|
HC COMP BURN GARM VEST SLEEVED
|
Facility
|
IP
|
$260.10
|
|
|
Service Code
|
HCPCS A6509
|
| Hospital Charge Code |
98300066
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$163.86 |
| Max. Negotiated Rate |
$234.09 |
| Rate for Payer: Aetna Commercial |
$221.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.06
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cofinity Advantage |
$182.07
|
| Rate for Payer: Cofinity Commercial |
$223.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.08
|
| Rate for Payer: Healthscope Commercial |
$234.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.07
|
| Rate for Payer: PHP Commercial |
$221.09
|
| Rate for Payer: Priority Health SBD |
$163.86
|
|
|
HC COMP BURN GARM VEST SLEEVELESS
|
Facility
|
OP
|
$137.33
|
|
|
Service Code
|
HCPCS A6509
|
| Hospital Charge Code |
98300067
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.97 |
| Max. Negotiated Rate |
$450.31 |
| Rate for Payer: Aetna Commercial |
$116.73
|
| Rate for Payer: Aetna Medicare |
$68.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.26
|
| Rate for Payer: BCBS Complete |
$54.93
|
| Rate for Payer: BCBS Trust/PPO |
$450.31
|
| Rate for Payer: BCN Commercial |
$450.31
|
| Rate for Payer: Cash Price |
$109.86
|
| Rate for Payer: Cash Price |
$109.86
|
| Rate for Payer: Cofinity Advantage |
$96.13
|
| Rate for Payer: Cofinity Commercial |
$118.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.86
|
| Rate for Payer: Healthscope Commercial |
$123.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.00
|
| Rate for Payer: PHP Commercial |
$116.73
|
| Rate for Payer: Priority Health SBD |
$86.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.26
|
| Rate for Payer: UHC Core |
$71.55
|
| Rate for Payer: UHC Exchange |
$53.97
|
|
|
HC COMP BURN GARM VEST SLEEVELESS
|
Facility
|
IP
|
$137.33
|
|
|
Service Code
|
HCPCS A6509
|
| Hospital Charge Code |
98300067
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$86.52 |
| Max. Negotiated Rate |
$123.60 |
| Rate for Payer: Aetna Commercial |
$116.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.26
|
| Rate for Payer: Cash Price |
$109.86
|
| Rate for Payer: Cofinity Advantage |
$96.13
|
| Rate for Payer: Cofinity Commercial |
$118.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.86
|
| Rate for Payer: Healthscope Commercial |
$123.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.00
|
| Rate for Payer: PHP Commercial |
$116.73
|
| Rate for Payer: Priority Health SBD |
$86.52
|
|
|
HC COMP BURN GARM ZIPPER
|
Facility
|
IP
|
$46.82
|
|
|
Service Code
|
HCPCS A9900
|
| Hospital Charge Code |
98300068
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.50 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.43
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Advantage |
$32.77
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.12
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: Priority Health SBD |
$29.50
|
|
|
HC COMP BURN GARM ZIPPER
|
Facility
|
OP
|
$46.82
|
|
|
Service Code
|
HCPCS A9900
|
| Hospital Charge Code |
98300068
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna Medicare |
$23.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.43
|
| Rate for Payer: BCBS Complete |
$18.73
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Advantage |
$32.77
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.12
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: Priority Health SBD |
$29.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.43
|
| Rate for Payer: UHC Core |
$24.39
|
| Rate for Payer: UHC Exchange |
$18.40
|
|
|
HC COMPLEMENT C 3
|
Facility
|
OP
|
$117.57
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200150
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$105.81 |
| Rate for Payer: Aetna Commercial |
$99.93
|
| Rate for Payer: Aetna Medicare |
$12.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.00
|
| Rate for Payer: BCBS Complete |
$6.59
|
| Rate for Payer: BCBS MAPPO |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$12.79
|
| Rate for Payer: BCN Commercial |
$12.79
|
| Rate for Payer: BCN Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cofinity Advantage |
$82.30
|
| Rate for Payer: Cofinity Commercial |
$101.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$105.81
|
| Rate for Payer: Mclaren Medicaid |
$6.28
|
