|
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 |
$161.06 |
| Max. Negotiated Rate |
$2,055.42 |
| Rate for Payer: Aetna Commercial |
$745.84
|
| Rate for Payer: Aetna Medicare |
$680.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$570.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$817.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$817.46
|
| Rate for Payer: BCBS Complete |
$368.05
|
| Rate for Payer: BCBS MAPPO |
$653.97
|
| Rate for Payer: BCBS Trust/PPO |
$161.06
|
| Rate for Payer: BCN Commercial |
$161.06
|
| Rate for Payer: BCN Medicare Advantage |
$653.97
|
| Rate for Payer: Cash Price |
$701.97
|
| 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 |
$653.97
|
| Rate for Payer: Healthscope Commercial |
$789.71
|
| Rate for Payer: Mclaren Medicaid |
$350.53
|
| Rate for Payer: Mclaren Medicare |
$653.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$686.67
|
| Rate for Payer: Meridian Medicaid |
$368.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$752.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$745.84
|
| Rate for Payer: Nomi Health Commercial |
$1,373.34
|
| Rate for Payer: PACE Medicare |
$621.27
|
| Rate for Payer: PACE SWMI |
$653.97
|
| Rate for Payer: PHP Commercial |
$745.84
|
| Rate for Payer: PHP Medicare Advantage |
$653.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$350.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$570.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,055.42
|
| Rate for Payer: Priority Health Medicare |
$653.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,644.34
|
| Rate for Payer: Priority Health SBD |
$552.80
|
| Rate for Payer: Railroad Medicare Medicare |
$653.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$366.74
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$653.97
|
| Rate for Payer: UHC Medicare Advantage |
$653.97
|
| Rate for Payer: UHCCP Medicaid |
$368.19
|
| Rate for Payer: VA VA |
$653.97
|
|
|
HC COMPLEX MULTILAYER COMP DSG
|
Facility
|
OP
|
$810.90
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
76100024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.94 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$689.26
|
| Rate for Payer: Aetna Medicare |
$160.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$527.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$193.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$193.25
|
| Rate for Payer: BCBS Complete |
$87.01
|
| Rate for Payer: BCBS MAPPO |
$154.60
|
| Rate for Payer: BCBS Trust/PPO |
$87.88
|
| Rate for Payer: BCN Commercial |
$87.88
|
| Rate for Payer: BCN Medicare Advantage |
$154.60
|
| Rate for Payer: Cash Price |
$648.72
|
| 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 |
$154.60
|
| Rate for Payer: Healthscope Commercial |
$729.81
|
| Rate for Payer: Mclaren Medicaid |
$82.87
|
| Rate for Payer: Mclaren Medicare |
$154.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.33
|
| Rate for Payer: Meridian Medicaid |
$87.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$689.26
|
| Rate for Payer: Nomi Health Commercial |
$324.66
|
| Rate for Payer: PACE Medicare |
$146.87
|
| Rate for Payer: PACE SWMI |
$154.60
|
| Rate for Payer: PHP Commercial |
$689.26
|
| Rate for Payer: PHP Medicare Advantage |
$154.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$527.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$485.91
|
| Rate for Payer: Priority Health Medicare |
$154.60
|
| Rate for Payer: Priority Health Narrow Network |
$388.73
|
| Rate for Payer: Priority Health SBD |
$510.87
|
| Rate for Payer: Railroad Medicare Medicare |
$154.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.94
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$154.60
|
| Rate for Payer: UHC Medicare Advantage |
$154.60
|
| Rate for Payer: UHCCP Medicaid |
$87.04
|
| Rate for Payer: VA VA |
$154.60
|
|
|
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) |
$527.08
|
| 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 |
$527.08
|
| Rate for Payer: Priority Health SBD |
$510.87
|
|
|
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 COMPLEX UROFLOWMETRY
|
Facility
|
OP
|
$233.39
