|
HC FOREIGN BODY REMOVAL
|
Facility
|
IP
|
$468.74
|
|
| Hospital Charge Code |
45000042
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$295.31 |
| Max. Negotiated Rate |
$421.87 |
| Rate for Payer: Aetna Commercial |
$398.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.68
|
| Rate for Payer: Cash Price |
$374.99
|
| Rate for Payer: Cofinity Advantage |
$328.12
|
| Rate for Payer: Cofinity Commercial |
$403.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.99
|
| Rate for Payer: Healthscope Commercial |
$421.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$398.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.56
|
| Rate for Payer: PHP Commercial |
$398.43
|
| Rate for Payer: Priority Health SBD |
$295.31
|
|
|
HC FOREIGN BODY REMOVAL
|
Facility
|
OP
|
$287.22
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
76100068
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.88 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Commercial |
$244.14
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$307.60
|
| Rate for Payer: BCN Commercial |
$307.60
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$229.78
|
| Rate for Payer: Cash Price |
$229.78
|
| Rate for Payer: Cash Price |
$229.78
|
| Rate for Payer: Cofinity Advantage |
$201.05
|
| Rate for Payer: Cofinity Commercial |
$247.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$258.50
|
| Rate for Payer: Mclaren Medicaid |
$211.84
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.14
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.41
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$244.14
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health SBD |
$180.95
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.69
|
| Rate for Payer: UHC Core |
$149.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Exchange |
$112.88
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
HC FOREIGN BODY REMOVAL EAR
|
Facility
|
IP
|
$221.09
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
45000060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$139.29 |
| Max. Negotiated Rate |
$198.98 |
| Rate for Payer: Aetna Commercial |
$187.93
|
| Rate for Payer: Aetna Commercial |
$281.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.56
|
| Rate for Payer: Cash Price |
$176.87
|
| Rate for Payer: Cash Price |
$265.30
|
| Rate for Payer: Cofinity Advantage |
$154.76
|
| Rate for Payer: Cofinity Advantage |
$232.14
|
| Rate for Payer: Cofinity Commercial |
$190.14
|
| Rate for Payer: Cofinity Commercial |
$285.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.87
|
| Rate for Payer: Healthscope Commercial |
$298.47
|
| Rate for Payer: Healthscope Commercial |
$198.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$248.72
|
| Rate for Payer: PHP Commercial |
$187.93
|
| Rate for Payer: PHP Commercial |
$281.89
|
| Rate for Payer: Priority Health SBD |
$139.29
|
| Rate for Payer: Priority Health SBD |
$208.93
|
|
|
HC FOREIGN BODY REMOVAL EAR
|
Facility
|
OP
|
$221.09
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
45000060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$428.73 |
| Rate for Payer: Aetna Commercial |
$187.93
|
| Rate for Payer: Aetna Commercial |
$281.89
|
| Rate for Payer: Aetna Medicare |
$137.87
|
| Rate for Payer: Aetna Medicare |
$137.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$85.72
|
| Rate for Payer: BCBS Trust/PPO |
$85.72
|
| Rate for Payer: BCN Commercial |
$85.72
|
| Rate for Payer: BCN Commercial |
$85.72
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$176.87
|
| Rate for Payer: Cash Price |
$176.87
|
| Rate for Payer: Cash Price |
$265.30
|
| Rate for Payer: Cash Price |
$265.30
|
| Rate for Payer: Cash Price |
$265.30
|
| Rate for Payer: Cash Price |
$176.87
|
| Rate for Payer: Cofinity Advantage |
$232.14
|
| Rate for Payer: Cofinity Advantage |
$154.76
|
| Rate for Payer: Cofinity Commercial |
$190.14
|
| Rate for Payer: Cofinity Commercial |
$285.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$198.98
|
| Rate for Payer: Healthscope Commercial |
$298.47
|
| Rate for Payer: Mclaren Medicaid |
$69.33
|
| Rate for Payer: Mclaren Medicaid |
$69.33
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| 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 Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$139.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.89
|
| Rate for Payer: Nomi Health Commercial |
$397.71
|
| Rate for Payer: Nomi Health Commercial |
$397.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$248.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.82
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$187.93
|
| Rate for Payer: PHP Commercial |
$281.89
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| 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 Cigna Priority Health/HMO/PPO/Narrow Network |
$428.73
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health SBD |
