|
HC COMPLEMENT C 4
|
Facility
|
IP
|
$115.26
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200151
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$72.61 |
| Max. Negotiated Rate |
$103.73 |
| Rate for Payer: Aetna Commercial |
$97.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.92
|
| Rate for Payer: Cash Price |
$92.21
|
| Rate for Payer: Cofinity Commercial |
$80.68
|
| Rate for Payer: Cofinity Commercial |
$99.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.21
|
| Rate for Payer: Healthscope Commercial |
$103.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.97
|
| Rate for Payer: PHP Commercial |
$97.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.92
|
| Rate for Payer: Priority Health SBD |
$72.61
|
|
|
HC COMPLEMENT C 4
|
Facility
|
OP
|
$115.26
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200151
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$103.73 |
| Rate for Payer: Aetna Commercial |
$97.97
|
| Rate for Payer: Aetna Medicare |
$12.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.92
|
| 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 |
$6.75
|
| Rate for Payer: BCBS MAPPO |
$12.00
|
| Rate for Payer: BCN Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$92.21
|
| Rate for Payer: Cash Price |
$92.21
|
| Rate for Payer: Cofinity Commercial |
$99.12
|
| Rate for Payer: Cofinity Commercial |
$80.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$103.73
|
| Rate for Payer: Mclaren Medicaid |
$6.43
|
| 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 |
$6.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.97
|
| Rate for Payer: PACE Medicare |
$11.40
|
| Rate for Payer: PACE SWMI |
$12.00
|
| Rate for Payer: PHP Commercial |
$97.97
|
| Rate for Payer: PHP Medicare Advantage |
$12.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.92
|
| Rate for Payer: Priority Health Medicare |
$12.00
|
| Rate for Payer: Priority Health SBD |
$72.61
|
| Rate for Payer: Railroad Medicare Medicare |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.00
|
| Rate for Payer: UHC Medicare Advantage |
$12.00
|
| Rate for Payer: UHCCP Medicaid |
$6.76
|
| Rate for Payer: VA VA |
$12.00
|
|
|
HC COMPLEMENT C 5
|
Facility
|
IP
|
$72.83
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200152
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna Commercial |
$61.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.34
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$50.98
|
| Rate for Payer: Cofinity Commercial |
$62.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Healthscope Commercial |
$65.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: PHP Commercial |
$61.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.34
|
| Rate for Payer: Priority Health SBD |
$45.88
|
|
|
HC COMPLEMENT C 5
|
Facility
|
OP
|
$72.83
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200152
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna Commercial |
$61.91
|
| Rate for Payer: Aetna Medicare |
$12.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.34
|
| 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 |
$6.75
|
| Rate for Payer: BCBS MAPPO |
$12.00
|
| Rate for Payer: BCN Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$62.63
|
| Rate for Payer: Cofinity Commercial |
$50.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$65.55
|
| Rate for Payer: Mclaren Medicaid |
$6.43
|
| 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 |
$6.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: PACE Medicare |
$11.40
|
| Rate for Payer: PACE SWMI |
$12.00
|
| Rate for Payer: PHP Commercial |
$61.91
|
| Rate for Payer: PHP Medicare Advantage |
$12.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.34
|
| Rate for Payer: Priority Health Medicare |
$12.00
|
| Rate for Payer: Priority Health SBD |
$45.88
|
| Rate for Payer: Railroad Medicare Medicare |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.00
|
| Rate for Payer: UHC Medicare Advantage |
$12.00
|
| Rate for Payer: UHCCP Medicaid |
$6.76
|
| Rate for Payer: VA VA |
$12.00
|
|
|
HC COMPLEMENT CH50 TOTAL
|
Facility
|
OP
|
$39.54
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
30200154
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.89 |
