|
HC ETHOSUXIMIDE/ZARONTIN LEVEL
|
Facility
|
OP
|
$58.26
|
|
|
Service Code
|
CPT 80168
|
| Hospital Charge Code |
30100029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.55 |
| Max. Negotiated Rate |
$52.43 |
| Rate for Payer: Aetna Commercial |
$49.52
|
| Rate for Payer: Aetna Medicare |
$16.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.43
|
| Rate for Payer: BCBS Complete |
$8.97
|
| Rate for Payer: BCBS MAPPO |
$16.34
|
| Rate for Payer: BCBS Trust/PPO |
$17.43
|
| Rate for Payer: BCN Commercial |
$17.43
|
| Rate for Payer: BCN Medicare Advantage |
$16.34
|
| Rate for Payer: Cash Price |
$46.61
|
| Rate for Payer: Cash Price |
$46.61
|
| Rate for Payer: Cofinity Advantage |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$50.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.34
|
| Rate for Payer: Healthscope Commercial |
$52.43
|
| Rate for Payer: Mclaren Medicaid |
$8.55
|
| Rate for Payer: Mclaren Medicare |
$16.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.16
|
| Rate for Payer: Meridian Medicaid |
$17.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.52
|
| Rate for Payer: Nomi Health Commercial |
$24.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.70
|
| Rate for Payer: PACE Medicare |
$15.52
|
| Rate for Payer: PACE SWMI |
$16.34
|
| Rate for Payer: PHP Commercial |
$49.52
|
| Rate for Payer: PHP Medicare Advantage |
$16.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16.34
|
| Rate for Payer: Priority Health Medicare |
$16.34
|
| Rate for Payer: Priority Health SBD |
$36.70
|
| Rate for Payer: Priority Health Tiered Network |
$13.07
|
| Rate for Payer: Railroad Medicare Medicare |
$16.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.51
|
| Rate for Payer: UHC Core |
$24.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.34
|
| Rate for Payer: UHC Exchange |
$24.51
|
| Rate for Payer: UHC Medicaid |
$8.55
|
| Rate for Payer: UHCCP Medicaid |
$8.55
|
| Rate for Payer: VA VA |
$16.34
|
|
|
HC ETHOSUXIMIDE/ZARONTIN LEVEL
|
Facility
|
IP
|
$58.26
|
|
|
Service Code
|
CPT 80168
|
| Hospital Charge Code |
30100029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.70 |
| Max. Negotiated Rate |
$52.43 |
| Rate for Payer: Aetna Commercial |
$49.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.87
|
| Rate for Payer: Cash Price |
$46.61
|
| Rate for Payer: Cofinity Advantage |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$50.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.61
|
| Rate for Payer: Healthscope Commercial |
$52.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.70
|
| Rate for Payer: PHP Commercial |
$49.52
|
| Rate for Payer: Priority Health SBD |
$36.70
|
|
|
HC ETHYLENE GLYCOL
|
Facility
|
IP
|
$167.50
|
|
|
Service Code
|
CPT 82693
|
| Hospital Charge Code |
30100197
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$105.53 |
| Max. Negotiated Rate |
$150.75 |
| Rate for Payer: Aetna Commercial |
$142.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.88
|
| Rate for Payer: Cash Price |
$134.00
|
| Rate for Payer: Cofinity Advantage |
$117.25
|
| Rate for Payer: Cofinity Commercial |
$144.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.00
|
| Rate for Payer: Healthscope Commercial |
$150.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.62
|
| Rate for Payer: PHP Commercial |
$142.38
|
| Rate for Payer: Priority Health SBD |
$105.53
|
|
|
HC ETHYLENE GLYCOL
|
Facility
|
OP
|
$167.50
|
|
|
Service Code
|
CPT 82693
|
| Hospital Charge Code |
30100197
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.79 |
| Max. Negotiated Rate |
$150.75 |
| Rate for Payer: Aetna Commercial |
$142.38
|
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.62
|
| Rate for Payer: BCBS Complete |
$8.18
|
| Rate for Payer: BCBS MAPPO |
$14.90
|
| Rate for Payer: BCBS Trust/PPO |
$15.89
|
| Rate for Payer: BCN Commercial |
$15.89
|
| Rate for Payer: BCN Medicare Advantage |
$14.90
|
| Rate for Payer: Cash Price |
$134.00
|
| Rate for Payer: Cash Price |
$134.00
|
| Rate for Payer: Cofinity Advantage |
$117.25
|
| Rate for Payer: Cofinity Commercial |
