|
HC CONNECTOR V
|
Facility
|
IP
|
$7.80
|
|
| Hospital Charge Code |
27000678
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$7.02 |
| Rate for Payer: Aetna Commercial |
$6.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.07
|
| Rate for Payer: Cash Price |
$6.24
|
| Rate for Payer: Cofinity Advantage |
$5.46
|
| Rate for Payer: Cofinity Commercial |
$6.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.24
|
| Rate for Payer: Healthscope Commercial |
$7.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.85
|
| Rate for Payer: PHP Commercial |
$6.63
|
| Rate for Payer: Priority Health SBD |
$4.91
|
|
|
HC CONNECTOR Y
|
Facility
|
IP
|
$5.47
|
|
| Hospital Charge Code |
27000048
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$4.92 |
| Rate for Payer: Aetna Commercial |
$4.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.56
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Cofinity Advantage |
$3.83
|
| Rate for Payer: Cofinity Commercial |
$4.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.38
|
| Rate for Payer: Healthscope Commercial |
$4.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.10
|
| Rate for Payer: PHP Commercial |
$4.65
|
| Rate for Payer: Priority Health SBD |
$3.45
|
|
|
HC CONNECTOR Y
|
Facility
|
OP
|
$5.47
|
|
| Hospital Charge Code |
27000048
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$4.92 |
| Rate for Payer: Aetna Commercial |
$4.65
|
| Rate for Payer: Aetna Medicare |
$2.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.56
|
| Rate for Payer: BCBS Complete |
$2.19
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Cofinity Advantage |
$3.83
|
| Rate for Payer: Cofinity Commercial |
$4.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.38
|
| Rate for Payer: Healthscope Commercial |
$4.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.10
|
| Rate for Payer: PHP Commercial |
$4.65
|
| Rate for Payer: Priority Health SBD |
$3.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.56
|
| Rate for Payer: UHC Core |
$2.85
|
| Rate for Payer: UHC Exchange |
$2.15
|
|
|
HC CONSULT NUTRITIONAL
|
Facility
|
OP
|
$35.66
|
|
| Hospital Charge Code |
94200010
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$14.01 |
| Max. Negotiated Rate |
$32.09 |
| Rate for Payer: Aetna Commercial |
$30.31
|
| Rate for Payer: Aetna Medicare |
$17.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.18
|
| Rate for Payer: BCBS Complete |
$14.26
|
| Rate for Payer: Cash Price |
$28.53
|
| Rate for Payer: Cofinity Advantage |
$24.96
|
| Rate for Payer: Cofinity Commercial |
$30.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.53
|
| Rate for Payer: Healthscope Commercial |
$32.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.75
|
| Rate for Payer: PHP Commercial |
$30.31
|
| Rate for Payer: Priority Health SBD |
$22.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.18
|
| Rate for Payer: UHC Core |
$18.58
|
| Rate for Payer: UHC Exchange |
$14.01
|
|
|
HC CONSULT NUTRITIONAL
|
Facility
|
IP
|
$35.66
|
|
| Hospital Charge Code |
94200010
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$22.47 |
| Max. Negotiated Rate |
$32.09 |
| Rate for Payer: Aetna Commercial |
$30.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.18
|
| Rate for Payer: Cash Price |
$28.53
|
| Rate for Payer: Cofinity Advantage |
$24.96
|
| Rate for Payer: Cofinity Commercial |
$30.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.53
|
| Rate for Payer: Healthscope Commercial |
$32.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.75
|
| Rate for Payer: PHP Commercial |
$30.31
|
| Rate for Payer: Priority Health SBD |
$22.47
|
|
|
HC CONT GLUCOSE MONITOR OFFICE EQUIP
|
Facility
|
OP
|
$1,004.28
|
|
|
Service Code
|
CPT 95250
|
| Hospital Charge Code |
94200001
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$69.38 |
| Max. Negotiated Rate |
$903.85 |
| Rate for Payer: Aetna Commercial |
$853.64
|
| Rate for Payer: Aetna Medicare |
$137.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$652.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.82
|
| Rate for Payer: BCBS Complete |
$72.86
|
| Rate for Payer: BCBS MAPPO |
$132.66
|
| Rate for Payer: BCBS Trust/PPO |
$632.16
|
| Rate for Payer: BCN Commercial |
$632.16
|
| Rate for Payer: BCN Medicare Advantage |
$132.66
|
| Rate for Payer: Cash Price |
$803.42
|
| Rate for Payer: Cash Price |
$803.42
|
| Rate for Payer: Cofinity Advantage |
$703.00
|
| Rate for Payer: Cofinity Commercial |
$863.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$803.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.66
|
| Rate for Payer: Healthscope Commercial |
$903.85
|
| Rate for Payer: Mclaren Medicaid |
