|
HC HCCORO/CABG ANGIOS ONLY
|
Facility
|
OP
|
$6,358.90
|
|
|
Service Code
|
CPT 93455
|
| Hospital Charge Code |
48100014
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$975.45 |
| Max. Negotiated Rate |
$6,837.00 |
| Rate for Payer: Aetna Commercial |
$5,405.06
|
| Rate for Payer: Aetna Medicare |
$3,015.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,133.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,624.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,624.31
|
| Rate for Payer: BCBS Complete |
$1,665.44
|
| Rate for Payer: BCBS MAPPO |
$2,899.45
|
| Rate for Payer: BCBS Trust/PPO |
$3,395.60
|
| Rate for Payer: BCN Medicare Advantage |
$2,899.45
|
| Rate for Payer: Cash Price |
$5,087.12
|
| Rate for Payer: Cash Price |
$5,087.12
|
| Rate for Payer: Cofinity Commercial |
$5,468.65
|
| Rate for Payer: Cofinity Commercial |
$4,451.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,899.45
|
| Rate for Payer: Healthscope Commercial |
$5,723.01
|
| Rate for Payer: Mclaren Medicaid |
$1,586.00
|
| Rate for Payer: Mclaren Medicare |
$2,899.45
|
| Rate for Payer: Meridian Medicaid |
$1,665.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,044.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,334.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,405.06
|
| Rate for Payer: PACE Medicare |
$2,754.48
|
| Rate for Payer: PACE SWMI |
$2,899.45
|
| Rate for Payer: PHP Commercial |
$5,405.06
|
| Rate for Payer: PHP Medicare Advantage |
$2,899.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,586.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,451.23
|
| Rate for Payer: Priority Health Medicare |
$2,899.45
|
| Rate for Payer: Priority Health SBD |
$4,006.11
|
| Rate for Payer: Railroad Medicare Medicare |
$2,899.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,073.00
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,899.45
|
| Rate for Payer: UHC Exchange |
$975.45
|
| Rate for Payer: UHC Medicare Advantage |
$2,986.43
|
| Rate for Payer: VA VA |
$2,899.45
|
|
|
HC HCG SERUM QUANTITATIVE
|
Facility
|
OP
|
$62.22
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
30100465
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna Commercial |
$52.89
|
| Rate for Payer: Aetna Medicare |
$15.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.81
|
| Rate for Payer: BCBS Complete |
$8.64
|
| Rate for Payer: BCBS MAPPO |
$15.05
|
| Rate for Payer: BCBS Trust/PPO |
$11.79
|
| Rate for Payer: BCN Medicare Advantage |
$15.05
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cofinity Commercial |
$43.55
|
| Rate for Payer: Cofinity Commercial |
$53.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.05
|
| Rate for Payer: Healthscope Commercial |
$56.00
|
| Rate for Payer: Mclaren Medicaid |
$8.23
|
| Rate for Payer: Mclaren Medicare |
$15.05
|
| Rate for Payer: Meridian Medicaid |
$8.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.89
|
| Rate for Payer: PACE Medicare |
$14.30
|
| Rate for Payer: PACE SWMI |
$15.05
|
| Rate for Payer: PHP Commercial |
$52.89
|
| Rate for Payer: PHP Medicare Advantage |
$15.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.55
|
| Rate for Payer: Priority Health Medicare |
$15.05
|
| Rate for Payer: Priority Health SBD |
$39.20
|
| Rate for Payer: Railroad Medicare Medicare |
$15.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.06
|
| Rate for Payer: UHC Core |
$25.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.05
|
| Rate for Payer: UHC Exchange |
$15.05
|
| Rate for Payer: UHC Medicare Advantage |
$15.50
|
| Rate for Payer: VA VA |
$15.05
|
|
|
HC HCG SERUM QUANTITATIVE
|
Facility
|
IP
|
$62.22
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
30100465
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna Commercial |
$52.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.44
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cofinity Commercial |
$43.55
|
| Rate for Payer: Cofinity Commercial |
$53.51
|
| Rate for Payer: Healthscope Commercial |
$56.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.89
|
| Rate for Payer: PHP Commercial |
$52.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.55
|
| Rate for Payer: Priority Health SBD |
$39.20
|
|
|
HC HCV GENOTYPE RESOLUTION
|
Facility
|
IP
|
$395.58
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
30600262
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$249.22 |
| Max. Negotiated Rate |
$356.02 |
| Rate for Payer: Aetna Commercial |
$336.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.13
