|
HC COLPOSCOPY CERVIX W ADJ VAGINA W BX
|
Facility
|
OP
|
$426.04
|
|
|
Service Code
|
CPT 57455
|
| Hospital Charge Code |
76100205
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.02 |
| Max. Negotiated Rate |
$835.10 |
| Rate for Payer: Aetna Commercial |
$362.13
|
| Rate for Payer: Aetna Medicare |
$308.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$370.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$370.84
|
| Rate for Payer: BCBS Complete |
$166.97
|
| Rate for Payer: BCBS MAPPO |
$296.67
|
| Rate for Payer: BCN Medicare Advantage |
$296.67
|
| Rate for Payer: Cash Price |
$340.83
|
| Rate for Payer: Cash Price |
$340.83
|
| Rate for Payer: Cofinity Commercial |
$366.39
|
| Rate for Payer: Cofinity Commercial |
$298.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$298.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$296.67
|
| Rate for Payer: Healthscope Commercial |
$383.44
|
| Rate for Payer: Mclaren Medicaid |
$159.02
|
| Rate for Payer: Mclaren Medicare |
$296.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$311.50
|
| Rate for Payer: Meridian Medicaid |
$166.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$341.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.13
|
| Rate for Payer: PACE Medicare |
$281.84
|
| Rate for Payer: PACE SWMI |
$296.67
|
| Rate for Payer: PHP Commercial |
$362.13
|
| Rate for Payer: PHP Medicare Advantage |
$296.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.93
|
| Rate for Payer: Priority Health Medicare |
$296.67
|
| Rate for Payer: Priority Health SBD |
$268.41
|
| Rate for Payer: Railroad Medicare Medicare |
$296.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$835.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$296.67
|
| Rate for Payer: UHC Medicare Advantage |
$296.67
|
| Rate for Payer: UHCCP Medicaid |
$167.03
|
| Rate for Payer: VA VA |
$296.67
|
|
|
HC COLPOSCOPY CERVIX W ADJ VAGINA W BX
|
Facility
|
IP
|
$426.04
|
|
|
Service Code
|
CPT 57455
|
| Hospital Charge Code |
76100205
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$268.41 |
| Max. Negotiated Rate |
$383.44 |
| Rate for Payer: Aetna Commercial |
$362.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.93
|
| Rate for Payer: Cash Price |
$340.83
|
| Rate for Payer: Cofinity Commercial |
$298.23
|
| Rate for Payer: Cofinity Commercial |
$366.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$298.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.83
|
| Rate for Payer: Healthscope Commercial |
$383.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.13
|
| Rate for Payer: PHP Commercial |
$362.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.93
|
| Rate for Payer: Priority Health SBD |
$268.41
|
|
|
HC COLPOSCOPY OF CERVIX/VAGINA W/BIOPSY AND CURETTAGE
|
Facility
|
IP
|
$368.30
|
|
|
Service Code
|
CPT 57454
|
| Hospital Charge Code |
76100140
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.03 |
| Max. Negotiated Rate |
$331.47 |
| Rate for Payer: Aetna Commercial |
$313.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.40
|
| Rate for Payer: Cash Price |
$294.64
|
| Rate for Payer: Cofinity Commercial |
$257.81
|
| Rate for Payer: Cofinity Commercial |
$316.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$257.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.64
|
| Rate for Payer: Healthscope Commercial |
$331.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.06
|
| Rate for Payer: PHP Commercial |
$313.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.40
|
| Rate for Payer: Priority Health SBD |
$232.03
|
|
|
HC COLPOSCOPY OF CERVIX/VAGINA W/BIOPSY AND CURETTAGE
|
Facility
|
OP
|
$368.30
|
|
|
Service Code
|
CPT 57454
|
| Hospital Charge Code |
76100140
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.02 |
| Max. Negotiated Rate |
$835.10 |
| Rate for Payer: Aetna Commercial |
$313.06
|
| Rate for Payer: Aetna Medicare |
$308.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$370.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$370.84
|
| Rate for Payer: BCBS Complete |
$166.97
|
| Rate for Payer: BCBS MAPPO |
$296.67
|
| Rate for Payer: BCN Medicare Advantage |
$296.67
|
| Rate for Payer: Cash Price |
$294.64
|
| Rate for Payer: Cash Price |
$294.64
|
| Rate for Payer: Cofinity Commercial |