$69.38
|
| Rate for Payer: Mclaren Medicare |
$132.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.29
|
| Rate for Payer: Meridian Medicaid |
$139.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$853.64
|
| Rate for Payer: Nomi Health Commercial |
$397.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$753.21
|
| Rate for Payer: PACE Medicare |
$126.03
|
| Rate for Payer: PACE SWMI |
$132.66
|
| Rate for Payer: PHP Commercial |
$853.64
|
| Rate for Payer: PHP Medicare Advantage |
$132.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.99
|
| Rate for Payer: Priority Health Medicare |
$132.66
|
| Rate for Payer: Priority Health SBD |
$632.70
|
| Rate for Payer: Priority Health Tiered Network |
$343.19
|
| Rate for Payer: Railroad Medicare Medicare |
$132.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$652.78
|
| Rate for Payer: UHC Core |
$523.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.66
|
| Rate for Payer: UHC Exchange |
$394.68
|
| Rate for Payer: UHC Medicaid |
$69.38
|
| Rate for Payer: UHCCP Medicaid |
$69.38
|
| Rate for Payer: VA VA |
$132.66
|
|
|
HC CONT GLUCOSE MONITOR OFFICE EQUIP
|
Facility
|
IP
|
$1,004.28
|
|
|
Service Code
|
CPT 95250
|
| Hospital Charge Code |
94200001
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$632.70 |
| Max. Negotiated Rate |
$903.85 |
| Rate for Payer: Aetna Commercial |
$853.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$652.78
|
| Rate for Payer: Cash Price |
$803.42
|
| Rate for Payer: Cofinity Advantage |
$703.00
|
| Rate for Payer: Cofinity Commercial |
$863.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$803.42
|
| Rate for Payer: Healthscope Commercial |
$903.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$853.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$753.21
|
| Rate for Payer: PHP Commercial |
$853.64
|
| Rate for Payer: Priority Health SBD |
$632.70
|
|
|
HC CONT GLUCOSE MONITOR PATIENT EQUIP
|
Facility
|
OP
|
$387.71
|
|
|
Service Code
|
CPT 95249
|
| Hospital Charge Code |
94200038
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$348.94 |
| Rate for Payer: Aetna Commercial |
$329.55
|
| Rate for Payer: Aetna Medicare |
$61.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$287.20
|
| Rate for Payer: BCN Commercial |
$287.20
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Cash Price |
$310.17
|
| Rate for Payer: Cash Price |
$310.17
|
| Rate for Payer: Cofinity Advantage |
$271.40
|
| Rate for Payer: Cofinity Commercial |
$333.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$348.94
|
| Rate for Payer: Mclaren Medicaid |
$30.74
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$61.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.55
|
| Rate for Payer: Nomi Health Commercial |
$176.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.78
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Commercial |
$329.55
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$190.09
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health SBD |
$244.26
|
| Rate for Payer: Priority Health Tiered Network |
$152.07
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.01
|
| Rate for Payer: UHC Core |
$202.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Exchange |
$152.37
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: VA VA |
$58.78
|
|
|
HC CONT GLUCOSE MONITOR PATIENT EQUIP
|
Facility
|
IP
|
$387.71
|
|
|
Service Code
|
CPT 95249
|
| Hospital Charge Code |
94200038
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$244.26 |
| Max. Negotiated Rate |
$348.94 |
| Rate for Payer: Aetna Commercial |
$329.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.01
|
| Rate for Payer: Cash Price |
$310.17
|
| Rate for Payer: Cofinity Advantage |
$271.40
|
| Rate for Payer: Cofinity Commercial |
$333.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.17
|
| Rate for Payer: Healthscope Commercial |
$348.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.78
|
| Rate for Payer: PHP Commercial |
$329.55
|
| Rate for Payer: Priority Health SBD |
$244.26
|
|
|
HC CONTINUOUS NEB SUBSEQUENT HR
|
Facility
|
IP
|
$106.62
|
|
|
Service Code
|
CPT 94645
|
| Hospital Charge Code |
41000007
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$67.17 |
| Max. Negotiated Rate |
$95.96 |
| Rate for Payer: Aetna Commercial |
$90.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.30
|
| Rate for Payer: Cash Price |
$85.30
|
| Rate for Payer: Cofinity Advantage |
$74.63
|
| Rate for Payer: Cofinity Commercial |
$91.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.30
|
| Rate for Payer: Healthscope Commercial |
$95.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.97
