| Rate for Payer: Aetna Commercial |
$7.57
|
| Rate for Payer: Aetna Medicare |
$4.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.79
|
| Rate for Payer: BCBS Complete |
$3.56
|
| Rate for Payer: BCBS Trust/PPO |
$2.29
|
| Rate for Payer: BCN Commercial |
$2.29
|
| Rate for Payer: Cash Price |
$7.13
|
| Rate for Payer: Cash Price |
$7.13
|
| Rate for Payer: Cofinity Advantage |
$6.24
|
| Rate for Payer: Cofinity Commercial |
$7.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.13
|
| Rate for Payer: Healthscope Commercial |
$8.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.68
|
| Rate for Payer: PHP Commercial |
$7.57
|
| Rate for Payer: Priority Health SBD |
$5.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.59
|
| Rate for Payer: UHC Core |
$13.59
|
| Rate for Payer: UHC Exchange |
$13.59
|
|
|
HC COLLECT CAPILLARY BLOOD SPECIMEN
|
Facility
|
OP
|
$8.91
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
30000175
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$13.59 |
| Rate for Payer: Aetna Commercial |
$7.57
|
| Rate for Payer: Aetna Medicare |
$4.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.79
|
| Rate for Payer: BCBS Complete |
$3.56
|
| Rate for Payer: BCBS Trust/PPO |
$2.29
|
| Rate for Payer: BCN Commercial |
$2.29
|
| Rate for Payer: Cash Price |
$7.13
|
| Rate for Payer: Cash Price |
$7.13
|
| Rate for Payer: Cofinity Advantage |
$6.24
|
| Rate for Payer: Cofinity Commercial |
$7.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.13
|
| Rate for Payer: Healthscope Commercial |
$8.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.68
|
| Rate for Payer: PHP Commercial |
$7.57
|
| Rate for Payer: Priority Health SBD |
$5.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.59
|
| Rate for Payer: UHC Core |
$13.59
|
| Rate for Payer: UHC Exchange |
$13.59
|
|
|
HC COLLECT CAPILLARY BLOOD SPECIMEN
|
Facility
|
IP
|
$8.91
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
30000175
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$8.02 |
| Rate for Payer: Aetna Commercial |
$7.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.79
|
| Rate for Payer: Cash Price |
$7.13
|
| Rate for Payer: Cofinity Advantage |
$6.24
|
| Rate for Payer: Cofinity Commercial |
$7.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.13
|
| Rate for Payer: Healthscope Commercial |
$8.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.68
|
| Rate for Payer: PHP Commercial |
$7.57
|
| Rate for Payer: Priority Health SBD |
$5.61
|
|
|
HC COLON DECOMPRESSION
|
Facility
|
OP
|
$2,450.59
|
|
| Hospital Charge Code |
36000019
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$980.24 |
| Max. Negotiated Rate |
$2,205.53 |
| Rate for Payer: Aetna Commercial |
$2,083.00
|
| Rate for Payer: Aetna Medicare |
$1,225.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,592.88
|
| Rate for Payer: BCBS Complete |
$980.24
|
| Rate for Payer: Cash Price |
$1,960.47
|
| Rate for Payer: Cofinity Advantage |
$1,715.41
|
| Rate for Payer: Cofinity Commercial |
$2,107.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,960.47
|
| Rate for Payer: Healthscope Commercial |
$2,205.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,960.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,083.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,837.94
|
| Rate for Payer: PHP Commercial |
$2,083.00
|
| Rate for Payer: Priority Health SBD |
$1,543.87
|
|
|
HC COLON DECOMPRESSION
|
Facility
|
IP
|
$2,450.59
|
|
| Hospital Charge Code |
36000019
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,543.87 |
| Max. Negotiated Rate |
$2,205.53 |
| Rate for Payer: Aetna Commercial |
$2,083.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,592.88
|
| Rate for Payer: Cash Price |
$1,960.47
|
| Rate for Payer: Cofinity Advantage |
$1,715.41
|
| Rate for Payer: Cofinity Commercial |
$2,107.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,960.47
|
| Rate for Payer: Healthscope Commercial |
$2,205.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,083.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,837.94
|
| Rate for Payer: PHP Commercial |
$2,083.00
|
| Rate for Payer: Priority Health SBD |
$1,543.87
|
|
|
HC COLON MOTILITY STUDY 6 HRS CONT RECORDING
|
Facility
|
IP
|
$373.92
|
|
|
Service Code
|
CPT 91117
|
| Hospital Charge Code |
75000011
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$235.57 |
| Max. Negotiated Rate |
$336.53 |
| Rate for Payer: Aetna Commercial |
$317.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.05
|
| Rate for Payer: Cash Price |
$299.14
|
| Rate for Payer: Cofinity Advantage |
$261.74
|
| Rate for Payer: Cofinity Commercial |
$321.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.14
|
| Rate for Payer: Healthscope Commercial |
$336.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.44
|
| Rate for Payer: PHP Commercial |
$317.83
|
| Rate for Payer: Priority Health SBD |
$235.57
|
|
|
HC COLON MOTILITY STUDY 6 HRS CONT RECORDING
|
Facility
|
OP
|
$373.92
|
|
|
Service Code
|
CPT 91117
|