$316.74
|
| Rate for Payer: Cofinity Commercial |
$257.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$257.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$296.67
|
| Rate for Payer: Healthscope Commercial |
$331.47
|
| Rate for Payer: Mclaren Medicaid |
$159.02
|
| Rate for Payer: Mclaren Medicare |
$296.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$311.50
|
| Rate for Payer: Meridian Medicaid |
$166.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$341.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.06
|
| Rate for Payer: PACE Medicare |
$281.84
|
| Rate for Payer: PACE SWMI |
$296.67
|
| Rate for Payer: PHP Commercial |
$313.06
|
| Rate for Payer: PHP Medicare Advantage |
$296.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.40
|
| Rate for Payer: Priority Health Medicare |
$296.67
|
| Rate for Payer: Priority Health SBD |
$232.03
|
| Rate for Payer: Railroad Medicare Medicare |
$296.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$835.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$296.67
|
| Rate for Payer: UHC Medicare Advantage |
$296.67
|
| Rate for Payer: UHCCP Medicaid |
$167.03
|
| Rate for Payer: VA VA |
$296.67
|
|
|
HC COLPOSCOPY VAGINA W/BIOPSY
|
Facility
|
OP
|
$870.81
|
|
|
Service Code
|
CPT 57421
|
| Hospital Charge Code |
76100223
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$455.18 |
| Max. Negotiated Rate |
$2,390.47 |
| Rate for Payer: Aetna Commercial |
$740.19
|
| Rate for Payer: Aetna Medicare |
$883.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$566.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,061.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,061.53
|
| Rate for Payer: BCBS Complete |
$477.94
|
| Rate for Payer: BCBS MAPPO |
$849.22
|
| Rate for Payer: BCN Medicare Advantage |
$849.22
|
| Rate for Payer: Cash Price |
$696.65
|
| Rate for Payer: Cash Price |
$696.65
|
| Rate for Payer: Cofinity Commercial |
$748.90
|
| Rate for Payer: Cofinity Commercial |
$609.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$609.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$696.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$849.22
|
| Rate for Payer: Healthscope Commercial |
$783.73
|
| Rate for Payer: Mclaren Medicaid |
$455.18
|
| Rate for Payer: Mclaren Medicare |
$849.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$891.68
|
| Rate for Payer: Meridian Medicaid |
$477.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$976.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$740.19
|
| Rate for Payer: PACE Medicare |
$806.76
|
| Rate for Payer: PACE SWMI |
$849.22
|
| Rate for Payer: PHP Commercial |
$740.19
|
| Rate for Payer: PHP Medicare Advantage |
$849.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$455.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.03
|
| Rate for Payer: Priority Health Medicare |
$849.22
|
| Rate for Payer: Priority Health SBD |
$548.61
|
| Rate for Payer: Railroad Medicare Medicare |
$849.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,390.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$849.22
|
| Rate for Payer: UHC Medicare Advantage |
$849.22
|
| Rate for Payer: UHCCP Medicaid |
$478.11
|
| Rate for Payer: VA VA |
$849.22
|
|
|
HC COLPOSCOPY VAGINA W/BIOPSY
|
Facility
|
IP
|
$870.81
|
|
|
Service Code
|
CPT 57421
|
| Hospital Charge Code |
76100223
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$548.61 |
| Max. Negotiated Rate |
$783.73 |
| Rate for Payer: Aetna Commercial |
$740.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$566.03
|
| Rate for Payer: Cash Price |
$696.65
|
| Rate for Payer: Cofinity Commercial |
$609.57
|
| Rate for Payer: Cofinity Commercial |
$748.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$609.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$696.65
|
| Rate for Payer: Healthscope Commercial |
$783.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$740.19
|
| Rate for Payer: PHP Commercial |
$740.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.03
|
| Rate for Payer: Priority Health SBD |
$548.61
|
|
|
HC COLPOSCOPY VAGINA W/O BIOPSY
|
Facility
|
OP
|
$422.48
|
|
|
Service Code
|
CPT 57420
|
| Hospital Charge Code |
76100254
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.02 |