$144.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.90
|
| Rate for Payer: Healthscope Commercial |
$150.75
|
| Rate for Payer: Mclaren Medicaid |
$7.79
|
| Rate for Payer: Mclaren Medicare |
$14.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.64
|
| Rate for Payer: Meridian Medicaid |
$15.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.38
|
| Rate for Payer: Nomi Health Commercial |
$22.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.62
|
| Rate for Payer: PACE Medicare |
$14.15
|
| Rate for Payer: PACE SWMI |
$14.90
|
| Rate for Payer: PHP Commercial |
$142.38
|
| Rate for Payer: PHP Medicare Advantage |
$14.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.90
|
| Rate for Payer: Priority Health Medicare |
$14.90
|
| Rate for Payer: Priority Health SBD |
$105.53
|
| Rate for Payer: Priority Health Tiered Network |
$11.92
|
| Rate for Payer: Railroad Medicare Medicare |
$14.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.35
|
| Rate for Payer: UHC Core |
$22.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.90
|
| Rate for Payer: UHC Exchange |
$22.35
|
| Rate for Payer: UHC Medicaid |
$7.79
|
| Rate for Payer: UHCCP Medicaid |
$7.79
|
| Rate for Payer: VA VA |
$14.90
|
|
|
HC ETHYL GLUCURONIDE SCREEN W/REFLEX, URINE
|
Facility
|
OP
|
$130.99
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100749
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$117.89 |
| Rate for Payer: Aetna Commercial |
$111.34
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: BCBS Complete |
$34.13
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$66.26
|
| Rate for Payer: BCN Commercial |
$66.26
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$104.79
|
| Rate for Payer: Cash Price |
$104.79
|
| Rate for Payer: Cofinity Advantage |
$91.69
|
| Rate for Payer: Cofinity Commercial |
$112.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$117.89
|
| Rate for Payer: Mclaren Medicaid |
$32.50
|
| 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 |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.34
|
| Rate for Payer: Nomi Health Commercial |
$93.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.24
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$111.34
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$62.14
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$82.52
|
| Rate for Payer: Priority Health Tiered Network |
$49.71
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.21
|
| Rate for Payer: UHC Core |
$93.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$62.14
|
| Rate for Payer: UHC Exchange |
$93.21
|
| Rate for Payer: UHC Medicaid |
$32.50
|
| Rate for Payer: UHCCP Medicaid |
$32.50
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC ETHYL GLUCURONIDE SCREEN W/REFLEX, URINE
|
Facility
|
IP
|
$130.99
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100749
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$82.52 |
| Max. Negotiated Rate |
$117.89 |
| Rate for Payer: Aetna Commercial |
$111.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.14
|
| Rate for Payer: Cash Price |
$104.79
|
| Rate for Payer: Cofinity Advantage |
$91.69
|
| Rate for Payer: Cofinity Commercial |
$112.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.79
|
| Rate for Payer: Healthscope Commercial |
$117.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.24
|
| Rate for Payer: PHP Commercial |
$111.34
|
| Rate for Payer: Priority Health SBD |
$82.52
|
|
|
HC ETONOGESTREL IMPLANT SYSTEM
|
Facility
|
OP
|
$1,577.34
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
63600148
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$630.94 |
| Max. Negotiated Rate |
$3,190.80 |
| Rate for Payer: Aetna Commercial |
$1,340.74
|
| Rate for Payer: Aetna Medicare |
$788.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,025.27
|
| Rate for Payer: BCBS Complete |
$630.94
|
| Rate for Payer: BCBS Trust/PPO |
$3,190.80
|
| Rate for Payer: BCN Commercial |
$3,190.80
|
| Rate for Payer: Cash Price |
$1,261.87
|
| Rate for Payer: Cash Price |
$1,261.87
|