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
76100192
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$14.94 |
| Max. Negotiated Rate |
$958.92 |
| Rate for Payer: Aetna Commercial |
$198.38
|
| Rate for Payer: Aetna Medicare |
$317.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.38
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$73.71
|
| Rate for Payer: BCN Commercial |
$73.71
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| Rate for Payer: Cash Price |
$186.71
|
| Rate for Payer: Cash Price |
$186.71
|
| 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: Health Alliance Plan Medicare Advantage |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$210.05
|
| Rate for Payer: Mclaren Medicaid |
$163.53
|
| Rate for Payer: Mclaren Medicare |
$305.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.36
|
| Rate for Payer: Meridian Medicaid |
$171.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.38
|
| Rate for Payer: Nomi Health Commercial |
$915.30
|
| Rate for Payer: PACE Medicare |
$289.84
|
| Rate for Payer: PACE SWMI |
$305.10
|
| Rate for Payer: PHP Commercial |
$198.38
|
| Rate for Payer: PHP Medicare Advantage |
$305.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$958.92
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$767.14
|
| Rate for Payer: Priority Health SBD |
$147.04
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.94
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.10
|
| Rate for Payer: UHC Medicare Advantage |
$305.10
|
| Rate for Payer: UHCCP Medicaid |
$171.77
|
| Rate for Payer: VA VA |
$305.10
|
|
|
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 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: BCBS Trust/PPO |
$17.93
|
| Rate for Payer: BCN Commercial |
$17.93
|
| 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: Nomi Health Commercial |
$15.84
|
| 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 HMO/PPO/Tiered Network |
$10.70
|
| Rate for Payer: Priority Health Medicare |
$10.56
|
| Rate for Payer: Priority Health Narrow Network |
$8.56
|
| Rate for Payer: Priority Health SBD |
$24.68
|
| Rate for Payer: Railroad Medicare Medicare |
$10.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.67
|
| 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 COMPONENT POOLING
|
Facility
|
OP
|
$124.13
|
|
|
Service Code
|
CPT 86965
|
| Hospital Charge Code |
39000027
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$10.85 |
| Max. Negotiated Rate |
$527.71 |
| Rate for Payer: Aetna Commercial |
$105.51
|
| Rate for Payer: Aetna Medicare |
$174.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$209.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$209.88
|
| Rate for Payer: BCBS Complete |
$94.49
|
| Rate for Payer: BCBS MAPPO |
$167.90
|
| Rate for Payer: BCBS Trust/PPO |
$10.85
|
| Rate for Payer: BCN Commercial |
$10.85
|
| Rate for Payer: BCN Medicare Advantage |
$167.90
|
| 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 |
$167.90
|
| Rate for Payer: Healthscope Commercial |
$111.72
|
| Rate for Payer: Mclaren Medicaid |
$89.99
|
| Rate for Payer: Mclaren Medicare |
$167.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.30
|
| Rate for Payer: Meridian Medicaid |
$94.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.51
|
| Rate for Payer: Nomi Health Commercial |
$503.70
|
| Rate for Payer: PACE Medicare |
$159.50
|
| Rate for Payer: PACE SWMI |
$167.90
|
| Rate for Payer: PHP Commercial |
$105.51
|
| Rate for Payer: PHP Medicare Advantage |
$167.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$527.71
|
| Rate for Payer: Priority Health Medicare |
$167.90
|
| Rate for Payer: Priority Health Narrow Network |
$422.17
|
| Rate for Payer: Priority Health SBD |
$78.20
|
| Rate for Payer: Railroad Medicare Medicare |
$167.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$472.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.90
|
| Rate for Payer: UHC Exchange |
$91.86
|
| Rate for Payer: UHC Medicare Advantage |
$167.90
|
| Rate for Payer: UHCCP Medicaid |
$94.53
|
| Rate for Payer: VA VA |
$167.90
|
|
|
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
|
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 COMPONENT THAWING