| Max. Negotiated Rate |
$57.20 |
| Rate for Payer: Aetna Commercial |
$33.61
|
| Rate for Payer: Aetna Medicare |
$21.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.70
|
| 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 |
$11.44
|
| Rate for Payer: BCBS MAPPO |
$20.32
|
| Rate for Payer: BCN Medicare Advantage |
$20.32
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Cofinity Commercial |
$34.00
|
| Rate for Payer: Cofinity Commercial |
$27.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.32
|
| Rate for Payer: Healthscope Commercial |
$35.59
|
| Rate for Payer: Mclaren Medicaid |
$10.89
|
| 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 |
$11.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.61
|
| Rate for Payer: PACE Medicare |
$19.30
|
| Rate for Payer: PACE SWMI |
$20.32
|
| Rate for Payer: PHP Commercial |
$33.61
|
| Rate for Payer: PHP Medicare Advantage |
$20.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health Medicare |
$20.32
|
| Rate for Payer: Priority Health SBD |
$24.91
|
| Rate for Payer: Railroad Medicare Medicare |
$20.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.32
|
| Rate for Payer: UHC Medicare Advantage |
$20.32
|
| Rate for Payer: UHCCP Medicaid |
$11.44
|
| Rate for Payer: VA VA |
$20.32
|
|
|
HC COMPLEMENT CH50 TOTAL
|
Facility
|
IP
|
$39.54
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
30200154
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.91 |
| Max. Negotiated Rate |
$35.59 |
| Rate for Payer: Aetna Commercial |
$33.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.70
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Cofinity Commercial |
$27.68
|
| Rate for Payer: Cofinity Commercial |
$34.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.63
|
| Rate for Payer: Healthscope Commercial |
$35.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.61
|
| Rate for Payer: PHP Commercial |
$33.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health SBD |
$24.91
|
|
|
HC COMPLEX CYSTOMETROGRAM
|
Facility
|
OP
|
$397.27
|
|
|
Service Code
|
CPT 51726
|
| Hospital Charge Code |
76100190
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.14 |
| Max. Negotiated Rate |
$667.69 |
| Rate for Payer: Aetna Commercial |
$337.68
|
| Rate for Payer: Aetna Medicare |
$246.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.50
|
| Rate for Payer: BCBS Complete |
$133.50
|
| Rate for Payer: BCBS MAPPO |
$237.20
|
| Rate for Payer: BCN Medicare Advantage |
$237.20
|
| Rate for Payer: Cash Price |
$317.82
|
| Rate for Payer: Cash Price |
$317.82
|
| Rate for Payer: Cofinity Commercial |
$341.65
|
| Rate for Payer: Cofinity Commercial |
$278.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$278.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.20
|
| Rate for Payer: Healthscope Commercial |
$357.54
|
| Rate for Payer: Mclaren Medicaid |
$127.14
|
| Rate for Payer: Mclaren Medicare |
$237.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.06
|
| Rate for Payer: Meridian Medicaid |
$133.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.68
|
| Rate for Payer: PACE Medicare |
$225.34
|
| Rate for Payer: PACE SWMI |
$237.20
|
| Rate for Payer: PHP Commercial |
$337.68
|
| Rate for Payer: PHP Medicare Advantage |
$237.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.23
|
| Rate for Payer: Priority Health Medicare |
$237.20
|
| Rate for Payer: Priority Health SBD |
$250.28
|
| Rate for Payer: Railroad Medicare Medicare |
$237.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$667.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$237.20
|
| Rate for Payer: UHC Medicare Advantage |
$237.20
|
| Rate for Payer: UHCCP Medicaid |
$133.54
|
| Rate for Payer: VA VA |
$237.20
|
|
|
HC COMPLEX CYSTOMETROGRAM
|
Facility
|
IP
|
$397.27
|
|
|
Service Code
|
CPT 51726
|
| Hospital Charge Code |
76100190
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.28 |
| Max. Negotiated Rate |
$357.54 |
| Rate for Payer: Aetna Commercial |
$337.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.23
|
| Rate for Payer: Cash Price |
$317.82
|
| Rate for Payer: Cofinity Commercial |
$278.09
|
| Rate for Payer: Cofinity Commercial |