$208.93
|
| Rate for Payer: Priority Health SBD |
$139.29
|
| Rate for Payer: Priority Health Tiered Network |
$342.98
|
| Rate for Payer: Priority Health Tiered Network |
$342.98
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.56
|
| Rate for Payer: UHC Core |
$172.78
|
| Rate for Payer: UHC Core |
$115.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$130.33
|
| Rate for Payer: UHC Exchange |
$86.89
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
| Rate for Payer: VA VA |
$132.57
|
|
|
HC FOREIGN BODY REMOVAL MUSCLE OR TENDON SHEATH SIMPLE
|
Facility
|
IP
|
$1,199.57
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
76100133
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$755.73 |
| Max. Negotiated Rate |
$1,079.61 |
| Rate for Payer: Aetna Commercial |
$1,019.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$779.72
|
| Rate for Payer: Cash Price |
$959.66
|
| Rate for Payer: Cofinity Advantage |
$839.70
|
| Rate for Payer: Cofinity Commercial |
$1,031.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$959.66
|
| Rate for Payer: Healthscope Commercial |
$1,079.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,019.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$899.68
|
| Rate for Payer: PHP Commercial |
$1,019.63
|
| Rate for Payer: Priority Health SBD |
$755.73
|
|
|
HC FOREIGN BODY REMOVAL MUSCLE OR TENDON SHEATH SIMPLE
|
Facility
|
OP
|
$1,199.57
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
76100133
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$471.43 |
| Max. Negotiated Rate |
$5,321.93 |
| Rate for Payer: Aetna Commercial |
$1,019.63
|
| Rate for Payer: Aetna Medicare |
$1,711.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$779.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,236.38
|
| Rate for Payer: BCN Commercial |
$1,236.38
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Cash Price |
$959.66
|
| Rate for Payer: Cash Price |
$959.66
|
| Rate for Payer: Cash Price |
$959.66
|
| Rate for Payer: Cofinity Advantage |
$839.70
|
| Rate for Payer: Cofinity Commercial |
$1,031.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$959.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Healthscope Commercial |
$1,079.61
|
| Rate for Payer: Mclaren Medicaid |
$860.68
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$1,727.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,019.63
|
| Rate for Payer: Nomi Health Commercial |
$4,936.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$899.68
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Commercial |
$1,019.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,321.93
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health SBD |
$755.73
|
| Rate for Payer: Priority Health Tiered Network |
$4,257.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$779.72
|
| Rate for Payer: UHC Core |
$624.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,645.66
|
| Rate for Payer: UHC Exchange |
$471.43
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: VA VA |
$1,645.66
|
|
|
HC FOREIGN BODY REMOVAL NOSE
|
Facility
|
OP
|
$236.28
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
45000059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.49 |
| Max. Negotiated Rate |
$428.73 |
| Rate for Payer: Aetna Commercial |
$200.84
|
| Rate for Payer: Aetna Medicare |
$137.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.58
|
| 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 |
$55.49
|
| Rate for Payer: BCN Commercial |
$55.49
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$189.02
|
| Rate for Payer: Cash Price |
$189.02
|
| Rate for Payer: Cash Price |
$189.02
|
| Rate for Payer: Cofinity Advantage |
$165.40
|
| Rate for Payer: Cofinity Commercial |
$203.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$212.65
|
| 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 |
$200.84
|
| Rate for Payer: Nomi Health Commercial |
$397.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.21
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$200.84
|
| 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 |
$148.86
|
| 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) |
$153.58
|
| Rate for Payer: UHC Core |
$123.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$92.86
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
HC FOREIGN BODY REMOVAL NOSE
|
Facility
|
IP
|
$236.28
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
45000059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$148.86 |
| Max. Negotiated Rate |
$212.65 |
| Rate for Payer: Aetna Commercial |
$200.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.58
|
| Rate for Payer: Cash Price |
$189.02
|
| Rate for Payer: Cofinity Advantage |
$165.40
|
| Rate for Payer: Cofinity Commercial |
$203.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.02
|
| Rate for Payer: Healthscope Commercial |
$212.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.21