|
Facility
|
OP
|
$108.12
|
|
|
Service Code
|
CPT 86927
|
| Hospital Charge Code |
39000025
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$527.71 |
| Rate for Payer: Aetna Commercial |
$91.90
|
| Rate for Payer: Aetna Medicare |
$174.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$209.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$209.88
|
| Rate for Payer: BCBS Complete |
$94.49
|
| Rate for Payer: BCBS MAPPO |
$167.90
|
| Rate for Payer: BCBS Trust/PPO |
$2.89
|
| Rate for Payer: BCN Commercial |
$2.89
|
| Rate for Payer: BCN Medicare Advantage |
$167.90
|
| 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 |
$167.90
|
| Rate for Payer: Healthscope Commercial |
$97.31
|
| Rate for Payer: Mclaren Medicaid |
$89.99
|
| Rate for Payer: Mclaren Medicare |
$167.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.30
|
| Rate for Payer: Meridian Medicaid |
$94.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.90
|
| Rate for Payer: Nomi Health Commercial |
$503.70
|
| Rate for Payer: PACE Medicare |
$159.50
|
| Rate for Payer: PACE SWMI |
$167.90
|
| Rate for Payer: PHP Commercial |
$91.90
|
| Rate for Payer: PHP Medicare Advantage |
$167.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$527.71
|
| Rate for Payer: Priority Health Medicare |
$167.90
|
| Rate for Payer: Priority Health Narrow Network |
$422.17
|
| Rate for Payer: Priority Health SBD |
$68.12
|
| Rate for Payer: Railroad Medicare Medicare |
$167.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$472.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.90
|
| Rate for Payer: UHC Exchange |
$80.01
|
| Rate for Payer: UHC Medicare Advantage |
$167.90
|
| Rate for Payer: UHCCP Medicaid |
$94.53
|
| Rate for Payer: VA VA |
$167.90
|
|
|
HC COMPREHENSIVE HEARING TEST
|
Facility
|
OP
|
$212.17
|
|
|
Service Code
|
CPT 92557
|
| Hospital Charge Code |
47100012
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$32.96 |
| Max. Negotiated Rate |
$481.80 |
| Rate for Payer: Aetna Commercial |
$180.34
|
| Rate for Payer: Aetna Medicare |
$159.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.62
|
| Rate for Payer: BCBS Complete |
$86.28
|
| Rate for Payer: BCBS MAPPO |
$153.30
|
| Rate for Payer: BCBS Trust/PPO |
$69.40
|
| Rate for Payer: BCN Commercial |
$69.40
|
| Rate for Payer: BCN Medicare Advantage |
$153.30
|
| 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 |
$153.30
|
| Rate for Payer: Healthscope Commercial |
$190.95
|
| Rate for Payer: Mclaren Medicaid |
$82.17
|
| Rate for Payer: Mclaren Medicare |
$153.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.96
|
| Rate for Payer: Meridian Medicaid |
$86.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.34
|
| Rate for Payer: Nomi Health Commercial |
$459.90
|
| Rate for Payer: PACE Medicare |
$145.64
|
| Rate for Payer: PACE SWMI |
$153.30
|
| Rate for Payer: PHP Commercial |
$180.34
|
| Rate for Payer: PHP Medicare Advantage |
$153.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$481.80
|
| Rate for Payer: Priority Health Medicare |
$153.30
|
| Rate for Payer: Priority Health Narrow Network |
$385.44
|
| Rate for Payer: Priority Health SBD |
$133.67
|
| Rate for Payer: Railroad Medicare Medicare |
$153.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.30
|
| Rate for Payer: UHC Exchange |
$157.01
|
| Rate for Payer: UHC Medicare Advantage |
$153.30
|
| Rate for Payer: UHCCP Medicaid |
$86.31
|
| Rate for Payer: VA VA |
$153.30
|
|
|
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 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
|
|
|
HC COMPRESS BURN GARM GAUNTLET-EL
|
Facility
|
OP
|
$87.72
|
|
|
Service Code
|
HCPCS A6505
|
| Hospital Charge Code |
98300069
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$399.24 |
| Rate for Payer: Aetna Commercial |
$74.56
|
| Rate for Payer: Aetna Medicare |
$43.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.02
|
| Rate for Payer: BCBS Complete |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$399.24
|
| Rate for Payer: BCN Commercial |
$399.24
|
| Rate for Payer: Cash Price |
$70.18
|
| 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
|
|
|