|
| Rate for Payer: Cash Price |
$316.46
|
| Rate for Payer: Cofinity Commercial |
$276.91
|
| Rate for Payer: Cofinity Commercial |
$340.20
|
| Rate for Payer: Healthscope Commercial |
$356.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$336.24
|
| Rate for Payer: PHP Commercial |
$336.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.91
|
| Rate for Payer: Priority Health SBD |
$249.22
|
|
|
HC HCV GENOTYPE RESOLUTION
|
Facility
|
OP
|
$395.58
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
30600262
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$140.83 |
| Max. Negotiated Rate |
$437.57 |
| Rate for Payer: Aetna Commercial |
$336.24
|
| Rate for Payer: Aetna Medicare |
$267.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$321.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$321.81
|
| Rate for Payer: BCBS Complete |
$147.88
|
| Rate for Payer: BCBS MAPPO |
$257.45
|
| Rate for Payer: BCBS Trust/PPO |
$201.61
|
| Rate for Payer: BCN Medicare Advantage |
$257.45
|
| Rate for Payer: Cash Price |
$316.46
|
| Rate for Payer: Cash Price |
$316.46
|
| Rate for Payer: Cofinity Commercial |
$276.91
|
| Rate for Payer: Cofinity Commercial |
$340.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.45
|
| Rate for Payer: Healthscope Commercial |
$356.02
|
| Rate for Payer: Mclaren Medicaid |
$140.83
|
| Rate for Payer: Mclaren Medicare |
$257.45
|
| Rate for Payer: Meridian Medicaid |
$147.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$270.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$296.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$336.24
|
| Rate for Payer: PACE Medicare |
$244.58
|
| Rate for Payer: PACE SWMI |
$257.45
|
| Rate for Payer: PHP Commercial |
$336.24
|
| Rate for Payer: PHP Medicare Advantage |
$257.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.91
|
| Rate for Payer: Priority Health Medicare |
$257.45
|
| Rate for Payer: Priority Health SBD |
$249.22
|
| Rate for Payer: Railroad Medicare Medicare |
$257.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.94
|
| Rate for Payer: UHC Core |
$437.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$257.45
|
| Rate for Payer: UHC Exchange |
$257.45
|
| Rate for Payer: UHC Medicare Advantage |
$265.17
|
| Rate for Payer: VA VA |
$257.45
|
|
|
HC HDL CHOLESTEROL
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
30100282
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna Medicare |
$8.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.24
|
| Rate for Payer: BCBS Complete |
$4.70
|
| Rate for Payer: BCBS MAPPO |
$8.19
|
| Rate for Payer: BCBS Trust/PPO |
$6.41
|
| Rate for Payer: BCN Medicare Advantage |
$8.19
|
| 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 |
$8.19
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Mclaren Medicaid |
$4.48
|
| Rate for Payer: Mclaren Medicare |
$8.19
|
| Rate for Payer: Meridian Medicaid |
$4.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.01
|
| Rate for Payer: PACE Medicare |
$7.78
|
| Rate for Payer: PACE SWMI |
$8.19
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: PHP Medicare Advantage |
$8.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.42
|
| Rate for Payer: Priority Health Medicare |
$8.19
|
| Rate for Payer: Priority Health SBD |
$19.28
|
| Rate for Payer: Railroad Medicare Medicare |
$8.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.83
|
| Rate for Payer: UHC Core |
$13.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.19
|
| Rate for Payer: UHC Exchange |
$8.19
|
| Rate for Payer: UHC Medicare Advantage |
$8.44
|
| Rate for Payer: VA VA |
$8.19
|
|
|
HC HDL CHOLESTEROL
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
30100282
|
|
Hospital Revenue Code
|
301
|
| 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 HDL CHOLESTEROL LMPP
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
30100690
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health SBD |
$12.85
|
|
|
HC HDL CHOLESTEROL LMPP
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
30100690
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$8.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.24
|
| Rate for Payer: BCBS Complete |
$4.70
|
| Rate for Payer: BCBS MAPPO |
$8.19
|
| Rate for Payer: BCBS Trust/PPO |
$6.41
|
| Rate for Payer: BCN Medicare Advantage |
$8.19
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.19
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Mclaren Medicaid |
$4.48
|
| Rate for Payer: Mclaren Medicare |
$8.19