|
| Rate for Payer: PHP Commercial |
$200.84
|
| Rate for Payer: Priority Health SBD |
$148.86
|
|
|
HC FOREIGN BODY RETRIEV (VASC)
|
Facility
|
IP
|
$4,091.87
|
|
|
Service Code
|
CPT 37197
|
| Hospital Charge Code |
36100375
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,577.88 |
| Max. Negotiated Rate |
$3,682.68 |
| Rate for Payer: Aetna Commercial |
$3,478.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,659.72
|
| Rate for Payer: Cash Price |
$3,273.50
|
| Rate for Payer: Cofinity Advantage |
$2,864.31
|
| Rate for Payer: Cofinity Commercial |
$3,519.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,273.50
|
| Rate for Payer: Healthscope Commercial |
$3,682.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,478.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,068.90
|
| Rate for Payer: PHP Commercial |
$3,478.09
|
| Rate for Payer: Priority Health SBD |
$2,577.88
|
|
|
HC FOREIGN BODY RETRIEV (VASC)
|
Facility
|
OP
|
$4,091.87
|
|
|
Service Code
|
CPT 37197
|
| Hospital Charge Code |
36100375
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,645.43 |
| Max. Negotiated Rate |
$10,174.29 |
| Rate for Payer: Aetna Commercial |
$3,478.09
|
| Rate for Payer: Aetna Medicare |
$3,271.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,659.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,703.94
|
| Rate for Payer: BCN Commercial |
$1,703.94
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$3,273.50
|
| Rate for Payer: Cash Price |
$3,273.50
|
| Rate for Payer: Cash Price |
$3,273.50
|
| Rate for Payer: Cofinity Advantage |
$2,864.31
|
| Rate for Payer: Cofinity Commercial |
$3,519.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,273.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$3,682.68
|
| Rate for Payer: Mclaren Medicaid |
$1,645.43
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$3,303.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,478.09
|
| Rate for Payer: Nomi Health Commercial |
$9,438.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,068.90
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$3,478.09
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,174.29
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health SBD |
$2,577.88
|
| Rate for Payer: Priority Health Tiered Network |
$8,139.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
HC FORESKIN MANIP W LYSIS ADH AND STRETCH
|
Facility
|
IP
|
$373.92
|
|
|
Service Code
|
CPT 54450
|
| Hospital Charge Code |
76100269
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$235.57 |
| Max. Negotiated Rate |
$336.53 |
| Rate for Payer: Aetna Commercial |
$317.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.05
|
| Rate for Payer: Cash Price |
$299.14
|
| Rate for Payer: Cofinity Advantage |
$261.74
|
| Rate for Payer: Cofinity Commercial |
$321.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.14
|
| Rate for Payer: Healthscope Commercial |
$336.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.44
|
| Rate for Payer: PHP Commercial |
$317.83
|
| Rate for Payer: Priority Health SBD |
$235.57
|
|
|
HC FORESKIN MANIP W LYSIS ADH AND STRETCH
|
Facility
|
OP
|
$373.92
|
|
|
Service Code
|
CPT 54450
|
| Hospital Charge Code |
76100269
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$805.08 |
| Rate for Payer: Aetna Commercial |
$317.83
|
| Rate for Payer: Aetna Medicare |
$258.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$311.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$311.19
|
| Rate for Payer: BCBS Complete |
$136.72
|
| Rate for Payer: BCBS MAPPO |
$248.95
|
| Rate for Payer: BCBS Trust/PPO |
$133.66
|
| Rate for Payer: BCN Commercial |
$133.66
|
| Rate for Payer: BCN Medicare Advantage |
$248.95
|
| Rate for Payer: Cash Price |
$299.14
|
| Rate for Payer: Cash Price |
$299.14
|
| Rate for Payer: Cash Price |
$299.14
|
| Rate for Payer: Cofinity Advantage |
$261.74
|
| Rate for Payer: Cofinity Commercial |
$321.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.95
|
| Rate for Payer: Healthscope Commercial |
$336.53
|
| Rate for Payer: Mclaren Medicaid |
$130.20
|
| Rate for Payer: Mclaren Medicare |
$248.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.40
|
| Rate for Payer: Meridian Medicaid |
$261.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$286.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$273.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.83
|
| Rate for Payer: Nomi Health Commercial |
$746.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.44
|
| Rate for Payer: PACE Medicare |
$236.50
|
| Rate for Payer: PACE SWMI |
$248.95
|
| Rate for Payer: PHP Commercial |
$317.83
|
| Rate for Payer: PHP Medicare Advantage |
$248.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$805.08
|
| Rate for Payer: Priority Health Medicare |
$248.95
|
| Rate for Payer: Priority Health SBD |
$235.57
|
| Rate for Payer: Priority Health Tiered Network |