|
| Rate for Payer: PHP Commercial |
$90.63
|
| Rate for Payer: Priority Health SBD |
$67.17
|
|
|
HC CONTINUOUS NEB SUBSEQUENT HR
|
Facility
|
OP
|
$106.62
|
|
|
Service Code
|
CPT 94645
|
| Hospital Charge Code |
41000007
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$41.90 |
| Max. Negotiated Rate |
$95.96 |
| Rate for Payer: Aetna Commercial |
$90.63
|
| Rate for Payer: Aetna Medicare |
$53.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.30
|
| Rate for Payer: BCBS Complete |
$42.65
|
| Rate for Payer: BCBS Trust/PPO |
$74.02
|
| Rate for Payer: BCN Commercial |
$74.02
|
| Rate for Payer: Cash Price |
$85.30
|
| Rate for Payer: Cash Price |
$85.30
|
| Rate for Payer: Cofinity Advantage |
$74.63
|
| Rate for Payer: Cofinity Commercial |
$91.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.30
|
| Rate for Payer: Healthscope Commercial |
$95.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.97
|
| Rate for Payer: PHP Commercial |
$90.63
|
| Rate for Payer: Priority Health SBD |
$67.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.30
|
| Rate for Payer: UHC Core |
$55.55
|
| Rate for Payer: UHC Exchange |
$41.90
|
|
|
HC CONTINUOUS NEB TX INITIAL HOUR
|
Facility
|
IP
|
$382.93
|
|
|
Service Code
|
CPT 94644
|
| Hospital Charge Code |
41000006
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$241.25 |
| Max. Negotiated Rate |
$344.64 |
| Rate for Payer: Aetna Commercial |
$325.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.90
|
| Rate for Payer: Cash Price |
$306.34
|
| Rate for Payer: Cofinity Advantage |
$268.05
|
| Rate for Payer: Cofinity Commercial |
$329.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.34
|
| Rate for Payer: Healthscope Commercial |
$344.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$287.20
|
| Rate for Payer: PHP Commercial |
$325.49
|
| Rate for Payer: Priority Health SBD |
$241.25
|
|
|
HC CONTINUOUS NEB TX INITIAL HOUR
|
Facility
|
OP
|
$382.93
|
|
|
Service Code
|
CPT 94644
|
| Hospital Charge Code |
41000006
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$428.73 |
| Rate for Payer: Aetna Commercial |
$325.49
|
| Rate for Payer: Aetna Medicare |
$137.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$253.15
|
| Rate for Payer: BCN Commercial |
$253.15
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$306.34
|
| Rate for Payer: Cash Price |
$306.34
|
| Rate for Payer: Cofinity Advantage |
$268.05
|
| Rate for Payer: Cofinity Commercial |
$329.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$344.64
|
| Rate for Payer: Mclaren Medicaid |
$69.33
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$139.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.49
|
| Rate for Payer: Nomi Health Commercial |
$397.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$287.20
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$325.49
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.73
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health SBD |
$241.25
|
| Rate for Payer: Priority Health Tiered Network |
$342.98
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.90
|
| Rate for Payer: UHC Core |
$199.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$150.49
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
HC CONT PHYSICS CONSULT
|
Facility
|
OP
|
$596.39
|
|
|
Service Code
|
CPT 77336
|
| Hospital Charge Code |
33300015
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$70.05 |
| Max. Negotiated Rate |
$536.75 |
| Rate for Payer: Aetna Commercial |
$506.93
|
| Rate for Payer: Aetna Medicare |
$139.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$387.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$167.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$167.41
|
| Rate for Payer: BCBS Complete |
$73.55
|
| Rate for Payer: BCBS MAPPO |
$133.93
|
| Rate for Payer: BCBS Trust/PPO |
$207.45
|
| Rate for Payer: BCN Commercial |
$207.45
|
| Rate for Payer: BCN Medicare Advantage |
$133.93
|
| Rate for Payer: Cash Price |
$477.11
|
| Rate for Payer: Cash Price |
$477.11
|
| Rate for Payer: Cofinity Advantage |
$417.47
|
| Rate for Payer: Cofinity Commercial |
$512.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$477.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.93
|
| Rate for Payer: Healthscope Commercial |
$536.75
|
| Rate for Payer: Mclaren Medicaid |
$70.05
|
| Rate for Payer: Mclaren Medicare |
$133.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.63
|
| Rate for Payer: Meridian Medicaid |
$140.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$147.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.93
|
| Rate for Payer: Nomi Health Commercial |