| Rate for Payer: Cofinity Advantage |
$1,104.14
|
| Rate for Payer: Cofinity Commercial |
$1,356.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.87
|
| Rate for Payer: Healthscope Commercial |
$1,419.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,261.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,183.01
|
| Rate for Payer: PHP Commercial |
$1,340.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,287.51
|
| Rate for Payer: Priority Health SBD |
$993.72
|
| Rate for Payer: Priority Health Tiered Network |
$1,030.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,525.21
|
| Rate for Payer: UHC Core |
$2,525.21
|
| Rate for Payer: UHC Exchange |
$2,525.21
|
|
|
HC ETONOGESTREL IMPLANT SYSTEM
|
Facility
|
IP
|
$1,577.34
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
63600148
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$993.72 |
| Max. Negotiated Rate |
$1,419.61 |
| Rate for Payer: Aetna Commercial |
$1,340.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,025.27
|
| Rate for Payer: Cash Price |
$1,261.87
|
| Rate for Payer: Cofinity Advantage |
$1,104.14
|
| Rate for Payer: Cofinity Commercial |
$1,356.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.87
|
| Rate for Payer: Healthscope Commercial |
$1,419.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,183.01
|
| Rate for Payer: PHP Commercial |
$1,340.74
|
| Rate for Payer: Priority Health SBD |
$993.72
|
|
|
HC EUFLEXXA INJ PER DOSE
|
Facility
|
OP
|
$307.01
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
63600145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.22 |
| Max. Negotiated Rate |
$354.66 |
| Rate for Payer: Aetna Commercial |
$260.96
|
| Rate for Payer: Aetna Medicare |
$109.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$131.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$131.97
|
| Rate for Payer: BCBS Complete |
$57.98
|
| Rate for Payer: BCBS MAPPO |
$105.58
|
| Rate for Payer: BCBS Trust/PPO |
$264.58
|
| Rate for Payer: BCN Commercial |
$264.58
|
| Rate for Payer: BCN Medicare Advantage |
$105.58
|
| Rate for Payer: Cash Price |
$245.61
|
| Rate for Payer: Cash Price |
$245.61
|
| Rate for Payer: Cofinity Advantage |
$214.91
|
| Rate for Payer: Cofinity Commercial |
$264.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.58
|
| Rate for Payer: Healthscope Commercial |
$276.31
|
| Rate for Payer: Mclaren Medicaid |
$55.22
|
| Rate for Payer: Mclaren Medicare |
$105.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.86
|
| Rate for Payer: Meridian Medicaid |
$110.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$116.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.96
|
| Rate for Payer: Nomi Health Commercial |
$316.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.26
|
| Rate for Payer: PACE Medicare |
$100.30
|
| Rate for Payer: PACE SWMI |
$105.58
|
| Rate for Payer: PHP Commercial |
$260.96
|
| Rate for Payer: PHP Medicare Advantage |
$105.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$354.66
|
| Rate for Payer: Priority Health Medicare |
$105.58
|
| Rate for Payer: Priority Health SBD |
$193.42
|
| Rate for Payer: Priority Health Tiered Network |
$283.73
|
| Rate for Payer: Railroad Medicare Medicare |
$105.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.01
|
| Rate for Payer: UHC Core |
$174.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$105.58
|
| Rate for Payer: UHC Exchange |
$174.01
|
| Rate for Payer: UHC Medicaid |
$55.22
|
| Rate for Payer: UHCCP Medicaid |
$55.22
|
| Rate for Payer: VA VA |
$105.58
|
|
|
HC EUFLEXXA INJ PER DOSE
|
Facility
|
IP
|
$307.01
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
63600145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$193.42 |
| Max. Negotiated Rate |
$276.31 |
| Rate for Payer: Aetna Commercial |
$260.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.56
|
| Rate for Payer: Cash Price |
$245.61
|
| Rate for Payer: Cofinity Advantage |
$214.91
|
| Rate for Payer: Cofinity Commercial |
$264.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.61
|
| Rate for Payer: Healthscope Commercial |