| Max. Negotiated Rate |
$835.10 |
| Rate for Payer: Aetna Commercial |
$359.11
|
| Rate for Payer: Aetna Medicare |
$308.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$370.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$370.84
|
| Rate for Payer: BCBS Complete |
$166.97
|
| Rate for Payer: BCBS MAPPO |
$296.67
|
| Rate for Payer: BCN Medicare Advantage |
$296.67
|
| Rate for Payer: Cash Price |
$337.98
|
| Rate for Payer: Cash Price |
$337.98
|
| Rate for Payer: Cofinity Commercial |
$363.33
|
| Rate for Payer: Cofinity Commercial |
$295.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$295.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$296.67
|
| Rate for Payer: Healthscope Commercial |
$380.23
|
| Rate for Payer: Mclaren Medicaid |
$159.02
|
| Rate for Payer: Mclaren Medicare |
$296.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$311.50
|
| Rate for Payer: Meridian Medicaid |
$166.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$341.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.11
|
| Rate for Payer: PACE Medicare |
$281.84
|
| Rate for Payer: PACE SWMI |
$296.67
|
| Rate for Payer: PHP Commercial |
$359.11
|
| Rate for Payer: PHP Medicare Advantage |
$296.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.61
|
| Rate for Payer: Priority Health Medicare |
$296.67
|
| Rate for Payer: Priority Health SBD |
$266.16
|
| Rate for Payer: Railroad Medicare Medicare |
$296.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$835.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$296.67
|
| Rate for Payer: UHC Medicare Advantage |
$296.67
|
| Rate for Payer: UHCCP Medicaid |
$167.03
|
| Rate for Payer: VA VA |
$296.67
|
|
|
HC COLPOSCOPY VAGINA W/O BIOPSY
|
Facility
|
IP
|
$422.48
|
|
|
Service Code
|
CPT 57420
|
| Hospital Charge Code |
76100254
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.16 |
| Max. Negotiated Rate |
$380.23 |
| Rate for Payer: Aetna Commercial |
$359.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.61
|
| Rate for Payer: Cash Price |
$337.98
|
| Rate for Payer: Cofinity Commercial |
$295.74
|
| Rate for Payer: Cofinity Commercial |
$363.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$295.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.98
|
| Rate for Payer: Healthscope Commercial |
$380.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.11
|
| Rate for Payer: PHP Commercial |
$359.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.61
|
| Rate for Payer: Priority Health SBD |
$266.16
|
|
|
HC COLPOSCOPY, VULVA
|
Facility
|
IP
|
$328.77
|
|
|
Service Code
|
CPT 56820
|
| Hospital Charge Code |
76100258
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.13 |
| Max. Negotiated Rate |
$295.89 |
| Rate for Payer: Aetna Commercial |
$279.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.70
|
| Rate for Payer: Cash Price |
$263.02
|
| Rate for Payer: Cofinity Commercial |
$230.14
|
| Rate for Payer: Cofinity Commercial |
$282.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$230.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.02
|
| Rate for Payer: Healthscope Commercial |
$295.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.45
|
| Rate for Payer: PHP Commercial |
$279.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.70
|
| Rate for Payer: Priority Health SBD |
$207.13
|
|
|
HC COLPOSCOPY, VULVA
|
Facility
|
OP
|
$328.77
|
|
|
Service Code
|
CPT 56820
|
| Hospital Charge Code |
76100258
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.16 |
| Max. Negotiated Rate |
$552.28 |
| Rate for Payer: Aetna Commercial |
$279.45
|
| Rate for Payer: Aetna Medicare |
$204.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$245.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$245.25
|
| Rate for Payer: BCBS Complete |
$110.42
|
| Rate for Payer: BCBS MAPPO |
$196.20
|
| Rate for Payer: BCN Medicare Advantage |
$196.20
|
| Rate for Payer: Cash Price |
$263.02
|
| Rate for Payer: Cash Price |
$263.02
|
| Rate for Payer: Cofinity Commercial |
$282.74
|
| Rate for Payer: Cofinity Commercial |
$230.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$230.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.20
|
| Rate for Payer: Healthscope Commercial |
$295.89
|
| Rate for Payer: Mclaren Medicaid |