$401.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$447.29
|
| Rate for Payer: PACE Medicare |
$127.23
|
| Rate for Payer: PACE SWMI |
$133.93
|
| Rate for Payer: PHP Commercial |
$506.93
|
| Rate for Payer: PHP Medicare Advantage |
$133.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$433.11
|
| Rate for Payer: Priority Health Medicare |
$133.93
|
| Rate for Payer: Priority Health SBD |
$375.73
|
| Rate for Payer: Priority Health Tiered Network |
$346.49
|
| Rate for Payer: Railroad Medicare Medicare |
$133.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$387.65
|
| Rate for Payer: UHC Core |
$310.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$133.93
|
| Rate for Payer: UHC Exchange |
$234.38
|
| Rate for Payer: UHC Medicaid |
$70.05
|
| Rate for Payer: UHCCP Medicaid |
$70.05
|
| Rate for Payer: VA VA |
$133.93
|
|
|
HC CONT PHYSICS CONSULT
|
Facility
|
IP
|
$596.39
|
|
|
Service Code
|
CPT 77336
|
| Hospital Charge Code |
33300015
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$375.73 |
| Max. Negotiated Rate |
$536.75 |
| Rate for Payer: Aetna Commercial |
$506.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$387.65
|
| Rate for Payer: Cash Price |
$477.11
|
| Rate for Payer: Cofinity Advantage |
$417.47
|
| Rate for Payer: Cofinity Commercial |
$512.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$477.11
|
| Rate for Payer: Healthscope Commercial |
$536.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$447.29
|
| Rate for Payer: PHP Commercial |
$506.93
|
| Rate for Payer: Priority Health SBD |
$375.73
|
|
|
HC CONTRAST BATHS EACH 15 MIN
|
Facility
|
OP
|
$107.89
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
42000017
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$91.71
|
| Rate for Payer: Aetna Medicare |
$53.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.13
|
| Rate for Payer: BCBS Complete |
$43.16
|
| Rate for Payer: BCBS Trust/PPO |
$12.79
|
| Rate for Payer: BCN Commercial |
$12.79
|
| Rate for Payer: Cash Price |
$86.31
|
| Rate for Payer: Cash Price |
$86.31
|
| Rate for Payer: Cash Price |
$86.31
|
| Rate for Payer: Cofinity Advantage |
$75.52
|
| Rate for Payer: Cofinity Commercial |
$92.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.31
|
| Rate for Payer: Healthscope Commercial |
$97.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.71
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.92
|
| Rate for Payer: PHP Commercial |
$91.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.00
|
| Rate for Payer: Priority Health SBD |
$67.97
|
| Rate for Payer: Priority Health Tiered Network |
$11.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.13
|
| Rate for Payer: UHC Core |
$56.21
|
| Rate for Payer: UHC Exchange |
$42.40
|
|
|
HC CONTRAST BATHS EACH 15 MIN
|
Facility
|
IP
|
$107.89
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
42000017
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$67.97 |
| Max. Negotiated Rate |
$97.10 |
| Rate for Payer: Aetna Commercial |
$91.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.13
|
| Rate for Payer: Cash Price |
$86.31
|
| Rate for Payer: Cofinity Advantage |
$75.52
|
| Rate for Payer: Cofinity Commercial |
$92.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.31
|
| Rate for Payer: Healthscope Commercial |
$97.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.92
|
| Rate for Payer: PHP Commercial |
$91.71
|
| Rate for Payer: Priority Health SBD |
$67.97
|
|
|
HC CONTROL NASAL HEMORR POST PACK/CAUTERY INIT
|
Facility
|
IP
|
$461.04
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
76100530
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$290.46 |
| Max. Negotiated Rate |
$414.94 |
| Rate for Payer: Aetna Commercial |
$391.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$299.68
|
| Rate for Payer: Cash Price |
$368.83
|
| Rate for Payer: Cofinity Advantage |
$322.73
|
| Rate for Payer: Cofinity Commercial |
$396.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$368.83
|
| Rate for Payer: Healthscope Commercial |
$414.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$391.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$345.78
|
| Rate for Payer: PHP Commercial |
$391.88
|
| Rate for Payer: Priority Health SBD |
$290.46
|
|
|
HC CONTROL NASAL HEMORR POST PACK/CAUTERY INIT
|
Facility
|
OP
|
$461.04
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
76100530
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$428.73 |
| Rate for Payer: Aetna Commercial |
$391.88
|
| Rate for Payer: Aetna Medicare |
$137.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$299.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$183.32