|
| Rate for Payer: Meridian Medicaid |
$4.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PACE Medicare |
$7.78
|
| Rate for Payer: PACE SWMI |
$8.19
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: PHP Medicare Advantage |
$8.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health Medicare |
$8.19
|
| Rate for Payer: Priority Health SBD |
$12.85
|
| Rate for Payer: Railroad Medicare Medicare |
$8.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.83
|
| Rate for Payer: UHC Core |
$13.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.19
|
| Rate for Payer: UHC Exchange |
$8.19
|
| Rate for Payer: UHC Medicare Advantage |
$8.44
|
| Rate for Payer: VA VA |
$8.19
|
|
|
HC HDR 1 CHANNEL
|
Facility
|
OP
|
$1,950.65
|
|
|
Service Code
|
CPT 77770
|
| Hospital Charge Code |
33300055
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$342.18 |
| Max. Negotiated Rate |
$1,755.58 |
| Rate for Payer: Aetna Commercial |
$1,658.05
|
| Rate for Payer: Aetna Commercial |
$453.05
|
| Rate for Payer: Aetna Medicare |
$663.48
|
| Rate for Payer: Aetna Medicare |
$663.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$346.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,267.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$797.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$797.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$797.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$797.45
|
| Rate for Payer: BCBS Complete |
$366.44
|
| Rate for Payer: BCBS Complete |
$366.44
|
| Rate for Payer: BCBS MAPPO |
$637.96
|
| Rate for Payer: BCBS MAPPO |
$637.96
|
| Rate for Payer: BCBS Trust/PPO |
$642.19
|
| Rate for Payer: BCBS Trust/PPO |
$642.19
|
| Rate for Payer: BCN Medicare Advantage |
$637.96
|
| Rate for Payer: BCN Medicare Advantage |
$637.96
|
| Rate for Payer: Cash Price |
$426.40
|
| Rate for Payer: Cash Price |
$1,560.52
|
| Rate for Payer: Cash Price |
$426.40
|
| Rate for Payer: Cash Price |
$1,560.52
|
| Rate for Payer: Cofinity Commercial |
$1,677.56
|
| Rate for Payer: Cofinity Commercial |
$373.10
|
| Rate for Payer: Cofinity Commercial |
$458.38
|
| Rate for Payer: Cofinity Commercial |
$1,365.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$637.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$637.96
|
| Rate for Payer: Healthscope Commercial |
$479.70
|
| Rate for Payer: Healthscope Commercial |
$1,755.58
|
| Rate for Payer: Mclaren Medicaid |
$348.96
|
| Rate for Payer: Mclaren Medicaid |
$348.96
|
| Rate for Payer: Mclaren Medicare |
$637.96
|
| Rate for Payer: Mclaren Medicare |
$637.96
|
| Rate for Payer: Meridian Medicaid |
$366.44
|
| Rate for Payer: Meridian Medicaid |
$366.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$669.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$669.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$733.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$733.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,658.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$453.05
|
| Rate for Payer: PACE Medicare |
$606.06
|
| Rate for Payer: PACE Medicare |
$606.06
|
| Rate for Payer: PACE SWMI |
$637.96
|
| Rate for Payer: PACE SWMI |
$637.96
|
| Rate for Payer: PHP Commercial |
$1,658.05
|
| Rate for Payer: PHP Commercial |
$453.05
|
| Rate for Payer: PHP Medicare Advantage |
$637.96
|
| Rate for Payer: PHP Medicare Advantage |
$637.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,365.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$373.10
|
| Rate for Payer: Priority Health Medicare |
$637.96
|
| Rate for Payer: Priority Health Medicare |
$637.96
|
| Rate for Payer: Priority Health SBD |
$335.79
|
| Rate for Payer: Priority Health SBD |
$1,228.91
|
| Rate for Payer: Railroad Medicare Medicare |
$637.96
|
| Rate for Payer: Railroad Medicare Medicare |
$637.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$376.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$376.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$637.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$637.96
|
| Rate for Payer: UHC Exchange |
$342.18
|
| Rate for Payer: UHC Exchange |
$342.18
|
| Rate for Payer: UHC Medicare Advantage |
$657.10
|
| Rate for Payer: UHC Medicare Advantage |
$657.10
|
| Rate for Payer: VA VA |
$637.96
|
| Rate for Payer: VA VA |
$637.96
|
|
|
HC HDR 1 CHANNEL
|
Facility
|
IP
|
$1,950.65
|
|
|
Service Code
|
CPT 77770
|
| Hospital Charge Code |
33300055
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,228.91 |
| Max. Negotiated Rate |