| Rate for Payer: Mclaren Medicare |
$12.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.60
|
| Rate for Payer: Meridian Medicaid |
$12.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.93
|
| Rate for Payer: Nomi Health Commercial |
$18.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.18
|
| Rate for Payer: PACE Medicare |
$11.40
|
| Rate for Payer: PACE SWMI |
$12.00
|
| Rate for Payer: PHP Commercial |
$99.93
|
| Rate for Payer: PHP Medicare Advantage |
$12.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.00
|
| Rate for Payer: Priority Health Medicare |
$12.00
|
| Rate for Payer: Priority Health SBD |
$74.07
|
| Rate for Payer: Priority Health Tiered Network |
$9.60
|
| Rate for Payer: Railroad Medicare Medicare |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.00
|
| Rate for Payer: UHC Core |
$18.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.00
|
| Rate for Payer: UHC Exchange |
$18.00
|
| Rate for Payer: UHC Medicaid |
$6.28
|
| Rate for Payer: UHCCP Medicaid |
$6.28
|
| Rate for Payer: VA VA |
$12.00
|
|
|
HC COMPLEMENT C 3
|
Facility
|
IP
|
$117.57
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200150
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$74.07 |
| Max. Negotiated Rate |
$105.81 |
| Rate for Payer: Aetna Commercial |
$99.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.42
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cofinity Advantage |
$82.30
|
| Rate for Payer: Cofinity Commercial |
$101.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.06
|
| Rate for Payer: Healthscope Commercial |
$105.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.18
|
| Rate for Payer: PHP Commercial |
$99.93
|
| Rate for Payer: Priority Health SBD |
$74.07
|
|
|
HC COMPLEMENT C 4
|
Facility
|
OP
|
$117.57
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200151
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$105.81 |
| Rate for Payer: Aetna Commercial |
$99.93
|
| Rate for Payer: Aetna Medicare |
$12.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.00
|
| Rate for Payer: BCBS Complete |
$6.59
|
| Rate for Payer: BCBS MAPPO |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$12.79
|
| Rate for Payer: BCN Commercial |
$12.79
|
| Rate for Payer: BCN Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cofinity Advantage |
$82.30
|
| Rate for Payer: Cofinity Commercial |
$101.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$105.81
|
| Rate for Payer: Mclaren Medicaid |
$6.28
|
| Rate for Payer: Mclaren Medicare |
$12.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.60
|
| Rate for Payer: Meridian Medicaid |
$12.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.93
|
| Rate for Payer: Nomi Health Commercial |
$18.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.18
|
| Rate for Payer: PACE Medicare |
$11.40
|
| Rate for Payer: PACE SWMI |
$12.00
|
| Rate for Payer: PHP Commercial |
$99.93
|
| Rate for Payer: PHP Medicare Advantage |
$12.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.00
|
| Rate for Payer: Priority Health Medicare |
$12.00
|
| Rate for Payer: Priority Health SBD |
$74.07
|
| Rate for Payer: Priority Health Tiered Network |
$9.60
|
| Rate for Payer: Railroad Medicare Medicare |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.00
|
| Rate for Payer: UHC Core |
$18.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.00
|
| Rate for Payer: UHC Exchange |
$18.00
|
| Rate for Payer: UHC Medicaid |
$6.28
|
| Rate for Payer: UHCCP Medicaid |
$6.28
|
| Rate for Payer: VA VA |
$12.00
|
|
|
HC COMPLEMENT C 4
|
Facility
|
IP
|
$117.57
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200151
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$74.07 |
| Max. Negotiated Rate |
$105.81 |
| Rate for Payer: Aetna Commercial |
$99.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.42
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cofinity Advantage |
$82.30
|
| Rate for Payer: Cofinity Commercial |
$101.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.06
|
| Rate for Payer: Healthscope Commercial |
$105.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.18
|
| Rate for Payer: PHP Commercial |
$99.93
|
| Rate for Payer: Priority Health SBD |
$74.07
|
|
|
HC COMPLEMENT C 5
|
Facility
|
IP
|
$74.29
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200152
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$66.86 |