|
| Rate for Payer: BCN Commercial |
$183.32
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$368.83
|
| Rate for Payer: Cash Price |
$368.83
|
| Rate for Payer: Cash Price |
$368.83
|
| Rate for Payer: Cofinity Advantage |
$322.73
|
| Rate for Payer: Cofinity Commercial |
$396.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$368.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$414.94
|
| Rate for Payer: Mclaren Medicaid |
$69.33
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$139.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$391.88
|
| Rate for Payer: Nomi Health Commercial |
$397.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$345.78
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$391.88
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.73
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health SBD |
$290.46
|
| Rate for Payer: Priority Health Tiered Network |
$342.98
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$299.68
|
| Rate for Payer: UHC Core |
$240.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$181.19
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
HC CONTROL NOSEBLEED ANTERIOR SIMPLE
|
Facility
|
IP
|
$422.93
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
45000011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.45 |
| Max. Negotiated Rate |
$380.64 |
| Rate for Payer: Aetna Commercial |
$359.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.90
|
| Rate for Payer: Cash Price |
$338.34
|
| Rate for Payer: Cofinity Advantage |
$296.05
|
| Rate for Payer: Cofinity Commercial |
$363.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.34
|
| Rate for Payer: Healthscope Commercial |
$380.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$317.20
|
| Rate for Payer: PHP Commercial |
$359.49
|
| Rate for Payer: Priority Health SBD |
$266.45
|
|
|
HC CONTROL NOSEBLEED ANTERIOR SIMPLE
|
Facility
|
OP
|
$422.93
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
45000011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$428.73 |
| Rate for Payer: Aetna Commercial |
$359.49
|
| Rate for Payer: Aetna Medicare |
$137.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$132.00
|
| Rate for Payer: BCN Commercial |
$132.00
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$338.34
|
| Rate for Payer: Cash Price |
$338.34
|
| Rate for Payer: Cash Price |
$338.34
|
| Rate for Payer: Cofinity Advantage |
$296.05
|
| Rate for Payer: Cofinity Commercial |
$363.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$380.64
|
| Rate for Payer: Mclaren Medicaid |
$69.33
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$139.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.49
|
| Rate for Payer: Nomi Health Commercial |
$397.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$317.20
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$359.49
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.73
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health SBD |
$266.45
|
| Rate for Payer: Priority Health Tiered Network |
$342.98
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.90
|
| Rate for Payer: UHC Core |
$220.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$166.21
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
HC CONTROL OROPHARYNGEAL HEM SIMPLE
|
Facility
|
OP
|
$768.85
|
|
|
Service Code
|
CPT 42960
|
| Hospital Charge Code |
45000100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$1,737.88 |
| Rate for Payer: PHP Commercial |
$653.52
|
| Rate for Payer: Aetna Commercial |
$653.52
|
| Rate for Payer: Aetna Medicare |
$558.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$499.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.74
|
| Rate for Payer: BCBS Complete |
$295.13
|
| Rate for Payer: BCBS MAPPO |
$537.39
|
| Rate for Payer: BCBS Trust/PPO |
$376.65
|
| Rate for Payer: BCN Commercial |
$376.65
|
| Rate for Payer: BCN Medicare Advantage |
$537.39
|
| Rate for Payer: Cash Price |
$615.08
|
| Rate for Payer: Cash Price |
$615.08
|
| Rate for Payer: Cash Price |
$615.08
|
| Rate for Payer: Cofinity Advantage |
$538.20
|
| Rate for Payer: Cofinity Commercial |
$661.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$615.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.39
|
| Rate for Payer: Healthscope Commercial |
$691.97
|
| Rate for Payer: Mclaren Medicaid |
$281.05
|
| Rate for Payer: Mclaren Medicare |
$537.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.26
|
| Rate for Payer: Meridian Medicaid |
$564.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$618.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$591.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$653.52