$276.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.26
|
| Rate for Payer: PHP Commercial |
$260.96
|
| Rate for Payer: Priority Health SBD |
$193.42
|
|
|
HC EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
OP
|
$94.03
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
76100113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.95 |
| Max. Negotiated Rate |
$428.73 |
| Rate for Payer: Aetna Commercial |
$79.93
|
| Rate for Payer: Aetna Medicare |
$137.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$70.44
|
| Rate for Payer: BCN Commercial |
$70.44
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$75.22
|
| Rate for Payer: Cash Price |
$75.22
|
| Rate for Payer: Cash Price |
$75.22
|
| Rate for Payer: Cofinity Advantage |
$65.82
|
| Rate for Payer: Cofinity Commercial |
$80.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$84.63
|
| Rate for Payer: Mclaren Medicaid |
$69.33
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$139.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.93
|
| Rate for Payer: Nomi Health Commercial |
$397.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.52
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$79.93
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.73
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health SBD |
$59.24
|
| Rate for Payer: Priority Health Tiered Network |
$342.98
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.12
|
| Rate for Payer: UHC Core |
$48.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$36.95
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
HC EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
IP
|
$94.03
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
76100113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.24 |
| Max. Negotiated Rate |
$84.63 |
| Rate for Payer: Aetna Commercial |
$79.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.12
|
| Rate for Payer: Cash Price |
$75.22
|
| Rate for Payer: Cofinity Advantage |
$65.82
|
| Rate for Payer: Cofinity Commercial |
$80.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.22
|
| Rate for Payer: Healthscope Commercial |
$84.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.52
|
| Rate for Payer: PHP Commercial |
$79.93
|
| Rate for Payer: Priority Health SBD |
$59.24
|
|
|
HC EVAL APHASIA PER HR
|
Facility
|
IP
|
$266.96
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
44400013
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$168.18 |
| Max. Negotiated Rate |
$240.26 |
| Rate for Payer: Aetna Commercial |
$226.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.52
|
| Rate for Payer: Cash Price |
$213.57
|
| Rate for Payer: Cofinity Advantage |
$186.87
|
| Rate for Payer: Cofinity Commercial |
$229.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.57
|
| Rate for Payer: Healthscope Commercial |
$240.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.22
|
| Rate for Payer: PHP Commercial |
$226.92
|
| Rate for Payer: Priority Health SBD |
$168.18
|
|
|
HC EVAL APHASIA PER HR
|
Facility
|
OP
|
$266.96
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
44400013
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$81.39 |
| Max. Negotiated Rate |
$240.26 |
| Rate for Payer: Aetna Commercial |
$226.92
|
| Rate for Payer: Aetna Medicare |
$133.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.52
|
| Rate for Payer: BCBS Complete |
$106.78
|
| Rate for Payer: BCBS Trust/PPO |
$131.78
|
| Rate for Payer: BCN Commercial |
$131.78
|
| Rate for Payer: Cash Price |
$213.57
|
| Rate for Payer: Cash Price |
$213.57
|
| Rate for Payer: Cash Price |
$213.57
|
| Rate for Payer: Cofinity Advantage |
$186.87
|
| Rate for Payer: Cofinity Commercial |
$229.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.57
|
| Rate for Payer: Healthscope Commercial |
$240.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$213.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.92
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.22
|
| Rate for Payer: PHP Commercial |
$226.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$101.74