$341.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$278.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.82
|
| Rate for Payer: Healthscope Commercial |
$357.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.68
|
| Rate for Payer: PHP Commercial |
$337.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.23
|
| Rate for Payer: Priority Health SBD |
$250.28
|
|
|
HC COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE
|
Facility
|
OP
|
$877.06
|
|
|
Service Code
|
CPT 51727
|
| Hospital Charge Code |
76100220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$348.92 |
| Max. Negotiated Rate |
$1,832.42 |
| Rate for Payer: Aetna Commercial |
$745.50
|
| Rate for Payer: Aetna Medicare |
$677.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$570.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$813.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$813.71
|
| Rate for Payer: BCBS Complete |
$366.37
|
| Rate for Payer: BCBS MAPPO |
$650.97
|
| Rate for Payer: BCN Medicare Advantage |
$650.97
|
| Rate for Payer: Cash Price |
$701.65
|
| Rate for Payer: Cash Price |
$701.65
|
| Rate for Payer: Cofinity Commercial |
$754.27
|
| Rate for Payer: Cofinity Commercial |
$613.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$613.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$701.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$650.97
|
| Rate for Payer: Healthscope Commercial |
$789.35
|
| Rate for Payer: Mclaren Medicaid |
$348.92
|
| Rate for Payer: Mclaren Medicare |
$650.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$683.52
|
| Rate for Payer: Meridian Medicaid |
$366.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$748.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$745.50
|
| Rate for Payer: PACE Medicare |
$618.42
|
| Rate for Payer: PACE SWMI |
$650.97
|
| Rate for Payer: PHP Commercial |
$745.50
|
| Rate for Payer: PHP Medicare Advantage |
$650.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$570.09
|
| Rate for Payer: Priority Health Medicare |
$650.97
|
| Rate for Payer: Priority Health SBD |
$552.55
|
| Rate for Payer: Railroad Medicare Medicare |
$650.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,832.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$650.97
|
| Rate for Payer: UHC Medicare Advantage |
$650.97
|
| Rate for Payer: UHCCP Medicaid |
$366.50
|
| Rate for Payer: VA VA |
$650.97
|
|
|
HC COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE
|
Facility
|
IP
|
$877.06
|
|
|
Service Code
|
CPT 51727
|
| Hospital Charge Code |
76100220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$552.55 |
| Max. Negotiated Rate |
$789.35 |
| Rate for Payer: Aetna Commercial |
$745.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$570.09
|
| Rate for Payer: Cash Price |
$701.65
|
| Rate for Payer: Cofinity Commercial |
$613.94
|
| Rate for Payer: Cofinity Commercial |
$754.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$613.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$701.65
|
| Rate for Payer: Healthscope Commercial |
$789.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$745.50
|
| Rate for Payer: PHP Commercial |
$745.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$570.09
|
| Rate for Payer: Priority Health SBD |
$552.55
|
|
|
HC COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES
|
Facility
|
IP
|
$877.46
|
|
|
Service Code
|
CPT 51728
|
| Hospital Charge Code |
76100191
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$552.80 |
| Max. Negotiated Rate |
$789.71 |
| Rate for Payer: Aetna Commercial |
$745.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$570.35
|
| Rate for Payer: Cash Price |
$701.97
|
| Rate for Payer: Cofinity Commercial |
$614.22
|
| Rate for Payer: Cofinity Commercial |
$754.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$614.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$701.97
|
| Rate for Payer: Healthscope Commercial |
$789.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$745.84
|
| Rate for Payer: PHP Commercial |
$745.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$570.35
|
| Rate for Payer: Priority Health SBD |
$552.80
|
|
|
HC COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES
|
Facility
|
OP
|
$877.46
|
|
|
Service Code
|
CPT 51728
|
| Hospital Charge Code |
76100191
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$348.92 |
| Max. Negotiated Rate |
$1,832.42 |
| Rate for Payer: Aetna Commercial |
$745.84
|
| Rate for Payer: Aetna Medicare |
$677.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$570.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$813.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$813.71
|
| Rate for Payer: BCBS Complete |
$366.37
|
| Rate for Payer: BCBS MAPPO |
$650.97
|
| Rate for Payer: BCN Medicare Advantage |
$650.97
|
| Rate for Payer: Cash Price |
$701.97
|
| Rate for Payer: Cash Price |
$701.97
|
| Rate for Payer: Cofinity Commercial |
$754.62
|
| Rate for Payer: Cofinity Commercial |
$614.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$614.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$701.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$650.97
|
| Rate for Payer: Healthscope Commercial |
$789.71
|
| Rate for Payer: Mclaren Medicaid |
$348.92
|
| Rate for Payer: Mclaren Medicare |
$650.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$683.52
|
| Rate for Payer: Meridian Medicaid |
$366.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$748.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$745.84
|
| Rate for Payer: PACE Medicare |
$618.42
|
| Rate for Payer: PACE SWMI |
$650.97
|
| Rate for Payer: PHP Commercial |
$745.84
|
| Rate for Payer: PHP Medicare Advantage |
$650.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$570.35
|
| Rate for Payer: Priority Health Medicare |
$650.97
|
| Rate for Payer: Priority Health SBD |
$552.80
|
| Rate for Payer: Railroad Medicare Medicare |
$650.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,832.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$650.97
|
| Rate for Payer: UHC Medicare Advantage |
$650.97
|
| Rate for Payer: UHCCP Medicaid |
$366.50
|
| Rate for Payer: VA VA |
$650.97
|
|
|
HC COMPLEX MULTILAYER COMP DSG
|
Facility
|
IP
|
$810.90
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
76100024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$510.87 |
| Max. Negotiated Rate |
$729.81 |
| Rate for Payer: Aetna Commercial |
$689.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$527.09
|
| Rate for Payer: Cash Price |
$648.72
|
| Rate for Payer: Cofinity Commercial |
$567.63
|
| Rate for Payer: Cofinity Commercial |
$697.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$567.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$648.72
|
| Rate for Payer: Healthscope Commercial |
$729.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$689.26
|
| Rate for Payer: PHP Commercial |
$689.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$527.09
|
| Rate for Payer: Priority Health SBD |
$510.87
|
|
|
HC COMPLEX MULTILAYER COMP DSG
|
Facility
|
OP
|
$810.90
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
76100024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.49 |
| Max. Negotiated Rate |
$729.81 |
| Rate for Payer: Aetna Commercial |
$689.26
|
| Rate for Payer: Aetna Medicare |
$160.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$527.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$192.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$192.36
|
| Rate for Payer: BCBS Complete |
$86.61
|
| Rate for Payer: BCBS MAPPO |
$153.89
|
| Rate for Payer: BCN Medicare Advantage |
$153.89
|
| Rate for Payer: Cash Price |
$648.72
|
| Rate for Payer: Cash Price |
$648.72
|
| Rate for Payer: Cofinity Commercial |
$697.37
|
| Rate for Payer: Cofinity Commercial |
$567.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$567.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$648.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.89
|
| Rate for Payer: Healthscope Commercial |
$729.81
|
| Rate for Payer: Mclaren Medicaid |
$82.49
|
| Rate for Payer: Mclaren Medicare |
$153.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.58
|
| Rate for Payer: Meridian Medicaid |
$86.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$689.26
|
| Rate for Payer: PACE Medicare |
$146.20
|
| Rate for Payer: PACE SWMI |
$153.89
|
| Rate for Payer: PHP Commercial |
$689.26
|