| Rate for Payer: Aetna Commercial |
$63.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.29
|
| Rate for Payer: Cash Price |
$59.43
|
| Rate for Payer: Cofinity Advantage |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$63.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.43
|
| Rate for Payer: Healthscope Commercial |
$66.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.72
|
| Rate for Payer: PHP Commercial |
$63.15
|
| Rate for Payer: Priority Health SBD |
$46.80
|
|
|
HC COMPLEMENT C 5
|
Facility
|
OP
|
$74.29
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200152
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$66.86 |
| Rate for Payer: Aetna Commercial |
$63.15
|
| Rate for Payer: Aetna Medicare |
$12.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.00
|
| Rate for Payer: BCBS Complete |
$6.59
|
| Rate for Payer: BCBS MAPPO |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$12.79
|
| Rate for Payer: BCN Commercial |
$12.79
|
| Rate for Payer: BCN Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$59.43
|
| Rate for Payer: Cash Price |
$59.43
|
| Rate for Payer: Cofinity Advantage |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$63.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$66.86
|
| Rate for Payer: Mclaren Medicaid |
$6.28
|
| Rate for Payer: Mclaren Medicare |
$12.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.60
|
| Rate for Payer: Meridian Medicaid |
$12.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.15
|
| Rate for Payer: Nomi Health Commercial |
$18.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.72
|
| Rate for Payer: PACE Medicare |
$11.40
|
| Rate for Payer: PACE SWMI |
$12.00
|
| Rate for Payer: PHP Commercial |
$63.15
|
| Rate for Payer: PHP Medicare Advantage |
$12.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.00
|
| Rate for Payer: Priority Health Medicare |
$12.00
|
| Rate for Payer: Priority Health SBD |
$46.80
|
| Rate for Payer: Priority Health Tiered Network |
$9.60
|
| Rate for Payer: Railroad Medicare Medicare |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.00
|
| Rate for Payer: UHC Core |
$18.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.00
|
| Rate for Payer: UHC Exchange |
$18.00
|
| Rate for Payer: UHC Medicaid |
$6.28
|
| Rate for Payer: UHCCP Medicaid |
$6.28
|
| Rate for Payer: VA VA |
$12.00
|
|
|
HC COMPLEMENT CH50 TOTAL
|
Facility
|
OP
|
$40.33
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
30200154
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.63 |
| Max. Negotiated Rate |
$36.30 |
| Rate for Payer: Aetna Commercial |
$34.28
|
| Rate for Payer: Aetna Medicare |
$21.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.40
|
| Rate for Payer: BCBS Complete |
$11.16
|
| Rate for Payer: BCBS MAPPO |
$20.32
|
| Rate for Payer: BCBS Trust/PPO |
$21.67
|
| Rate for Payer: BCN Commercial |
$21.67
|
| Rate for Payer: BCN Medicare Advantage |
$20.32
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cofinity Advantage |
$28.23
|
| Rate for Payer: Cofinity Commercial |
$34.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.32
|
| Rate for Payer: Healthscope Commercial |
$36.30
|
| Rate for Payer: Mclaren Medicaid |
$10.63
|
| Rate for Payer: Mclaren Medicare |
$20.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.34
|
| Rate for Payer: Meridian Medicaid |
$21.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.28
|
| Rate for Payer: Nomi Health Commercial |
$30.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.25
|
| Rate for Payer: PACE Medicare |
$19.30
|
| Rate for Payer: PACE SWMI |
$20.32
|
| Rate for Payer: PHP Commercial |
$34.28
|
| Rate for Payer: PHP Medicare Advantage |
$20.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20.32
|
| Rate for Payer: Priority Health Medicare |
$20.32
|
| Rate for Payer: Priority Health SBD |
$25.41
|
| Rate for Payer: Priority Health Tiered Network |
$16.26
|
| Rate for Payer: Railroad Medicare Medicare |
$20.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.48
|
| Rate for Payer: UHC Core |
$30.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20.32
|
| Rate for Payer: UHC Exchange |
$30.48
|
| Rate for Payer: UHC Medicaid |
$10.63
|
| Rate for Payer: UHCCP Medicaid |
$10.63
|
| Rate for Payer: VA VA |
$20.32
|
|
|
HC COMPLEMENT CH50 TOTAL
|
Facility
|
IP
|
$40.33