$105.16
|
| Rate for Payer: Mclaren Medicare |
$196.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.01
|
| Rate for Payer: Meridian Medicaid |
$110.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.45
|
| Rate for Payer: PACE Medicare |
$186.39
|
| Rate for Payer: PACE SWMI |
$196.20
|
| Rate for Payer: PHP Commercial |
$279.45
|
| Rate for Payer: PHP Medicare Advantage |
$196.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.70
|
| Rate for Payer: Priority Health Medicare |
$196.20
|
| Rate for Payer: Priority Health SBD |
$207.13
|
| Rate for Payer: Railroad Medicare Medicare |
$196.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$552.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.20
|
| Rate for Payer: UHC Medicare Advantage |
$196.20
|
| Rate for Payer: UHCCP Medicaid |
$110.46
|
| Rate for Payer: VA VA |
$196.20
|
|
|
HC COLPOSCOPY VULVA W/BIOPSY
|
Facility
|
OP
|
$854.17
|
|
|
Service Code
|
CPT 56821
|
| Hospital Charge Code |
76100332
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.02 |
| Max. Negotiated Rate |
$835.10 |
| Rate for Payer: Aetna Commercial |
$726.04
|
| Rate for Payer: Aetna Medicare |
$308.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$555.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$370.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$370.84
|
| Rate for Payer: BCBS Complete |
$166.97
|
| Rate for Payer: BCBS MAPPO |
$296.67
|
| Rate for Payer: BCN Medicare Advantage |
$296.67
|
| Rate for Payer: Cash Price |
$683.34
|
| Rate for Payer: Cash Price |
$683.34
|
| Rate for Payer: Cofinity Commercial |
$734.59
|
| Rate for Payer: Cofinity Commercial |
$597.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$597.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$683.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$296.67
|
| Rate for Payer: Healthscope Commercial |
$768.75
|
| Rate for Payer: Mclaren Medicaid |
$159.02
|
| Rate for Payer: Mclaren Medicare |
$296.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$311.50
|
| Rate for Payer: Meridian Medicaid |
$166.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$341.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$726.04
|
| Rate for Payer: PACE Medicare |
$281.84
|
| Rate for Payer: PACE SWMI |
$296.67
|
| Rate for Payer: PHP Commercial |
$726.04
|
| Rate for Payer: PHP Medicare Advantage |
$296.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$555.21
|
| Rate for Payer: Priority Health Medicare |
$296.67
|
| Rate for Payer: Priority Health SBD |
$538.13
|
| Rate for Payer: Railroad Medicare Medicare |
$296.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$835.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$296.67
|
| Rate for Payer: UHC Medicare Advantage |
$296.67
|
| Rate for Payer: UHCCP Medicaid |
$167.03
|
| Rate for Payer: VA VA |
$296.67
|
|
|
HC COLPOSCOPY VULVA W/BIOPSY
|
Facility
|
IP
|
$854.17
|
|
|
Service Code
|
CPT 56821
|
| Hospital Charge Code |
76100332
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$538.13 |
| Max. Negotiated Rate |
$768.75 |
| Rate for Payer: Aetna Commercial |
$726.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$555.21
|
| Rate for Payer: Cash Price |
$683.34
|
| Rate for Payer: Cofinity Commercial |
$597.92
|
| Rate for Payer: Cofinity Commercial |
$734.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$597.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$683.34
|
| Rate for Payer: Healthscope Commercial |
$768.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$726.04
|
| Rate for Payer: PHP Commercial |
$726.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$555.21
|
| Rate for Payer: Priority Health SBD |
$538.13
|
|
|
HC COMBI CATH SUPPLY
|
Facility
|
OP
|
$123.46
|
|
| Hospital Charge Code |
27200116
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.38 |
| Max. Negotiated Rate |
$111.11 |
| Rate for Payer: Aetna Commercial |
$104.94
|
| Rate for Payer: Aetna Medicare |
$61.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.25
|
| Rate for Payer: BCBS Complete |
$49.38
|
| Rate for Payer: Cash Price |
$98.77
|
| Rate for Payer: Cofinity Commercial |
$106.18
|
| Rate for Payer: Cofinity Commercial |
$86.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.77