$1,755.58 |
| Rate for Payer: Aetna Commercial |
$1,658.05
|
| Rate for Payer: Aetna Commercial |
$453.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$346.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,267.92
|
| Rate for Payer: Cash Price |
$1,560.52
|
| Rate for Payer: Cash Price |
$426.40
|
| Rate for Payer: Cofinity Commercial |
$1,365.46
|
| Rate for Payer: Cofinity Commercial |
$1,677.56
|
| Rate for Payer: Cofinity Commercial |
$373.10
|
| Rate for Payer: Cofinity Commercial |
$458.38
|
| Rate for Payer: Healthscope Commercial |
$1,755.58
|
| Rate for Payer: Healthscope Commercial |
$479.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$453.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,658.05
|
| Rate for Payer: PHP Commercial |
$453.05
|
| Rate for Payer: PHP Commercial |
$1,658.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,365.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$373.10
|
| Rate for Payer: Priority Health SBD |
$1,228.91
|
| Rate for Payer: Priority Health SBD |
$335.79
|
|
|
HC HDR 2-12 CHANNELS
|
Facility
|
OP
|
$2,166.72
|
|
|
Service Code
|
CPT 77771
|
| Hospital Charge Code |
33300056
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$348.96 |
| Max. Negotiated Rate |
$1,950.05 |
| Rate for Payer: Aetna Commercial |
$1,841.71
|
| Rate for Payer: Aetna Commercial |
$1,553.80
|
| Rate for Payer: Aetna Medicare |
$663.48
|
| Rate for Payer: Aetna Medicare |
$663.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,408.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,188.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$797.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$797.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$797.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$797.45
|
| Rate for Payer: BCBS Complete |
$366.44
|
| Rate for Payer: BCBS Complete |
$366.44
|
| Rate for Payer: BCBS MAPPO |
$637.96
|
| Rate for Payer: BCBS MAPPO |
$637.96
|
| Rate for Payer: BCBS Trust/PPO |
$642.19
|
| Rate for Payer: BCBS Trust/PPO |
$642.19
|
| Rate for Payer: BCN Medicare Advantage |
$637.96
|
| Rate for Payer: BCN Medicare Advantage |
$637.96
|
| Rate for Payer: Cash Price |
$1,462.40
|
| Rate for Payer: Cash Price |
$1,733.38
|
| Rate for Payer: Cash Price |
$1,733.38
|
| Rate for Payer: Cash Price |
$1,462.40
|
| Rate for Payer: Cofinity Commercial |
$1,572.08
|
| Rate for Payer: Cofinity Commercial |
$1,863.38
|
| Rate for Payer: Cofinity Commercial |
$1,516.70
|
| Rate for Payer: Cofinity Commercial |
$1,279.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$637.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$637.96
|
| Rate for Payer: Healthscope Commercial |
$1,950.05
|
| Rate for Payer: Healthscope Commercial |
$1,645.20
|
| Rate for Payer: Mclaren Medicaid |
$348.96
|
| Rate for Payer: Mclaren Medicaid |
$348.96
|
| Rate for Payer: Mclaren Medicare |
$637.96
|
| Rate for Payer: Mclaren Medicare |
$637.96
|
| Rate for Payer: Meridian Medicaid |
$366.44
|
| Rate for Payer: Meridian Medicaid |
$366.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$669.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$669.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$733.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$733.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,553.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,841.71
|
| Rate for Payer: PACE Medicare |
$606.06
|
| Rate for Payer: PACE Medicare |
$606.06
|
| Rate for Payer: PACE SWMI |
$637.96
|
| Rate for Payer: PACE SWMI |
$637.96
|
| Rate for Payer: PHP Commercial |
$1,553.80
|
| Rate for Payer: PHP Commercial |
$1,841.71
|
| Rate for Payer: PHP Medicare Advantage |
$637.96
|
| Rate for Payer: PHP Medicare Advantage |
$637.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,516.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,279.60
|
| Rate for Payer: Priority Health Medicare |
$637.96
|
| Rate for Payer: Priority Health Medicare |
$637.96
|
| Rate for Payer: Priority Health SBD |
$1,151.64
|
| Rate for Payer: Priority Health SBD |
$1,365.03
|
| Rate for Payer: Railroad Medicare Medicare |
$637.96
|
| Rate for Payer: Railroad Medicare Medicare |
$637.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$654.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$654.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$637.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$637.96
|
| Rate for Payer: UHC Exchange |
$594.96
|
| Rate for Payer: UHC Exchange |