| Rate for Payer: PHP Medicare Advantage |
$153.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$527.09
|
| Rate for Payer: Priority Health Medicare |
$153.89
|
| Rate for Payer: Priority Health SBD |
$510.87
|
| Rate for Payer: Railroad Medicare Medicare |
$153.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$433.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.89
|
| Rate for Payer: UHC Medicare Advantage |
$153.89
|
| Rate for Payer: UHCCP Medicaid |
$86.64
|
| Rate for Payer: VA VA |
$153.89
|
|
|
HC COMPLEX UROFLOWMETRY
|
Facility
|
OP
|
$233.39
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
76100192
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$147.04 |
| Max. Negotiated Rate |
$854.89 |
| Rate for Payer: Aetna Commercial |
$198.38
|
| Rate for Payer: Aetna Medicare |
$315.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$186.71
|
| Rate for Payer: Cash Price |
$186.71
|
| Rate for Payer: Cofinity Commercial |
$200.72
|
| Rate for Payer: Cofinity Commercial |
$163.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$163.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$210.05
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.38
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$198.38
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.70
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health SBD |
$147.04
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$170.98
|
| Rate for Payer: VA VA |
$303.70
|
|
|
HC COMPLEX UROFLOWMETRY
|
Facility
|
IP
|
$233.39
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
76100192
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$147.04 |
| Max. Negotiated Rate |
$210.05 |
| Rate for Payer: Aetna Commercial |
$198.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.70
|
| Rate for Payer: Cash Price |
$186.71
|
| Rate for Payer: Cofinity Commercial |
$163.37
|
| Rate for Payer: Cofinity Commercial |
$200.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$163.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.71
|
| Rate for Payer: Healthscope Commercial |
$210.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.38
|
| Rate for Payer: PHP Commercial |
$198.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.70
|
| Rate for Payer: Priority Health SBD |
$147.04
|
|
|
HC COMP METABOLIC PANEL
|
Facility
|
OP
|
$39.17
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
30100013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.66 |
| Max. Negotiated Rate |
$35.25 |
| Rate for Payer: Aetna Commercial |
$33.29
|
| Rate for Payer: Aetna Medicare |
$10.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.46
|
| 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 |
$5.94
|
| Rate for Payer: BCBS MAPPO |
$10.56
|
| Rate for Payer: BCN Medicare Advantage |
$10.56
|
| Rate for Payer: Cash Price |
$31.34
|
| Rate for Payer: Cash Price |
$31.34
|
| Rate for Payer: Cofinity Commercial |
$33.69
|
| Rate for Payer: Cofinity Commercial |
$27.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.56
|
| Rate for Payer: Healthscope Commercial |
$35.25
|
| Rate for Payer: Mclaren Medicaid |
$5.66
|
| 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 |
$5.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.29
|
| Rate for Payer: PACE Medicare |
$10.03
|
| Rate for Payer: PACE SWMI |
$10.56
|
| Rate for Payer: PHP Commercial |
$33.29
|
| Rate for Payer: PHP Medicare Advantage |
$10.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.46
|
| Rate for Payer: Priority Health Medicare |
$10.56
|
| Rate for Payer: Priority Health SBD |
$24.68
|
| Rate for Payer: Railroad Medicare Medicare |
$10.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.56
|
| Rate for Payer: UHC Medicare Advantage |
$10.56
|
| Rate for Payer: UHCCP Medicaid |
$5.95
|
| Rate for Payer: VA VA |
$10.56
|
|
|
HC COMP METABOLIC PANEL
|
Facility
|
IP
|
$39.17
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
30100013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.68 |
| Max. Negotiated Rate |
$35.25 |
| Rate for Payer: Aetna Commercial |
$33.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.46
|
| Rate for Payer: Cash Price |
$31.34
|
| Rate for Payer: Cofinity Commercial |
$27.42