|
| Rate for Payer: Healthscope Commercial |
$111.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.94
|
| Rate for Payer: PHP Commercial |
$104.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.25
|
| Rate for Payer: Priority Health SBD |
$77.78
|
|
|
HC COMBI CATH SUPPLY
|
Facility
|
IP
|
$123.46
|
|
| Hospital Charge Code |
27200116
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.78 |
| Max. Negotiated Rate |
$111.11 |
| Rate for Payer: Aetna Commercial |
$104.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.25
|
| Rate for Payer: Cash Price |
$98.77
|
| Rate for Payer: Cofinity Commercial |
$106.18
|
| Rate for Payer: Cofinity Commercial |
$86.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.77
|
| Rate for Payer: Healthscope Commercial |
$111.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.94
|
| Rate for Payer: PHP Commercial |
$104.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.25
|
| Rate for Payer: Priority Health SBD |
$77.78
|
|
|
HC COMBINED VACCINE, MMR+VARICELLA, SUBQ
|
Facility
|
IP
|
$213.28
|
|
|
Service Code
|
CPT 90710
|
| Hospital Charge Code |
63600206
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$134.37 |
| Max. Negotiated Rate |
$191.95 |
| Rate for Payer: Aetna Commercial |
$181.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.63
|
| Rate for Payer: Cash Price |
$170.62
|
| Rate for Payer: Cofinity Commercial |
$149.30
|
| Rate for Payer: Cofinity Commercial |
$183.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$149.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.62
|
| Rate for Payer: Healthscope Commercial |
$191.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.29
|
| Rate for Payer: PHP Commercial |
$181.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.63
|
| Rate for Payer: Priority Health SBD |
$134.37
|
|
|
HC COMBINED VACCINE, MMR+VARICELLA, SUBQ
|
Facility
|
OP
|
$213.28
|
|
|
Service Code
|
CPT 90710
|
| Hospital Charge Code |
63600206
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.31 |
| Max. Negotiated Rate |
$191.95 |
| Rate for Payer: Aetna Commercial |
$181.29
|
| Rate for Payer: Aetna Medicare |
$106.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.63
|
| Rate for Payer: BCBS Complete |
$85.31
|
| Rate for Payer: Cash Price |
$170.62
|
| Rate for Payer: Cofinity Commercial |
$149.30
|
| Rate for Payer: Cofinity Commercial |
$183.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$149.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.62
|
| Rate for Payer: Healthscope Commercial |
$191.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.29
|
| Rate for Payer: PHP Commercial |
$181.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.63
|
| Rate for Payer: Priority Health SBD |
$134.37
|
|
|
HC COMMON REED IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200080
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC COMMON REED IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200080
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
|
|
HC COMM WORK REINTEGRATION EA 15 MIN
|
Facility
|
OP
|
$96.90
|
|
|
Service Code
|
CPT 97537
|
| Hospital Charge Code |
42000031
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$38.76 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$82.36
|
| Rate for Payer: Aetna Medicare |
$48.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.98
|
| Rate for Payer: BCBS Complete |
$38.76
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cofinity Commercial |
$83.33
|
| Rate for Payer: Cofinity Commercial |
$67.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.52
|
| Rate for Payer: Healthscope Commercial |
$87.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.36
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$82.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.98
|
| Rate for Payer: Priority Health SBD |
$61.05
|
| Rate for Payer: UHC Core |
$71.71
|
| Rate for Payer: UHC Exchange |
$71.71
|
|
|
HC COMM WORK REINTEGRATION EA 15 MIN
|
Facility
|
IP
|
$96.90
|
|
|
Service Code
|
CPT 97537
|
| Hospital Charge Code |
42000031
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$61.05 |
| Max. Negotiated Rate |
$87.21 |
| Rate for Payer: Aetna Commercial |
$82.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.98