$594.96
|
| Rate for Payer: UHC Medicare Advantage |
$657.10
|
| Rate for Payer: UHC Medicare Advantage |
$657.10
|
| Rate for Payer: VA VA |
$637.96
|
| Rate for Payer: VA VA |
$637.96
|
|
|
HC HDR 2-12 CHANNELS
|
Facility
|
IP
|
$1,828.00
|
|
|
Service Code
|
CPT 77771
|
| Hospital Charge Code |
33300056
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,151.64 |
| Max. Negotiated Rate |
$1,645.20 |
| Rate for Payer: Aetna Commercial |
$1,553.80
|
| Rate for Payer: Aetna Commercial |
$1,841.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,188.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,408.37
|
| Rate for Payer: Cash Price |
$1,462.40
|
| Rate for Payer: Cash Price |
$1,733.38
|
| Rate for Payer: Cofinity Commercial |
$1,572.08
|
| Rate for Payer: Cofinity Commercial |
$1,279.60
|
| Rate for Payer: Cofinity Commercial |
$1,516.70
|
| Rate for Payer: Cofinity Commercial |
$1,863.38
|
| Rate for Payer: Healthscope Commercial |
$1,645.20
|
| Rate for Payer: Healthscope Commercial |
$1,950.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,553.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,841.71
|
| Rate for Payer: PHP Commercial |
$1,553.80
|
| Rate for Payer: PHP Commercial |
$1,841.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,279.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,516.70
|
| Rate for Payer: Priority Health SBD |
$1,365.03
|
| Rate for Payer: Priority Health SBD |
$1,151.64
|
|
|
HC HDR IR 192 BRACHY SOURCE NSTRD
|
Facility
|
IP
|
$551.38
|
|
|
Service Code
|
HCPCS C1717
|
| Hospital Charge Code |
27800090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$347.37 |
| Max. Negotiated Rate |
$496.24 |
| Rate for Payer: Aetna Commercial |
$468.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$358.40
|
| Rate for Payer: Cash Price |
$441.10
|
| Rate for Payer: Cofinity Commercial |
$385.97
|
| Rate for Payer: Cofinity Commercial |
$474.19
|
| Rate for Payer: Healthscope Commercial |
$496.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$468.67
|
| Rate for Payer: PHP Commercial |
$468.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.97
|
| Rate for Payer: Priority Health SBD |
$347.37
|
|
|
HC HDR IR 192 BRACHY SOURCE NSTRD
|
Facility
|
OP
|
$551.38
|
|
|
Service Code
|
HCPCS C1717
|
| Hospital Charge Code |
27800090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.25 |
| Max. Negotiated Rate |
$1,041.79 |
| Rate for Payer: Aetna Commercial |
$468.67
|
| Rate for Payer: Aetna Medicare |
$337.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$358.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$405.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$405.05
|
| Rate for Payer: BCBS Complete |
$186.13
|
| Rate for Payer: BCBS MAPPO |
$324.04
|
| Rate for Payer: BCN Medicare Advantage |
$324.04
|
| Rate for Payer: Cash Price |
$441.10
|
| Rate for Payer: Cash Price |
$441.10
|
| Rate for Payer: Cofinity Commercial |
$474.19
|
| Rate for Payer: Cofinity Commercial |
$385.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.04
|
| Rate for Payer: Healthscope Commercial |
$496.24
|
| Rate for Payer: Mclaren Medicaid |
$177.25
|
| Rate for Payer: Mclaren Medicare |
$324.04
|
| Rate for Payer: Meridian Medicaid |
$186.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$340.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$372.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$468.67
|
| Rate for Payer: PACE Medicare |
$307.84
|
| Rate for Payer: PACE SWMI |
$324.04
|
| Rate for Payer: PHP Commercial |
$468.67
|
| Rate for Payer: PHP Medicare Advantage |
$324.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$177.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,041.79
|
| Rate for Payer: Priority Health Medicare |
$324.04
|
| Rate for Payer: Priority Health Narrow Network |
$833.43
|
| Rate for Payer: Priority Health SBD |
$347.37
|
| Rate for Payer: Railroad Medicare Medicare |
$324.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$908.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.04
|
| Rate for Payer: UHC Exchange |
$619.27
|
| Rate for Payer: UHC Medicare Advantage |
$333.76
|
| Rate for Payer: VA VA |
$324.04
|
|
|
HC HDR OVER 12 CHANNELS
|
Facility
|
IP
|
$2,391.07
|
|
|
Service Code
|
CPT 77772
|
| Hospital Charge Code |
33300057
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,506.37 |
| Max. Negotiated Rate |
$2,151.96 |
| Rate for Payer: Aetna Commercial |
$2,032.41
|
| Rate for Payer: Aetna Commercial |