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
30200154
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.41 |
| Max. Negotiated Rate |
$36.30 |
| Rate for Payer: Aetna Commercial |
$34.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.21
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cofinity Advantage |
$28.23
|
| Rate for Payer: Cofinity Commercial |
$34.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.26
|
| Rate for Payer: Healthscope Commercial |
$36.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.25
|
| Rate for Payer: PHP Commercial |
$34.28
|
| Rate for Payer: Priority Health SBD |
$25.41
|
|
|
HC COMPLEX CYSTOMETROGRAM
|
Facility
|
OP
|
$405.22
|
|
|
Service Code
|
CPT 51726
|
| Hospital Charge Code |
76100190
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$805.08 |
| Rate for Payer: Aetna Commercial |
$344.44
|
| Rate for Payer: Aetna Medicare |
$258.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$311.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$311.19
|
| Rate for Payer: BCBS Complete |
$136.72
|
| Rate for Payer: BCBS MAPPO |
$248.95
|
| Rate for Payer: BCBS Trust/PPO |
$369.60
|
| Rate for Payer: BCN Commercial |
$369.60
|
| Rate for Payer: BCN Medicare Advantage |
$248.95
|
| Rate for Payer: Cash Price |
$324.18
|
| Rate for Payer: Cash Price |
$324.18
|
| Rate for Payer: Cash Price |
$324.18
|
| Rate for Payer: Cofinity Advantage |
$283.65
|
| Rate for Payer: Cofinity Commercial |
$348.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.95
|
| Rate for Payer: Healthscope Commercial |
$364.70
|
| Rate for Payer: Mclaren Medicaid |
$130.20
|
| Rate for Payer: Mclaren Medicare |
$248.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.40
|
| Rate for Payer: Meridian Medicaid |
$261.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$286.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$273.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.44
|
| Rate for Payer: Nomi Health Commercial |
$746.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.92
|
| Rate for Payer: PACE Medicare |
$236.50
|
| Rate for Payer: PACE SWMI |
$248.95
|
| Rate for Payer: PHP Commercial |
$344.44
|
| Rate for Payer: PHP Medicare Advantage |
$248.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$805.08
|
| Rate for Payer: Priority Health Medicare |
$248.95
|
| Rate for Payer: Priority Health SBD |
$255.29
|
| Rate for Payer: Priority Health Tiered Network |
$644.06
|
| Rate for Payer: Railroad Medicare Medicare |
$248.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$263.39
|
| Rate for Payer: UHC Core |
$211.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$248.95
|
| Rate for Payer: UHC Exchange |
$159.25
|
| Rate for Payer: UHC Medicaid |
$130.20
|
| Rate for Payer: UHCCP Medicaid |
$130.20
|
| Rate for Payer: VA VA |
$248.95
|
|
|
HC COMPLEX CYSTOMETROGRAM
|
Facility
|
IP
|
$405.22
|
|
|
Service Code
|
CPT 51726
|
| Hospital Charge Code |
76100190
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$255.29 |
| Max. Negotiated Rate |
$364.70 |
| Rate for Payer: Aetna Commercial |
$344.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.39
|
| Rate for Payer: Cash Price |
$324.18
|
| Rate for Payer: Cofinity Advantage |
$283.65
|
| Rate for Payer: Cofinity Commercial |
$348.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.18
|
| Rate for Payer: Healthscope Commercial |
$364.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.92
|
| Rate for Payer: PHP Commercial |
$344.44
|
| Rate for Payer: Priority Health SBD |
$255.29
|
|
|
HC COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE
|
Facility
|
OP
|
$894.60
|
|
|
Service Code
|
CPT 51727
|
| Hospital Charge Code |
76100220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$200.37 |
| Max. Negotiated Rate |
$2,246.88 |
| Rate for Payer: Aetna Commercial |
$760.41
|
| Rate for Payer: Aetna Medicare |
$722.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$868.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$868.49
|
| Rate for Payer: BCBS Complete |
$381.58
|
| Rate for Payer: BCBS MAPPO |
$694.79
|
| Rate for Payer: BCBS Trust/PPO |
$200.37
|
| Rate for Payer: BCN Commercial |
$200.37
|
| Rate for Payer: BCN Medicare Advantage |
$694.79
|
| Rate for Payer: Cash Price |
$715.68
|
| Rate for Payer: Cash Price |
$715.68
|
| Rate for Payer: Cash Price |
$715.68