$644.06
|
| Rate for Payer: Railroad Medicare Medicare |
$248.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.05
|
| Rate for Payer: UHC Core |
$194.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$248.95
|
| Rate for Payer: UHC Exchange |
$146.95
|
| Rate for Payer: UHC Medicaid |
$130.20
|
| Rate for Payer: UHCCP Medicaid |
$130.20
|
| Rate for Payer: VA VA |
$248.95
|
|
|
HC FORMALDEHYDE ALLERGY SCREEN
|
Facility
|
OP
|
$24.61
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200017
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$22.15 |
| Rate for Payer: Aetna Commercial |
$20.92
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.69
|
| Rate for Payer: Cash Price |
$19.69
|
| Rate for Payer: Cofinity Advantage |
$17.23
|
| Rate for Payer: Cofinity Commercial |
$21.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.15
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.92
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.46
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$20.92
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$15.50
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC FORMALDEHYDE ALLERGY SCREEN
|
Facility
|
IP
|
$24.61
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200017
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$22.15 |
| Rate for Payer: Aetna Commercial |
$20.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.00
|
| Rate for Payer: Cash Price |
$19.69
|
| Rate for Payer: Cofinity Advantage |
$17.23
|
| Rate for Payer: Cofinity Commercial |
$21.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.69
|
| Rate for Payer: Healthscope Commercial |
$22.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.46
|
| Rate for Payer: PHP Commercial |
$20.92
|
| Rate for Payer: Priority Health SBD |
$15.50
|
|
|
HC FORMALDEHYDE ALLERGY SCREEN REF LAB
|
Facility
|
IP
|
$36.08
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200125
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.73 |
| Max. Negotiated Rate |
$32.47 |
| Rate for Payer: Aetna Commercial |
$30.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.45
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cofinity Advantage |
$25.26
|
| Rate for Payer: Cofinity Commercial |
$31.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.86
|
| Rate for Payer: Healthscope Commercial |
$32.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.06
|
| Rate for Payer: PHP Commercial |
$30.67
|
| Rate for Payer: Priority Health SBD |
$22.73
|
|
|
HC FORMALDEHYDE ALLERGY SCREEN REF LAB
|
Facility
|
OP
|
$36.08
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200125
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$32.47 |
| Rate for Payer: Aetna Commercial |
$30.67
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cofinity Advantage |
$25.26
|
| Rate for Payer: Cofinity Commercial |
$31.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$32.47
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.67
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.06
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$30.67
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$22.73
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC FRACTURE/DISLOCATION TX LEVEL 1
|
Facility
|
IP
|
$704.42
|
|
| Hospital Charge Code |
45000044
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$443.78 |
| Max. Negotiated Rate |
$633.98 |
| Rate for Payer: Aetna Commercial |
$598.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$457.87
|
| Rate for Payer: Cash Price |
$563.54
|
| Rate for Payer: Cofinity Advantage |
$493.09
|
| Rate for Payer: Cofinity Commercial |
$605.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$563.54
|
| Rate for Payer: Healthscope Commercial |
$633.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$598.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$528.32
|
| Rate for Payer: PHP Commercial |
$598.76
|
| Rate for Payer: Priority Health SBD |
$443.78
|
|
|
HC FRACTURE/DISLOCATION TX LEVEL 1
|
Facility
|
OP
|
$704.42
|
|
| Hospital Charge Code |
45000044
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$633.98 |
| Rate for Payer: Aetna Commercial |
$598.76
|
| Rate for Payer: Aetna Medicare |
$352.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$457.87
|
| Rate for Payer: BCBS Complete |
$281.77
|
| Rate for Payer: Cash Price |
$563.54
|
| Rate for Payer: Cash Price |
$563.54
|
| Rate for Payer: Cofinity Advantage |
$493.09
|
| Rate for Payer: Cofinity Commercial |
$605.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$563.54
|
| Rate for Payer: Healthscope Commercial |
$633.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$563.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$598.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$528.32
|
| Rate for Payer: PHP Commercial |
$598.76
|
| Rate for Payer: Priority Health SBD |
$443.78
|
| Rate for Payer: UHCCP Medicaid |
$144.00
|
|
|