$2,278.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,554.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,742.00
|
| Rate for Payer: Cash Price |
$1,912.86
|
| Rate for Payer: Cash Price |
$2,144.00
|
| Rate for Payer: Cofinity Commercial |
$1,876.00
|
| Rate for Payer: Cofinity Commercial |
$1,673.75
|
| Rate for Payer: Cofinity Commercial |
$2,056.32
|
| Rate for Payer: Cofinity Commercial |
$2,304.80
|
| Rate for Payer: Healthscope Commercial |
$2,151.96
|
| Rate for Payer: Healthscope Commercial |
$2,412.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,032.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,278.00
|
| Rate for Payer: PHP Commercial |
$2,278.00
|
| Rate for Payer: PHP Commercial |
$2,032.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,673.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,876.00
|
| Rate for Payer: Priority Health SBD |
$1,506.37
|
| Rate for Payer: Priority Health SBD |
$1,688.40
|
|
|
HC HDR OVER 12 CHANNELS
|
Facility
|
OP
|
$2,680.00
|
|
|
Service Code
|
CPT 77772
|
| Hospital Charge Code |
33300057
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$348.96 |
| Max. Negotiated Rate |
$2,412.00 |
| Rate for Payer: Aetna Commercial |
$2,278.00
|
| Rate for Payer: Aetna Commercial |
$2,032.41
|
| Rate for Payer: Aetna Medicare |
$663.48
|
| Rate for Payer: Aetna Medicare |
$663.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,742.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,554.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$797.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$797.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$797.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$797.45
|
| Rate for Payer: BCBS Complete |
$366.44
|
| Rate for Payer: BCBS Complete |
$366.44
|
| Rate for Payer: BCBS MAPPO |
$637.96
|
| Rate for Payer: BCBS MAPPO |
$637.96
|
| Rate for Payer: BCBS Trust/PPO |
$642.19
|
| Rate for Payer: BCBS Trust/PPO |
$642.19
|
| Rate for Payer: BCN Medicare Advantage |
$637.96
|
| Rate for Payer: BCN Medicare Advantage |
$637.96
|
| Rate for Payer: Cash Price |
$2,144.00
|
| Rate for Payer: Cash Price |
$1,912.86
|
| Rate for Payer: Cash Price |
$2,144.00
|
| Rate for Payer: Cash Price |
$1,912.86
|
| Rate for Payer: Cofinity Commercial |
$2,304.80
|
| Rate for Payer: Cofinity Commercial |
$1,673.75
|
| Rate for Payer: Cofinity Commercial |
$1,876.00
|
| Rate for Payer: Cofinity Commercial |
$2,056.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$637.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$637.96
|
| Rate for Payer: Healthscope Commercial |
$2,151.96
|
| Rate for Payer: Healthscope Commercial |
$2,412.00
|
| Rate for Payer: Mclaren Medicaid |
$348.96
|
| Rate for Payer: Mclaren Medicaid |
$348.96
|
| Rate for Payer: Mclaren Medicare |
$637.96
|
| Rate for Payer: Mclaren Medicare |
$637.96
|
| Rate for Payer: Meridian Medicaid |
$366.44
|
| Rate for Payer: Meridian Medicaid |
$366.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$669.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$669.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$733.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$733.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,278.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,032.41
|
| Rate for Payer: PACE Medicare |
$606.06
|
| Rate for Payer: PACE Medicare |
$606.06
|
| Rate for Payer: PACE SWMI |
$637.96
|
| Rate for Payer: PACE SWMI |
$637.96
|
| Rate for Payer: PHP Commercial |
$2,278.00
|
| Rate for Payer: PHP Commercial |
$2,032.41
|
| Rate for Payer: PHP Medicare Advantage |
$637.96
|
| Rate for Payer: PHP Medicare Advantage |
$637.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,673.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,876.00
|
| Rate for Payer: Priority Health Medicare |
$637.96
|
| Rate for Payer: Priority Health Medicare |
$637.96
|
| Rate for Payer: Priority Health SBD |
$1,506.37
|
| Rate for Payer: Priority Health SBD |
$1,688.40
|
| Rate for Payer: Railroad Medicare Medicare |
$637.96
|
| Rate for Payer: Railroad Medicare Medicare |
$637.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$977.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$977.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$637.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$637.96
|
| Rate for Payer: UHC Exchange |
$888.35
|
| Rate for Payer: UHC Exchange |
$888.35
|
| Rate for Payer: UHC Medicare Advantage |
$657.10
|
| Rate for Payer: UHC Medicare Advantage |
$657.10
|