| Hospital Charge Code |
75000011
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$695.77 |
| Rate for Payer: Aetna Commercial |
$317.83
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$210.23
|
| Rate for Payer: BCN Commercial |
$210.23
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$299.14
|
| Rate for Payer: Cash Price |
$299.14
|
| Rate for Payer: Cofinity Advantage |
$261.74
|
| Rate for Payer: Cofinity Commercial |
$321.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$336.53
|
| Rate for Payer: Mclaren Medicaid |
$112.52
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.83
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.44
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$317.83
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$235.57
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC COLONOSCOPY
|
Facility
|
IP
|
$2,663.93
|
|
| Hospital Charge Code |
36000020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,678.28 |
| Max. Negotiated Rate |
$2,397.54 |
| Rate for Payer: Aetna Commercial |
$2,264.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,731.55
|
| Rate for Payer: Cash Price |
$2,131.14
|
| Rate for Payer: Cofinity Advantage |
$1,864.75
|
| Rate for Payer: Cofinity Commercial |
$2,290.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,131.14
|
| Rate for Payer: Healthscope Commercial |
$2,397.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,264.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,997.95
|
| Rate for Payer: PHP Commercial |
$2,264.34
|
| Rate for Payer: Priority Health SBD |
$1,678.28
|
|
|
HC COLONOSCOPY
|
Facility
|
OP
|
$2,663.93
|
|
| Hospital Charge Code |
36000020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,065.57 |
| Max. Negotiated Rate |
$2,397.54 |
| Rate for Payer: Aetna Commercial |
$2,264.34
|
| Rate for Payer: Aetna Medicare |
$1,331.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,731.55
|
| Rate for Payer: BCBS Complete |
$1,065.57
|
| Rate for Payer: Cash Price |
$2,131.14
|
| Rate for Payer: Cofinity Advantage |
$1,864.75
|
| Rate for Payer: Cofinity Commercial |
$2,290.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,131.14
|
| Rate for Payer: Healthscope Commercial |
$2,397.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,131.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,264.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,997.95
|
| Rate for Payer: PHP Commercial |
$2,264.34
|
| Rate for Payer: Priority Health SBD |
$1,678.28
|
|
|
HC COLONOSCOPY W EUS EXAM
|
Facility
|
IP
|
$2,856.06
|
|
| Hospital Charge Code |
36000022
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,799.32 |
| Max. Negotiated Rate |
$2,570.45 |
| Rate for Payer: Aetna Commercial |
$2,427.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,856.44
|
| Rate for Payer: Cash Price |
$2,284.85
|
| Rate for Payer: Cofinity Advantage |
$1,999.24
|
| Rate for Payer: Cofinity Commercial |
$2,456.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,284.85
|
| Rate for Payer: Healthscope Commercial |
$2,570.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,427.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,142.05
|
| Rate for Payer: PHP Commercial |
$2,427.65
|
| Rate for Payer: Priority Health SBD |
$1,799.32
|
|
|
HC COLONOSCOPY W EUS EXAM
|
Facility
|
OP
|
$2,856.06
|
|
| Hospital Charge Code |
36000022
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,142.42 |
| Max. Negotiated Rate |
$2,570.45 |
| Rate for Payer: Aetna Commercial |
$2,427.65
|
| Rate for Payer: Aetna Medicare |
$1,428.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,856.44
|
| Rate for Payer: BCBS Complete |
$1,142.42
|
| Rate for Payer: Cash Price |
$2,284.85
|
| Rate for Payer: Cofinity Advantage |
$1,999.24
|
| Rate for Payer: Cofinity Commercial |
$2,456.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,284.85
|
| Rate for Payer: Healthscope Commercial |
$2,570.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,284.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,427.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,142.05
|
| Rate for Payer: PHP Commercial |
$2,427.65
|
| Rate for Payer: Priority Health SBD |
$1,799.32
|
|
|
HC COLPOSCOPY CERVIX VAG ELTRD CONIZATION CERVIX
|
Facility
|
IP
|
$7,108.93
|
|
|
Service Code
|
CPT 57461
|
| Hospital Charge Code |
76100328
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,478.63 |
| Max. Negotiated Rate |
$6,398.04 |
| Rate for Payer: Aetna Commercial |
$6,042.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,620.80
|
| Rate for Payer: Cash Price |
$5,687.14
|
| Rate for Payer: Cofinity Advantage |
$4,976.25
|
| Rate for Payer: Cofinity Commercial |
$6,113.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,687.14
|
| Rate for Payer: Healthscope Commercial |
$6,398.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,042.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,331.70
|
| Rate for Payer: PHP Commercial |
$6,042.59
|
| Rate for Payer: Priority Health SBD |
$4,478.63
|
|