|
| Rate for Payer: Nomi Health Commercial |
$1,612.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$576.64
|
| Rate for Payer: PACE Medicare |
$510.52
|
| Rate for Payer: PACE SWMI |
$537.39
|
| Rate for Payer: PHP Medicare Advantage |
$537.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,737.88
|
| Rate for Payer: Priority Health Medicare |
$537.39
|
| Rate for Payer: Priority Health SBD |
$484.38
|
| Rate for Payer: Priority Health Tiered Network |
$1,390.30
|
| Rate for Payer: Railroad Medicare Medicare |
$537.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$537.39
|
| Rate for Payer: UHC Medicaid |
$281.05
|
| Rate for Payer: UHCCP Medicaid |
$144.00
|
| Rate for Payer: VA VA |
$537.39
|
|
|
HC CONTROL OROPHARYNGEAL HEM SIMPLE
|
Facility
|
IP
|
$768.85
|
|
|
Service Code
|
CPT 42960
|
| Hospital Charge Code |
45000100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$484.38 |
| Max. Negotiated Rate |
$691.97 |
| Rate for Payer: Aetna Commercial |
$653.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$499.75
|
| Rate for Payer: Cash Price |
$615.08
|
| Rate for Payer: Cofinity Advantage |
$538.20
|
| Rate for Payer: Cofinity Commercial |
$661.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$615.08
|
| Rate for Payer: Healthscope Commercial |
$691.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$653.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$576.64
|
| Rate for Payer: PHP Commercial |
$653.52
|
| Rate for Payer: Priority Health SBD |
$484.38
|
|
|
HC CONTROL OROPHARYNG HEMORRHAGE SIMPLE
|
Facility
|
OP
|
$1,369.17
|
|
|
Service Code
|
CPT 42960
|
| Hospital Charge Code |
76100478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.05 |
| Max. Negotiated Rate |
$1,737.88 |
| Rate for Payer: Aetna Commercial |
$1,163.79
|
| Rate for Payer: Aetna Medicare |
$558.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$889.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.74
|
| Rate for Payer: BCBS Complete |
$295.13
|
| Rate for Payer: BCBS MAPPO |
$537.39
|
| Rate for Payer: BCBS Trust/PPO |
$376.65
|
| Rate for Payer: BCN Commercial |
$376.65
|
| Rate for Payer: BCN Medicare Advantage |
$537.39
|
| Rate for Payer: Cash Price |
$1,095.34
|
| Rate for Payer: Cash Price |
$1,095.34
|
| Rate for Payer: Cash Price |
$1,095.34
|
| Rate for Payer: Cofinity Advantage |
$958.42
|
| Rate for Payer: Cofinity Commercial |
$1,177.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,095.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.39
|
| Rate for Payer: Healthscope Commercial |
$1,232.25
|
| Rate for Payer: Mclaren Medicaid |
$281.05
|
| Rate for Payer: Mclaren Medicare |
$537.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.26
|
| Rate for Payer: Meridian Medicaid |
$564.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$618.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$591.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,163.79
|
| Rate for Payer: Nomi Health Commercial |
$1,612.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,026.88
|
| Rate for Payer: PACE Medicare |
$510.52
|
| Rate for Payer: PACE SWMI |
$537.39
|
| Rate for Payer: PHP Commercial |
$1,163.79
|
| Rate for Payer: PHP Medicare Advantage |
$537.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,737.88
|
| Rate for Payer: Priority Health Medicare |
$537.39
|
| Rate for Payer: Priority Health SBD |
$862.58
|
| Rate for Payer: Priority Health Tiered Network |
$1,390.30
|
| Rate for Payer: Railroad Medicare Medicare |
$537.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$889.96
|
| Rate for Payer: UHC Core |
$713.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$537.39
|
| Rate for Payer: UHC Exchange |
$538.08
|
| Rate for Payer: UHC Medicaid |
$281.05
|
| Rate for Payer: UHCCP Medicaid |
$281.05
|
| Rate for Payer: VA VA |
$537.39
|
|
|
HC CONTROL OROPHARYNG HEMORRHAGE SIMPLE
|
Facility
|
IP
|
$1,369.17
|
|
|
Service Code
|
CPT 42960
|
| Hospital Charge Code |
76100478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$862.58 |
| Max. Negotiated Rate |
$1,232.25 |
| Rate for Payer: Aetna Commercial |
$1,163.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$889.96
|
| Rate for Payer: Cash Price |
$1,095.34
|
| Rate for Payer: Cofinity Advantage |
$958.42
|
| Rate for Payer: Cofinity Commercial |
$1,177.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,095.34
|
| Rate for Payer: Healthscope Commercial |
$1,232.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,163.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,026.88
|
| Rate for Payer: PHP Commercial |
$1,163.79
|
| Rate for Payer: Priority Health SBD |
$862.58
|
|