|
| Rate for Payer: Cofinity Advantage |
$626.22
|
| Rate for Payer: Cofinity Commercial |
$769.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$715.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$694.79
|
| Rate for Payer: Healthscope Commercial |
$805.14
|
| Rate for Payer: Mclaren Medicaid |
$363.38
|
| Rate for Payer: Mclaren Medicare |
$694.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$729.53
|
| Rate for Payer: Meridian Medicaid |
$729.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$799.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$764.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$760.41
|
| Rate for Payer: Nomi Health Commercial |
$2,084.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$670.95
|
| Rate for Payer: PACE Medicare |
$660.05
|
| Rate for Payer: PACE SWMI |
$694.79
|
| Rate for Payer: PHP Commercial |
$760.41
|
| Rate for Payer: PHP Medicare Advantage |
$694.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,246.88
|
| Rate for Payer: Priority Health Medicare |
$694.79
|
| Rate for Payer: Priority Health SBD |
$563.60
|
| Rate for Payer: Priority Health Tiered Network |
$1,797.50
|
| Rate for Payer: Railroad Medicare Medicare |
$694.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$581.49
|
| Rate for Payer: UHC Core |
$466.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$694.79
|
| Rate for Payer: UHC Exchange |
$351.58
|
| Rate for Payer: UHC Medicaid |
$363.38
|
| Rate for Payer: UHCCP Medicaid |
$363.38
|
| Rate for Payer: VA VA |
$694.79
|
|
|
HC COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE
|
Facility
|
IP
|
$894.60
|
|
|
Service Code
|
CPT 51727
|
| Hospital Charge Code |
76100220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$563.60 |
| Max. Negotiated Rate |
$805.14 |
| Rate for Payer: Aetna Commercial |
$760.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.49
|
| Rate for Payer: Cash Price |
$715.68
|
| Rate for Payer: Cofinity Advantage |
$626.22
|
| Rate for Payer: Cofinity Commercial |
$769.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$715.68
|
| Rate for Payer: Healthscope Commercial |
$805.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$760.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$670.95
|
| Rate for Payer: PHP Commercial |
$760.41
|
| Rate for Payer: Priority Health SBD |
$563.60
|
|
|
HC COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES
|
Facility
|
OP
|
$895.01
|
|
|
Service Code
|
CPT 51728
|
| Hospital Charge Code |
76100191
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$206.30 |
| Max. Negotiated Rate |
$2,246.88 |
| Rate for Payer: Aetna Commercial |
$760.76
|
| Rate for Payer: Aetna Medicare |
$722.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$868.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$868.49
|
| Rate for Payer: BCBS Complete |
$381.58
|
| Rate for Payer: BCBS MAPPO |
$694.79
|
| Rate for Payer: BCBS Trust/PPO |
$206.30
|
| Rate for Payer: BCN Commercial |
$206.30
|
| Rate for Payer: BCN Medicare Advantage |
$694.79
|
| Rate for Payer: Cash Price |
$716.01
|
| Rate for Payer: Cash Price |
$716.01
|
| Rate for Payer: Cash Price |
$716.01
|
| Rate for Payer: Cofinity Advantage |
$626.51
|
| Rate for Payer: Cofinity Commercial |
$769.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$694.79
|
| Rate for Payer: Healthscope Commercial |
$805.51
|
| Rate for Payer: Mclaren Medicaid |
$363.38
|
| Rate for Payer: Mclaren Medicare |
$694.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$729.53
|
| Rate for Payer: Meridian Medicaid |
$729.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$799.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$764.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$760.76
|
| Rate for Payer: Nomi Health Commercial |
$2,084.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$671.26
|
| Rate for Payer: PACE Medicare |
$660.05
|
| Rate for Payer: PACE SWMI |
$694.79
|
| Rate for Payer: PHP Commercial |
$760.76
|
| Rate for Payer: PHP Medicare Advantage |
$694.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,246.88
|
| Rate for Payer: Priority Health Medicare |
$694.79
|
| Rate for Payer: Priority Health SBD |
$563.86
|
| Rate for Payer: Priority Health Tiered Network |
$1,797.50
|
| Rate for Payer: Railroad Medicare Medicare |
$694.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$581.76