| Rate for Payer: VA VA |
$637.96
|
| Rate for Payer: VA VA |
$637.96
|
|
|
HC HDR SKIN SURFACE 1 CHANNEL
|
Facility
|
OP
|
$472.31
|
|
|
Service Code
|
CPT 77767
|
| Hospital Charge Code |
33300053
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$130.80 |
| Max. Negotiated Rate |
$425.08 |
| Rate for Payer: Aetna Commercial |
$401.46
|
| Rate for Payer: Aetna Medicare |
$248.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$298.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$298.91
|
| Rate for Payer: BCBS Complete |
$137.36
|
| Rate for Payer: BCBS MAPPO |
$239.13
|
| Rate for Payer: BCBS Trust/PPO |
$177.81
|
| Rate for Payer: BCN Medicare Advantage |
$239.13
|
| Rate for Payer: Cash Price |
$377.85
|
| Rate for Payer: Cash Price |
$377.85
|
| Rate for Payer: Cofinity Commercial |
$406.19
|
| Rate for Payer: Cofinity Commercial |
$330.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$239.13
|
| Rate for Payer: Healthscope Commercial |
$425.08
|
| Rate for Payer: Mclaren Medicaid |
$130.80
|
| Rate for Payer: Mclaren Medicare |
$239.13
|
| Rate for Payer: Meridian Medicaid |
$137.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$251.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$275.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$401.46
|
| Rate for Payer: PACE Medicare |
$227.17
|
| Rate for Payer: PACE SWMI |
$239.13
|
| Rate for Payer: PHP Commercial |
$401.46
|
| Rate for Payer: PHP Medicare Advantage |
$239.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.62
|
| Rate for Payer: Priority Health Medicare |
$239.13
|
| Rate for Payer: Priority Health SBD |
$297.56
|
| Rate for Payer: Railroad Medicare Medicare |
$239.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$239.13
|
| Rate for Payer: UHC Exchange |
$245.58
|
| Rate for Payer: UHC Medicare Advantage |
$246.30
|
| Rate for Payer: VA VA |
$239.13
|
|
|
HC HDR SKIN SURFACE 1 CHANNEL
|
Facility
|
IP
|
$472.31
|
|
|
Service Code
|
CPT 77767
|
| Hospital Charge Code |
33300053
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$297.56 |
| Max. Negotiated Rate |
$425.08 |
| Rate for Payer: Aetna Commercial |
$401.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.00
|
| Rate for Payer: Cash Price |
$377.85
|
| Rate for Payer: Cofinity Commercial |
$330.62
|
| Rate for Payer: Cofinity Commercial |
$406.19
|
| Rate for Payer: Healthscope Commercial |
$425.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$401.46
|
| Rate for Payer: PHP Commercial |
$401.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.62
|
| Rate for Payer: Priority Health SBD |
$297.56
|
|
|
HC HDR SKIN SURFACE 2 OR MORE CHANNELS
|
Facility
|
OP
|
$531.36
|
|
|
Service Code
|
CPT 77768
|
| Hospital Charge Code |
33300054
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$130.80 |
| Max. Negotiated Rate |
$478.22 |
| Rate for Payer: Aetna Commercial |
$451.66
|
| Rate for Payer: Aetna Medicare |
$248.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$298.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$298.91
|
| Rate for Payer: BCBS Complete |
$137.36
|
| Rate for Payer: BCBS MAPPO |
$239.13
|
| Rate for Payer: BCBS Trust/PPO |
$177.81
|
| Rate for Payer: BCN Medicare Advantage |
$239.13
|
| Rate for Payer: Cash Price |
$425.09
|
| Rate for Payer: Cash Price |
$425.09
|
| Rate for Payer: Cofinity Commercial |
$456.97
|
| Rate for Payer: Cofinity Commercial |
$371.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$239.13
|
| Rate for Payer: Healthscope Commercial |
$478.22
|
| Rate for Payer: Mclaren Medicaid |
$130.80
|
| Rate for Payer: Mclaren Medicare |
$239.13
|
| Rate for Payer: Meridian Medicaid |
$137.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$251.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$275.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$451.66
|
| Rate for Payer: PACE Medicare |
$227.17
|
| Rate for Payer: PACE SWMI |
$239.13
|
| Rate for Payer: PHP Commercial |
$451.66
|
| Rate for Payer: PHP Medicare Advantage |
$239.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$371.95
|
| Rate for Payer: Priority Health Medicare |
$239.13
|
| Rate for Payer: Priority Health SBD |
$334.76
|
| Rate for Payer: Railroad Medicare Medicare |
$239.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$395.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$239.13
|
| Rate for Payer: UHC Exchange |
$359.86
|
| Rate for Payer: UHC Medicare Advantage |
$246.30
|
| Rate for Payer: VA VA |
$239.13
|
|
|
HC HDR SKIN SURFACE 2 OR MORE CHANNELS
|