|
| Rate for Payer: Cofinity Commercial |
$33.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.34
|
| Rate for Payer: Healthscope Commercial |
$35.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.29
|
| Rate for Payer: PHP Commercial |
$33.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.46
|
| Rate for Payer: Priority Health SBD |
$24.68
|
|
|
HC COMPONENT POOLING
|
Facility
|
OP
|
$124.13
|
|
|
Service Code
|
CPT 86965
|
| Hospital Charge Code |
39000027
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$470.43 |
| Rate for Payer: Aetna Commercial |
$105.51
|
| Rate for Payer: Aetna Medicare |
$173.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$208.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$208.90
|
| Rate for Payer: BCBS Complete |
$94.06
|
| Rate for Payer: BCBS MAPPO |
$167.12
|
| Rate for Payer: BCN Medicare Advantage |
$167.12
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cofinity Commercial |
$86.89
|
| Rate for Payer: Cofinity Commercial |
$106.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.12
|
| Rate for Payer: Healthscope Commercial |
$111.72
|
| Rate for Payer: Mclaren Medicaid |
$89.58
|
| Rate for Payer: Mclaren Medicare |
$167.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.48
|
| Rate for Payer: Meridian Medicaid |
$94.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.51
|
| Rate for Payer: PACE Medicare |
$158.76
|
| Rate for Payer: PACE SWMI |
$167.12
|
| Rate for Payer: PHP Commercial |
$105.51
|
| Rate for Payer: PHP Medicare Advantage |
$167.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.68
|
| Rate for Payer: Priority Health Medicare |
$167.12
|
| Rate for Payer: Priority Health SBD |
$78.20
|
| Rate for Payer: Railroad Medicare Medicare |
$167.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$470.43
|
| Rate for Payer: UHC Core |
$91.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.12
|
| Rate for Payer: UHC Exchange |
$91.86
|
| Rate for Payer: UHC Medicare Advantage |
$167.12
|
| Rate for Payer: UHCCP Medicaid |
$94.09
|
| Rate for Payer: VA VA |
$167.12
|
|
|
HC COMPONENT POOLING
|
Facility
|
IP
|
$124.13
|
|
|
Service Code
|
CPT 86965
|
| Hospital Charge Code |
39000027
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$111.72 |
| Rate for Payer: Aetna Commercial |
$105.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.68
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cofinity Commercial |
$106.75
|
| Rate for Payer: Cofinity Commercial |
$86.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.30
|
| Rate for Payer: Healthscope Commercial |
$111.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.51
|
| Rate for Payer: PHP Commercial |
$105.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.68
|
| Rate for Payer: Priority Health SBD |
$78.20
|
|
|
HC COMPONENT THAWING
|
Facility
|
OP
|
$108.12
|
|
|
Service Code
|
CPT 86927
|
| Hospital Charge Code |
39000025
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$68.12 |
| Max. Negotiated Rate |
$470.43 |
| Rate for Payer: Aetna Commercial |
$91.90
|
| Rate for Payer: Aetna Medicare |
$173.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$208.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$208.90
|
| Rate for Payer: BCBS Complete |
$94.06
|
| Rate for Payer: BCBS MAPPO |
$167.12
|
| Rate for Payer: BCN Medicare Advantage |
$167.12
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cofinity Commercial |
$92.98
|
| Rate for Payer: Cofinity Commercial |
$75.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.12
|
| Rate for Payer: Healthscope Commercial |
$97.31
|
| Rate for Payer: Mclaren Medicaid |
$89.58
|
| Rate for Payer: Mclaren Medicare |
$167.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.48
|
| Rate for Payer: Meridian Medicaid |
$94.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.90
|
| Rate for Payer: PACE Medicare |
$158.76
|
| Rate for Payer: PACE SWMI |
$167.12
|
| Rate for Payer: PHP Commercial |
$91.90
|
| Rate for Payer: PHP Medicare Advantage |
$167.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.28
|
| Rate for Payer: Priority Health Medicare |
$167.12
|
| Rate for Payer: Priority Health SBD |
$68.12
|
| Rate for Payer: Railroad Medicare Medicare |