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cofinity Commercial |
$67.83
|
| Rate for Payer: Cofinity Commercial |
$83.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.52
|
| Rate for Payer: Healthscope Commercial |
$87.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.36
|
| Rate for Payer: PHP Commercial |
$82.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.98
|
| Rate for Payer: Priority Health SBD |
$61.05
|
|
|
HC COMPARTMENT PRESSURE CHECK
|
Facility
|
IP
|
$658.62
|
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$414.93 |
| Max. Negotiated Rate |
$592.76 |
| Rate for Payer: Aetna Commercial |
$559.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$428.10
|
| Rate for Payer: Cash Price |
$526.90
|
| Rate for Payer: Cofinity Commercial |
$461.03
|
| Rate for Payer: Cofinity Commercial |
$566.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$461.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$526.90
|
| Rate for Payer: Healthscope Commercial |
$592.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$559.83
|
| Rate for Payer: PHP Commercial |
$559.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$428.10
|
| Rate for Payer: Priority Health SBD |
$414.93
|
|
|
HC COMPARTMENT PRESSURE CHECK
|
Facility
|
OP
|
$658.62
|
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$263.45 |
| Max. Negotiated Rate |
$592.76 |
| Rate for Payer: Aetna Commercial |
$559.83
|
| Rate for Payer: Aetna Medicare |
$329.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$428.10
|
| Rate for Payer: BCBS Complete |
$263.45
|
| Rate for Payer: Cash Price |
$526.90
|
| Rate for Payer: Cofinity Commercial |
$461.03
|
| Rate for Payer: Cofinity Commercial |
$566.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$461.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$526.90
|
| Rate for Payer: Healthscope Commercial |
$592.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$559.83
|
| Rate for Payer: PHP Commercial |
$559.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$428.10
|
| Rate for Payer: Priority Health SBD |
$414.93
|
|
|
HC COMP BURN GARM 2 LEGS-WAIST
|
Facility
|
OP
|
$238.68
|
|
|
Service Code
|
HCPCS A6511
|
| Hospital Charge Code |
98300142
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$95.47 |
| Max. Negotiated Rate |
$214.81 |
| Rate for Payer: Aetna Commercial |
$202.88
|
| Rate for Payer: Aetna Medicare |
$119.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.14
|
| Rate for Payer: BCBS Complete |
$95.47
|
| Rate for Payer: Cash Price |
$190.94
|
| Rate for Payer: Cofinity Commercial |
$167.08
|
| Rate for Payer: Cofinity Commercial |
$205.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$167.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.94
|
| Rate for Payer: Healthscope Commercial |
$214.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.88
|
| Rate for Payer: PHP Commercial |
$202.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.14
|
| Rate for Payer: Priority Health SBD |
$150.37
|
|
|
HC COMP BURN GARM 2 LEGS-WAIST
|
Facility
|
IP
|
$238.68
|
|
|
Service Code
|
HCPCS A6511
|
| Hospital Charge Code |
98300142
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$150.37 |
| Max. Negotiated Rate |
$214.81 |
| Rate for Payer: Aetna Commercial |
$202.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.14
|
| Rate for Payer: Cash Price |
$190.94
|
| Rate for Payer: Cofinity Commercial |
$167.08
|
| Rate for Payer: Cofinity Commercial |
$205.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$167.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.94
|
| Rate for Payer: Healthscope Commercial |
$214.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.88
|
| Rate for Payer: PHP Commercial |
$202.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.14
|
| Rate for Payer: Priority Health SBD |
$150.37
|
|
|
HC COMP BURN GARM 2 OR MORE FAB/C
|
Facility
|
IP
|
$12.24
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300143
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.96
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Cofinity Commercial |
$8.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.40
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.96
|
| Rate for Payer: Priority Health SBD |
$7.71
|
|