|
| Rate for Payer: Priority Health SBD |
$168.18
|
| Rate for Payer: Priority Health Tiered Network |
$81.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.52
|
| Rate for Payer: UHC Core |
$139.09
|
| Rate for Payer: UHC Exchange |
$104.92
|
|
|
HC EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV 1ST HR
|
Facility
|
OP
|
$446.76
|
|
|
Service Code
|
CPT 92626
|
| Hospital Charge Code |
47100017
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$67.05 |
| Max. Negotiated Rate |
$414.63 |
| Rate for Payer: Aetna Commercial |
$379.75
|
| Rate for Payer: Aetna Medicare |
$133.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$160.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$160.26
|
| Rate for Payer: BCBS Complete |
$70.41
|
| Rate for Payer: BCBS MAPPO |
$128.21
|
| Rate for Payer: BCBS Trust/PPO |
$117.24
|
| Rate for Payer: BCN Commercial |
$117.24
|
| Rate for Payer: BCN Medicare Advantage |
$128.21
|
| Rate for Payer: Cash Price |
$357.41
|
| Rate for Payer: Cash Price |
$357.41
|
| Rate for Payer: Cofinity Advantage |
$312.73
|
| Rate for Payer: Cofinity Commercial |
$384.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.21
|
| Rate for Payer: Healthscope Commercial |
$402.08
|
| Rate for Payer: Mclaren Medicaid |
$67.05
|
| Rate for Payer: Mclaren Medicare |
$128.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.62
|
| Rate for Payer: Meridian Medicaid |
$134.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$147.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$141.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.75
|
| Rate for Payer: Nomi Health Commercial |
$384.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.07
|
| Rate for Payer: PACE Medicare |
$121.80
|
| Rate for Payer: PACE SWMI |
$128.21
|
| Rate for Payer: PHP Commercial |
$379.75
|
| Rate for Payer: PHP Medicare Advantage |
$128.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$414.63
|
| Rate for Payer: Priority Health Medicare |
$128.21
|
| Rate for Payer: Priority Health SBD |
$281.46
|
| Rate for Payer: Priority Health Tiered Network |
$331.70
|
| Rate for Payer: Railroad Medicare Medicare |
$128.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$290.39
|
| Rate for Payer: UHC Core |
$232.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$128.21
|
| Rate for Payer: UHC Exchange |
$175.58
|
| Rate for Payer: UHC Medicaid |
$67.05
|
| Rate for Payer: UHCCP Medicaid |
$67.05
|
| Rate for Payer: VA VA |
$128.21
|
|
|
HC EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV 1ST HR
|
Facility
|
IP
|
$446.76
|
|
|
Service Code
|
CPT 92626
|
| Hospital Charge Code |
47100017
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$281.46 |
| Max. Negotiated Rate |
$402.08 |
| Rate for Payer: Aetna Commercial |
$379.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.39
|
| Rate for Payer: Cash Price |
$357.41
|
| Rate for Payer: Cofinity Advantage |
$312.73
|
| Rate for Payer: Cofinity Commercial |
$384.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.41
|
| Rate for Payer: Healthscope Commercial |
$402.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.07
|
| Rate for Payer: PHP Commercial |
$379.75
|
| Rate for Payer: Priority Health SBD |
$281.46
|
|
|
HC EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV EA ADDL 15
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 92627
|
| Hospital Charge Code |
47100018
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$27.72 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.03
|
| Rate for Payer: Aetna Medicare |
$38.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.73
|
| Rate for Payer: BCBS Complete |
$30.60
|
| Rate for Payer: BCBS Trust/PPO |
$27.72
|
| Rate for Payer: BCN Commercial |
$27.72
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Advantage |
$53.55
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.38
|
| Rate for Payer: PHP Commercial |
$65.03
|
| Rate for Payer: Priority Health SBD |
$48.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.73
|
| Rate for Payer: UHC Core |