HC CONDITIONING PLAY AUDIOMETRY
|
Facility
|
OP
|
$148.92
|
|
|
Service Code
|
CPT 92582
|
| Hospital Charge Code |
76100512
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$481.80 |
| Rate for Payer: Aetna Commercial |
$126.58
|
| Rate for Payer: Aetna Medicare |
$159.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.62
|
| Rate for Payer: BCBS Complete |
$86.28
|
| Rate for Payer: BCBS MAPPO |
$153.30
|
| Rate for Payer: BCBS Trust/PPO |
$382.44
|
| Rate for Payer: BCN Commercial |
$382.44
|
| Rate for Payer: BCN Medicare Advantage |
$153.30
|
| Rate for Payer: Cash Price |
$119.14
|
| Rate for Payer: Cash Price |
$119.14
|
| Rate for Payer: Cofinity Commercial |
$128.07
|
| Rate for Payer: Cofinity Commercial |
$104.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.30
|
| Rate for Payer: Healthscope Commercial |
$134.03
|
| Rate for Payer: Mclaren Medicaid |
$82.17
|
| Rate for Payer: Mclaren Medicare |
$153.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.96
|
| Rate for Payer: Meridian Medicaid |
$86.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.58
|
| Rate for Payer: Nomi Health Commercial |
$459.90
|
| Rate for Payer: PACE Medicare |
$145.64
|
| Rate for Payer: PACE SWMI |
$153.30
|
| Rate for Payer: PHP Commercial |
$126.58
|
| Rate for Payer: PHP Medicare Advantage |
$153.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$481.80
|
| Rate for Payer: Priority Health Medicare |
$153.30
|
| Rate for Payer: Priority Health Narrow Network |
$385.44
|
| Rate for Payer: Priority Health SBD |
$93.82
|
| Rate for Payer: Railroad Medicare Medicare |
$153.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.30
|
| Rate for Payer: UHC Exchange |
$110.20
|
| Rate for Payer: UHC Medicare Advantage |
$153.30
|
| Rate for Payer: UHCCP Medicaid |
$86.31
|
| Rate for Payer: VA VA |
$153.30
|
|
|
HC CONDITIONING PLAY AUDIOMETRY
|
Facility
|
IP
|
$148.92
|
|
|
Service Code
|
CPT 92582
|
| Hospital Charge Code |
76100512
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$93.82 |
| Max. Negotiated Rate |
$134.03 |
| Rate for Payer: Aetna Commercial |
$126.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.80
|
| Rate for Payer: Cash Price |
$119.14
|
| Rate for Payer: Cofinity Commercial |
$104.24
|
| Rate for Payer: Cofinity Commercial |
$128.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.14
|
| Rate for Payer: Healthscope Commercial |
$134.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.58
|
| Rate for Payer: PHP Commercial |
$126.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.80
|
| Rate for Payer: Priority Health SBD |
$93.82
|
|
|
HC CONFIRMED DRUG ABUSE PANEL 9 U
|
Facility
|
OP
|
$104.04
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100643
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: BCBS Complete |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$55.01
|
| Rate for Payer: BCN Commercial |
$55.01
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Cofinity Commercial |
$72.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Mclaren Medicaid |
$33.31
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: Nomi Health Commercial |
$93.21
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.14
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$49.71
|
| Rate for Payer: Priority Health SBD |
$65.55
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$34.98
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC CONFIRMED DRUG ABUSE PANEL 9 U
|
Facility
|
IP
|
$104.04
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100643
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$65.55 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.63
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$72.83
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.63
|
| Rate for Payer: Priority Health SBD |
$65.55
|
|
|
HC CONIZ CERVIX W/WO D&C RPR ELTRD EXC
|
Facility
|
IP
|
$7,945.53
|
|
|
Service Code
|
CPT 57522
|
| Hospital Charge Code |
76100334
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,005.68 |
| Max. Negotiated Rate |
$7,150.98 |
| Rate for Payer: Aetna Commercial |
$6,753.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,164.59
|
| Rate for Payer: Cash Price |