|
| Rate for Payer: UHC Core |
$466.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$694.79
|
| Rate for Payer: UHC Exchange |
$351.74
|
| Rate for Payer: UHC Medicaid |
$363.38
|
| Rate for Payer: UHCCP Medicaid |
$363.38
|
| Rate for Payer: VA VA |
$694.79
|
|
|
HC COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES
|
Facility
|
IP
|
$895.01
|
|
|
Service Code
|
CPT 51728
|
| Hospital Charge Code |
76100191
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$563.86 |
| Max. Negotiated Rate |
$805.51 |
| Rate for Payer: Aetna Commercial |
$760.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.76
|
| Rate for Payer: Cash Price |
$716.01
|
| Rate for Payer: Cofinity Advantage |
$626.51
|
| Rate for Payer: Cofinity Commercial |
$769.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.01
|
| Rate for Payer: Healthscope Commercial |
$805.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$760.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$671.26
|
| Rate for Payer: PHP Commercial |
$760.76
|
| Rate for Payer: Priority Health SBD |
$563.86
|
|
|
HC COMPLEX MULTILAYER COMP DSG
|
Facility
|
OP
|
$827.12
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
76100024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.68 |
| Max. Negotiated Rate |
$744.41 |
| Rate for Payer: Aetna Commercial |
$703.05
|
| Rate for Payer: Aetna Medicare |
$168.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$537.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$202.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$202.40
|
| Rate for Payer: BCBS Complete |
$88.93
|
| Rate for Payer: BCBS MAPPO |
$161.92
|
| Rate for Payer: BCBS Trust/PPO |
$112.56
|
| Rate for Payer: BCN Commercial |
$112.56
|
| Rate for Payer: BCN Medicare Advantage |
$161.92
|
| Rate for Payer: Cash Price |
$661.70
|
| Rate for Payer: Cash Price |
$661.70
|
| Rate for Payer: Cash Price |
$661.70
|
| Rate for Payer: Cofinity Advantage |
$578.98
|
| Rate for Payer: Cofinity Commercial |
$711.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$661.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.92
|
| Rate for Payer: Healthscope Commercial |
$744.41
|
| Rate for Payer: Mclaren Medicaid |
$84.68
|
| Rate for Payer: Mclaren Medicare |
$161.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$170.02
|
| Rate for Payer: Meridian Medicaid |
$170.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$178.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$703.05
|
| Rate for Payer: Nomi Health Commercial |
$485.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$620.34
|
| Rate for Payer: PACE Medicare |
$153.82
|
| Rate for Payer: PACE SWMI |
$161.92
|
| Rate for Payer: PHP Commercial |
$703.05
|
| Rate for Payer: PHP Medicare Advantage |
$161.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$523.62
|
| Rate for Payer: Priority Health Medicare |
$161.92
|
| Rate for Payer: Priority Health SBD |
$521.09
|
| Rate for Payer: Priority Health Tiered Network |
$418.90
|
| Rate for Payer: Railroad Medicare Medicare |
$161.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$537.63
|
| Rate for Payer: UHC Core |
$430.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$161.92
|
| Rate for Payer: UHC Exchange |
$325.06
|
| Rate for Payer: UHC Medicaid |
$84.68
|
| Rate for Payer: UHCCP Medicaid |
$84.68
|
| Rate for Payer: VA VA |
$161.92
|
|
|
HC COMPLEX MULTILAYER COMP DSG
|
Facility
|
IP
|
$827.12
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
76100024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$521.09 |
| Max. Negotiated Rate |
$744.41 |
| Rate for Payer: Aetna Commercial |
$703.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$537.63
|
| Rate for Payer: Cash Price |
$661.70
|
| Rate for Payer: Cofinity Advantage |
$578.98
|
| Rate for Payer: Cofinity Commercial |
$711.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$661.70
|
| Rate for Payer: Healthscope Commercial |
$744.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$703.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$620.34
|
| Rate for Payer: PHP Commercial |
$703.05
|
| Rate for Payer: Priority Health SBD |
$521.09
|
|
|
HC COMPLEX UROFLOWMETRY
|
Facility
|
OP
|
$238.06
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
76100192
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.56 |