$39.86
|
| Rate for Payer: UHC Exchange |
$30.06
|
|
|
HC EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV EA ADDL 15
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 92627
|
| Hospital Charge Code |
47100018
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$48.20 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.73
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Advantage |
$53.55
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.38
|
| Rate for Payer: PHP Commercial |
$65.03
|
| Rate for Payer: Priority Health SBD |
$48.20
|
|
|
HC EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN
|
Facility
|
IP
|
$40.58
|
|
|
Service Code
|
CPT 92621
|
| Hospital Charge Code |
76100496
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$25.57 |
| Max. Negotiated Rate |
$36.52 |
| Rate for Payer: Aetna Commercial |
$34.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.38
|
| Rate for Payer: Cash Price |
$32.46
|
| Rate for Payer: Cofinity Advantage |
$28.41
|
| Rate for Payer: Cofinity Commercial |
$34.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.46
|
| Rate for Payer: Healthscope Commercial |
$36.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.43
|
| Rate for Payer: PHP Commercial |
$34.49
|
| Rate for Payer: Priority Health SBD |
$25.57
|
|
|
HC EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN
|
Facility
|
OP
|
$40.58
|
|
|
Service Code
|
CPT 92621
|
| Hospital Charge Code |
76100496
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$15.95 |
| Max. Negotiated Rate |
$36.52 |
| Rate for Payer: Aetna Commercial |
$34.49
|
| Rate for Payer: Aetna Medicare |
$20.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.38
|
| Rate for Payer: BCBS Complete |
$16.23
|
| Rate for Payer: Cash Price |
$32.46
|
| Rate for Payer: Cofinity Advantage |
$28.41
|
| Rate for Payer: Cofinity Commercial |
$34.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.46
|
| Rate for Payer: Healthscope Commercial |
$36.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.43
|
| Rate for Payer: PHP Commercial |
$34.49
|
| Rate for Payer: Priority Health SBD |
$25.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.38
|
| Rate for Payer: UHC Core |
$21.14
|
| Rate for Payer: UHC Exchange |
$15.95
|
|
|
HC EVAL ORAL SPEECH ADDL 30 MIN
|
Facility
|
IP
|
$119.02
|
|
|
Service Code
|
CPT 92608
|
| Hospital Charge Code |
44400015
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$74.98 |
| Max. Negotiated Rate |
$107.12 |
| Rate for Payer: Aetna Commercial |
$101.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.36
|
| Rate for Payer: Cash Price |
$95.22
|
| Rate for Payer: Cofinity Advantage |
$83.31
|
| Rate for Payer: Cofinity Commercial |
$102.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.22
|
| Rate for Payer: Healthscope Commercial |
$107.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.27
|
| Rate for Payer: PHP Commercial |
$101.17
|
| Rate for Payer: Priority Health SBD |
$74.98
|
|
|
HC EVAL ORAL SPEECH ADDL 30 MIN
|
Facility
|
OP
|
$119.02
|
|
|
Service Code
|
CPT 92608
|
| Hospital Charge Code |
44400015
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$101.17
|
| Rate for Payer: Aetna Medicare |
$59.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.36
|
| Rate for Payer: BCBS Complete |
$47.61
|
| Rate for Payer: BCBS Trust/PPO |
$66.80
|
| Rate for Payer: BCN Commercial |
$66.80
|
| Rate for Payer: Cash Price |
$95.22
|
| Rate for Payer: Cash Price |
$95.22
|
| Rate for Payer: Cash Price |
$95.22
|
| Rate for Payer: Cofinity Advantage |
$83.31
|
| Rate for Payer: Cofinity Commercial |
$102.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.22
|
| Rate for Payer: Healthscope Commercial |
$107.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.17
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.27
|
| Rate for Payer: PHP Commercial |
$101.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$39.00
|
| Rate for Payer: Priority Health SBD |
$74.98
|
| Rate for Payer: Priority Health Tiered Network |
$31.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.36