$6,356.42
|
| Rate for Payer: Cofinity Commercial |
$5,561.87
|
| Rate for Payer: Cofinity Commercial |
$6,833.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,561.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,356.42
|
| Rate for Payer: Healthscope Commercial |
$7,150.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,753.70
|
| Rate for Payer: PHP Commercial |
$6,753.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,164.59
|
| Rate for Payer: Priority Health SBD |
$5,005.68
|
|
|
HC CONIZ CERVIX W/WO D&C RPR ELTRD EXC
|
Facility
|
OP
|
$7,945.53
|
|
|
Service Code
|
CPT 57522
|
| Hospital Charge Code |
76100334
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.49 |
| Max. Negotiated Rate |
$9,791.14 |
| Rate for Payer: Aetna Commercial |
$6,753.70
|
| Rate for Payer: Aetna Medicare |
$3,239.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,164.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,324.88
|
| Rate for Payer: BCCCP Commercial |
$293.81
|
| Rate for Payer: BCN Commercial |
$1,324.88
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Cash Price |
$6,356.42
|
| Rate for Payer: Cash Price |
$6,356.42
|
| Rate for Payer: Cash Price |
$6,356.42
|
| Rate for Payer: Cofinity Commercial |
$6,833.16
|
| Rate for Payer: Cofinity Commercial |
$5,561.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,561.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,356.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Healthscope Commercial |
$7,150.98
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,753.70
|
| Rate for Payer: Nomi Health Commercial |
$6,542.00
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Commercial |
$6,753.70
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,164.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,791.14
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,832.91
|
| Rate for Payer: Priority Health SBD |
$5,005.68
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.49
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,753.88
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
HC CONNECTIVE TISSUE CASCADE ANA & CCP
|
Facility
|
OP
|
$31.83
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
30200156
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: Aetna Medicare |
$13.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.19
|
| Rate for Payer: BCBS Complete |
$7.29
|
| Rate for Payer: BCBS MAPPO |
$12.95
|
| Rate for Payer: BCBS Trust/PPO |
$11.46
|
| Rate for Payer: BCN Commercial |
$11.46
|
| Rate for Payer: BCN Medicare Advantage |
$12.95
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$27.37
|
| Rate for Payer: Cofinity Commercial |
$22.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.95
|
| Rate for Payer: Healthscope Commercial |
$28.65
|
| Rate for Payer: Mclaren Medicaid |
$6.94
|
| Rate for Payer: Mclaren Medicare |
$12.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.60
|
| Rate for Payer: Meridian Medicaid |
$7.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Nomi Health Commercial |
$19.42
|
| Rate for Payer: PACE Medicare |
$12.30
|
| Rate for Payer: PACE SWMI |
$12.95
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: PHP Medicare Advantage |
$12.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.32
|
| Rate for Payer: Priority Health Medicare |
$12.95
|
| Rate for Payer: Priority Health Narrow Network |
$10.66
|
| Rate for Payer: Priority Health SBD |
$20.05
|
| Rate for Payer: Railroad Medicare Medicare |
$12.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.95
|
| Rate for Payer: UHC Medicare Advantage |
$12.95
|
| Rate for Payer: UHCCP Medicaid |
$7.29
|
| Rate for Payer: VA VA |
$12.95
|
|
|
HC CONNECTIVE TISSUE CASCADE ANA & CCP
|
Facility
|
IP
|
$31.83
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
30200156
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.69
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$22.28
|
| Rate for Payer: Cofinity Commercial |
$27.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Healthscope Commercial |
$28.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.69
|
| Rate for Payer: Priority Health SBD |
$20.05
|
|