| Max. Negotiated Rate |
$695.77 |
| Rate for Payer: Aetna Commercial |
$202.35
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.74
|
| 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 |
$94.41
|
| Rate for Payer: BCN Commercial |
$94.41
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$190.45
|
| Rate for Payer: Cash Price |
$190.45
|
| Rate for Payer: Cash Price |
$190.45
|
| Rate for Payer: Cofinity Advantage |
$166.64
|
| Rate for Payer: Cofinity Commercial |
$204.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$214.25
|
| 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 |
$202.35
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.54
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$202.35
|
| 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 |
$149.98
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.74
|
| Rate for Payer: UHC Core |
$124.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$93.56
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC COMPLEX UROFLOWMETRY
|
Facility
|
IP
|
$238.06
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
76100192
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$149.98 |
| Max. Negotiated Rate |
$214.25 |
| Rate for Payer: Aetna Commercial |
$202.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.74
|
| Rate for Payer: Cash Price |
$190.45
|
| Rate for Payer: Cofinity Advantage |
$166.64
|
| Rate for Payer: Cofinity Commercial |
$204.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.45
|
| Rate for Payer: Healthscope Commercial |
$214.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.54
|
| Rate for Payer: PHP Commercial |
$202.35
|
| Rate for Payer: Priority Health SBD |
$149.98
|
|
|
HC COMP METABOLIC PANEL
|
Facility
|
IP
|
$39.95
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
30100013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.17 |
| Max. Negotiated Rate |
$35.95 |
| Rate for Payer: Aetna Commercial |
$33.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.97
|
| Rate for Payer: Cash Price |
$31.96
|
| Rate for Payer: Cofinity Advantage |
$27.96
|
| Rate for Payer: Cofinity Commercial |
$34.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.96
|
| Rate for Payer: Healthscope Commercial |
$35.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.96
|
| Rate for Payer: PHP Commercial |
$33.96
|
| Rate for Payer: Priority Health SBD |
$25.17
|
|
|
HC COMP METABOLIC PANEL
|
Facility
|
OP
|
$39.95
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
30100013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.52 |
| Max. Negotiated Rate |
$35.95 |
| Rate for Payer: Aetna Commercial |
$33.96
|
| Rate for Payer: Aetna Medicare |
$10.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.20
|
| Rate for Payer: BCBS Complete |
$5.80
|
| Rate for Payer: BCBS MAPPO |
$10.56
|
| Rate for Payer: BCBS Trust/PPO |
$21.59
|
| Rate for Payer: BCN Commercial |
$21.59
|
| Rate for Payer: BCN Medicare Advantage |
$10.56
|
| Rate for Payer: Cash Price |
$31.96
|
| Rate for Payer: Cash Price |
$31.96
|
| Rate for Payer: Cofinity Advantage |
$27.96
|
| Rate for Payer: Cofinity Commercial |
$34.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.56
|
| Rate for Payer: Healthscope Commercial |
$35.95
|
| Rate for Payer: Mclaren Medicaid |
$5.52
|
| Rate for Payer: Mclaren Medicare |
$10.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.09
|
| Rate for Payer: Meridian Medicaid |
$11.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.96
|
| Rate for Payer: Nomi Health Commercial |
$15.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.96
|
| Rate for Payer: PACE Medicare |
$10.03
|
| Rate for Payer: PACE SWMI |
$10.56
|
| Rate for Payer: PHP Commercial |
$33.96
|
| Rate for Payer: PHP Medicare Advantage |
$10.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10.56
|
| Rate for Payer: Priority Health Medicare |
$10.56
|
| Rate for Payer: Priority Health SBD |
$25.17
|
| Rate for Payer: Priority Health Tiered Network |
$8.45
|
| Rate for Payer: Railroad Medicare Medicare |
$10.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.84
|
| Rate for Payer: UHC Core |
$15.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.56
|
| Rate for Payer: UHC Exchange |
$15.84
|
| Rate for Payer: UHC Medicaid |
$5.52
|
| Rate for Payer: UHCCP Medicaid |
$5.52
|
| Rate for Payer: VA VA |
$10.56
|
|