|
| Rate for Payer: UHC Core |
$62.01
|
| Rate for Payer: UHC Exchange |
$46.77
|
|
|
HC EVAL ORAL SPEECH DEVICE
|
Facility
|
IP
|
$309.02
|
|
|
Service Code
|
CPT 92607
|
| Hospital Charge Code |
44400014
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$194.68 |
| Max. Negotiated Rate |
$278.12 |
| Rate for Payer: Aetna Commercial |
$262.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.86
|
| Rate for Payer: Cash Price |
$247.22
|
| Rate for Payer: Cofinity Advantage |
$216.31
|
| Rate for Payer: Cofinity Commercial |
$265.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.22
|
| Rate for Payer: Healthscope Commercial |
$278.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.76
|
| Rate for Payer: PHP Commercial |
$262.67
|
| Rate for Payer: Priority Health SBD |
$194.68
|
|
|
HC EVAL ORAL SPEECH DEVICE
|
Facility
|
OP
|
$309.02
|
|
|
Service Code
|
CPT 92607
|
| Hospital Charge Code |
44400014
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$121.44 |
| Max. Negotiated Rate |
$278.12 |
| Rate for Payer: Aetna Commercial |
$262.67
|
| Rate for Payer: Aetna Medicare |
$154.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.86
|
| Rate for Payer: BCBS Complete |
$123.61
|
| Rate for Payer: BCBS Trust/PPO |
$169.95
|
| Rate for Payer: BCN Commercial |
$169.95
|
| Rate for Payer: Cash Price |
$247.22
|
| Rate for Payer: Cash Price |
$247.22
|
| Rate for Payer: Cash Price |
$247.22
|
| Rate for Payer: Cofinity Advantage |
$216.31
|
| Rate for Payer: Cofinity Commercial |
$265.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.22
|
| Rate for Payer: Healthscope Commercial |
$278.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.67
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.76
|
| Rate for Payer: PHP Commercial |
$262.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$203.00
|
| Rate for Payer: Priority Health SBD |
$194.68
|
| Rate for Payer: Priority Health Tiered Network |
$162.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.86
|
| Rate for Payer: UHC Core |
$161.00
|
| Rate for Payer: UHC Exchange |
$121.44
|
|
|
HC EVENT MONITOR
|
Facility
|
OP
|
$520.44
|
|
|
Service Code
|
CPT 93270
|
| Hospital Charge Code |
48000003
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$19.45 |
| Max. Negotiated Rate |
$468.40 |
| Rate for Payer: Aetna Commercial |
$442.37
|
| Rate for Payer: Aetna Medicare |
$38.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.49
|
| Rate for Payer: BCBS Complete |
$20.42
|
| Rate for Payer: BCBS MAPPO |
$37.19
|
| Rate for Payer: BCBS Trust/PPO |
$34.05
|
| Rate for Payer: BCN Commercial |
$34.05
|
| Rate for Payer: BCN Medicare Advantage |
$37.19
|
| Rate for Payer: Cash Price |
$416.35
|
| Rate for Payer: Cash Price |
$416.35
|
| Rate for Payer: Cofinity Advantage |
$364.31
|
| Rate for Payer: Cofinity Commercial |
$447.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.19
|
| Rate for Payer: Healthscope Commercial |
$468.40
|
| Rate for Payer: Mclaren Medicaid |
$19.45
|
| Rate for Payer: Mclaren Medicare |
$37.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.05
|
| Rate for Payer: Meridian Medicaid |
$39.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.37
|
| Rate for Payer: Nomi Health Commercial |
$111.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.33
|
| Rate for Payer: PACE Medicare |
$35.33
|
| Rate for Payer: PACE SWMI |
$37.19
|
| Rate for Payer: PHP Commercial |
$442.37
|
| Rate for Payer: PHP Medicare Advantage |
$37.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$120.26
|
| Rate for Payer: Priority Health Medicare |
$37.19
|
| Rate for Payer: Priority Health SBD |
$327.88
|
| Rate for Payer: Priority Health Tiered Network |
$96.21
|
| Rate for Payer: Railroad Medicare Medicare |
$37.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$338.29
|
| Rate for Payer: UHC Core |
$271.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.19
|
| Rate for Payer: UHC Exchange |
$204.53
|
| Rate for Payer: UHC Medicaid |
$19.45
|
| Rate for Payer: UHCCP Medicaid |
$19.45
|
| Rate for Payer: VA VA |
$37.19
|
|