Facility
|
IP
|
$531.36
|
|
|
Service Code
|
CPT 77768
|
| Hospital Charge Code |
33300054
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$334.76 |
| Max. Negotiated Rate |
$478.22 |
| Rate for Payer: Aetna Commercial |
$451.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.38
|
| Rate for Payer: Cash Price |
$425.09
|
| Rate for Payer: Cofinity Commercial |
$371.95
|
| Rate for Payer: Cofinity Commercial |
$456.97
|
| Rate for Payer: Healthscope Commercial |
$478.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$451.66
|
| Rate for Payer: PHP Commercial |
$451.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$371.95
|
| Rate for Payer: Priority Health SBD |
$334.76
|
|
|
HC HEALTH & BEHAV ASSESS OR REASSESS
|
Facility
|
OP
|
$120.36
|
|
|
Service Code
|
CPT 96156
|
| Hospital Charge Code |
91400009
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$43.38 |
| Max. Negotiated Rate |
$232.97 |
| Rate for Payer: Aetna Commercial |
$102.31
|
| Rate for Payer: Aetna Medicare |
$82.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.23
|
| 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: BCN Medicare Advantage |
$79.31
|
| Rate for Payer: Cash Price |
$96.29
|
| Rate for Payer: Cash Price |
$96.29
|
| Rate for Payer: Cofinity Commercial |
$103.51
|
| Rate for Payer: Cofinity Commercial |
$84.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.31
|
| Rate for Payer: Healthscope Commercial |
$108.32
|
| 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 |
$102.31
|
| Rate for Payer: PACE Medicare |
$75.34
|
| Rate for Payer: PACE SWMI |
$79.31
|
| Rate for Payer: PHP Commercial |
$102.31
|
| 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 |
$84.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$232.97
|
| Rate for Payer: Priority Health Medicare |
$79.31
|
| Rate for Payer: Priority Health Narrow Network |
$186.38
|
| Rate for Payer: Priority Health SBD |
$75.83
|
| Rate for Payer: Railroad Medicare Medicare |
$79.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.31
|
| Rate for Payer: UHC Exchange |
$86.12
|
| Rate for Payer: UHC Medicare Advantage |
$81.69
|
| Rate for Payer: VA VA |
$79.31
|
|
|
HC HEALTH & BEHAV ASSESS OR REASSESS
|
Facility
|
IP
|
$120.36
|
|
|
Service Code
|
CPT 96156
|
| Hospital Charge Code |
91400009
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$75.83 |
| Max. Negotiated Rate |
$108.32 |
| Rate for Payer: Aetna Commercial |
$102.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.23
|
| Rate for Payer: Cash Price |
$96.29
|
| Rate for Payer: Cofinity Commercial |
$103.51
|
| Rate for Payer: Cofinity Commercial |
$84.25
|
| Rate for Payer: Healthscope Commercial |
$108.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.31
|
| Rate for Payer: PHP Commercial |
$102.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.25
|
| Rate for Payer: Priority Health SBD |
$75.83
|
|
|
HC HEALTH & BEHAV INTERVENT INDIV EA ADD 15 MIN
|
Facility
|
IP
|
$60.18
|
|
|
Service Code
|
CPT 96159
|
| Hospital Charge Code |
91400011
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$37.91 |
| Max. Negotiated Rate |
$54.16 |
| Rate for Payer: Aetna Commercial |
$51.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.12
|
| Rate for Payer: Cash Price |
$48.14
|
| Rate for Payer: Cofinity Commercial |
$42.13
|
| Rate for Payer: Cofinity Commercial |
$51.75
|
| Rate for Payer: Healthscope Commercial |
$54.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.15
|
| Rate for Payer: PHP Commercial |
$51.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.13
|
| Rate for Payer: Priority Health SBD |
$37.91
|
|
|
HC HEALTH & BEHAV INTERVENT INDIV EA ADD 15 MIN
|
Facility
|
OP
|
$60.18
|
|
|
Service Code
|
CPT 96159
|
| Hospital Charge Code |
91400011
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$19.32 |
| Max. Negotiated Rate |
$54.16 |
| Rate for Payer: Aetna Commercial |
$51.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.12
|
| Rate for Payer: BCBS Complete |
$24.07
|
| Rate for Payer: Cash Price |
$48.14
|
| Rate for Payer: Cash Price |
$48.14
|
| Rate for Payer: Cofinity Commercial |
$42.13
|
| Rate for Payer: Cofinity Commercial |
$51.75
|
| Rate for Payer: Healthscope Commercial |
$54.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.15
|
| Rate for Payer: PHP Commercial |
$51.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.13
|
| Rate for Payer: Priority Health SBD |
$37.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.25
|
| Rate for Payer: UHC Exchange |
$19.32
|
|