$167.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$470.43
|
| Rate for Payer: UHC Core |
$80.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.12
|
| Rate for Payer: UHC Exchange |
$80.01
|
| Rate for Payer: UHC Medicare Advantage |
$167.12
|
| Rate for Payer: UHCCP Medicaid |
$94.09
|
| Rate for Payer: VA VA |
$167.12
|
|
|
HC COMPONENT THAWING
|
Facility
|
IP
|
$108.12
|
|
|
Service Code
|
CPT 86927
|
| Hospital Charge Code |
39000025
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$68.12 |
| Max. Negotiated Rate |
$97.31 |
| Rate for Payer: Aetna Commercial |
$91.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.28
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cofinity Commercial |
$75.68
|
| Rate for Payer: Cofinity Commercial |
$92.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.50
|
| Rate for Payer: Healthscope Commercial |
$97.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.90
|
| Rate for Payer: PHP Commercial |
$91.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.28
|
| Rate for Payer: Priority Health SBD |
$68.12
|
|
|
HC COMPREHENSIVE HEARING TEST
|
Facility
|
IP
|
$212.17
|
|
|
Service Code
|
CPT 92557
|
| Hospital Charge Code |
47100012
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$133.67 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Aetna Commercial |
$180.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.91
|
| Rate for Payer: Cash Price |
$169.74
|
| Rate for Payer: Cofinity Commercial |
$148.52
|
| Rate for Payer: Cofinity Commercial |
$182.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.74
|
| Rate for Payer: Healthscope Commercial |
$190.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.34
|
| Rate for Payer: PHP Commercial |
$180.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.91
|
| Rate for Payer: Priority Health SBD |
$133.67
|
|
|
HC COMPREHENSIVE HEARING TEST
|
Facility
|
OP
|
$212.17
|
|
|
Service Code
|
CPT 92557
|
| Hospital Charge Code |
47100012
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$429.53 |
| Rate for Payer: Aetna Commercial |
$180.34
|
| Rate for Payer: Aetna Medicare |
$158.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.74
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$152.59
|
| Rate for Payer: BCN Medicare Advantage |
$152.59
|
| Rate for Payer: Cash Price |
$169.74
|
| Rate for Payer: Cash Price |
$169.74
|
| Rate for Payer: Cofinity Commercial |
$182.47
|
| Rate for Payer: Cofinity Commercial |
$148.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$190.95
|
| Rate for Payer: Mclaren Medicaid |
$81.79
|
| Rate for Payer: Mclaren Medicare |
$152.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.22
|
| Rate for Payer: Meridian Medicaid |
$85.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.34
|
| Rate for Payer: PACE Medicare |
$144.96
|
| Rate for Payer: PACE SWMI |
$152.59
|
| Rate for Payer: PHP Commercial |
$180.34
|
| Rate for Payer: PHP Medicare Advantage |
$152.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.91
|
| Rate for Payer: Priority Health Medicare |
$152.59
|
| Rate for Payer: Priority Health SBD |
$133.67
|
| Rate for Payer: Railroad Medicare Medicare |
$152.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.53
|
| Rate for Payer: UHC Core |
$157.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.59
|
| Rate for Payer: UHC Exchange |
$157.01
|
| Rate for Payer: UHC Medicare Advantage |
$152.59
|
| Rate for Payer: UHCCP Medicaid |
$85.91
|
| Rate for Payer: VA VA |
$152.59
|
|
|
HC COMPRESS BURN GARM GAUNTLET-EL
|
Facility
|
IP
|
$87.72
|
|
|
Service Code
|
HCPCS A6505
|
| Hospital Charge Code |
98300069
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$55.26 |
| Max. Negotiated Rate |
$78.95 |
| Rate for Payer: Aetna Commercial |
$74.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.02
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Cofinity Commercial |
$75.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Healthscope Commercial |
$78.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.56
|
| Rate for Payer: PHP Commercial |
$74.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.02
|
| Rate for Payer: Priority Health SBD |
$55.26
|
|