HC FRACTURE/DISLOCATION TX LEVEL II
|
Facility
|
OP
|
$3,102.33
|
|
| Hospital Charge Code |
45000104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$2,792.10 |
| Rate for Payer: Aetna Commercial |
$2,636.98
|
| Rate for Payer: Aetna Medicare |
$1,551.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,016.51
|
| Rate for Payer: BCBS Complete |
$1,240.93
|
| Rate for Payer: Cash Price |
$2,481.86
|
| Rate for Payer: Cash Price |
$2,481.86
|
| Rate for Payer: Cofinity Advantage |
$2,171.63
|
| Rate for Payer: Cofinity Commercial |
$2,668.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,481.86
|
| Rate for Payer: Healthscope Commercial |
$2,792.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,481.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,636.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,326.75
|
| Rate for Payer: PHP Commercial |
$2,636.98
|
| Rate for Payer: Priority Health SBD |
$1,954.47
|
| Rate for Payer: UHCCP Medicaid |
$144.00
|
|
|
HC FRACTURE/DISLOCATION TX LEVEL II
|
Facility
|
IP
|
$3,102.33
|
|
| Hospital Charge Code |
45000104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,954.47 |
| Max. Negotiated Rate |
$2,792.10 |
| Rate for Payer: Aetna Commercial |
$2,636.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,016.51
|
| Rate for Payer: Cash Price |
$2,481.86
|
| Rate for Payer: Cofinity Advantage |
$2,171.63
|
| Rate for Payer: Cofinity Commercial |
$2,668.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,481.86
|
| Rate for Payer: Healthscope Commercial |
$2,792.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,636.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,326.75
|
| Rate for Payer: PHP Commercial |
$2,636.98
|
| Rate for Payer: Priority Health SBD |
$1,954.47
|
|
|
HC FRAGILEX ANALYSIS
|
Facility
|
IP
|
$447.37
|
|
|
Service Code
|
CPT 81243
|
| Hospital Charge Code |
31000099
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$281.84 |
| Max. Negotiated Rate |
$402.63 |
| Rate for Payer: Aetna Commercial |
$380.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.79
|
| Rate for Payer: Cash Price |
$357.90
|
| Rate for Payer: Cofinity Advantage |
$313.16
|
| Rate for Payer: Cofinity Commercial |
$384.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.90
|
| Rate for Payer: Healthscope Commercial |
$402.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.53
|
| Rate for Payer: PHP Commercial |
$380.26
|
| Rate for Payer: Priority Health SBD |
$281.84
|
|
|
HC FRAGILEX ANALYSIS
|
Facility
|
OP
|
$447.37
|
|
|
Service Code
|
CPT 81243
|
| Hospital Charge Code |
31000099
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$29.83 |
| Max. Negotiated Rate |
$402.63 |
| Rate for Payer: Aetna Commercial |
$380.26
|
| Rate for Payer: Aetna Medicare |
$59.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.30
|
| Rate for Payer: BCBS Complete |
$31.33
|
| Rate for Payer: BCBS MAPPO |
$57.04
|
| Rate for Payer: BCBS Trust/PPO |
$60.82
|
| Rate for Payer: BCN Commercial |
$60.82
|
| Rate for Payer: BCN Medicare Advantage |
$57.04
|
| Rate for Payer: Cash Price |
$357.90
|
| Rate for Payer: Cash Price |
$357.90
|
| Rate for Payer: Cofinity Advantage |
$313.16
|
| Rate for Payer: Cofinity Commercial |
$384.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.04
|
| Rate for Payer: Healthscope Commercial |
$402.63
|
| Rate for Payer: Mclaren Medicaid |
$29.83
|
| Rate for Payer: Mclaren Medicare |
$57.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.89
|
| Rate for Payer: Meridian Medicaid |
$59.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$62.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.26
|
| Rate for Payer: Nomi Health Commercial |
$171.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.53
|
| Rate for Payer: PACE Medicare |
$54.19
|
| Rate for Payer: PACE SWMI |
$57.04
|
| Rate for Payer: PHP Commercial |
$380.26
|
| Rate for Payer: PHP Medicare Advantage |
$57.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$57.04
|
| Rate for Payer: Priority Health Medicare |
$57.04
|
| Rate for Payer: Priority Health SBD |
$281.84
|
| Rate for Payer: Priority Health Tiered Network |
$45.63
|
| Rate for Payer: Railroad Medicare Medicare |
$57.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.56
|
| Rate for Payer: UHC Core |
$85.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$57.04
|
| Rate for Payer: UHC Exchange |
$85.56
|
| Rate for Payer: UHC Medicaid |
$29.83
|
| Rate for Payer: UHCCP Medicaid |
$29.83
|
| Rate for Payer: VA VA |
$57.04
|
|
|
HC FRAGILE X FOLLOW UP
|
Facility
|
OP
|
$262.18
|
|
|
Service Code
|
CPT 81244
|
| Hospital Charge Code |
30000113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.48 |
| Max. Negotiated Rate |
$235.96 |
| Rate for Payer: Aetna Commercial |
$222.85
|
| Rate for Payer: Aetna Medicare |
$46.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.11
|
| Rate for Payer: BCBS Complete |
$24.65
|
| Rate for Payer: BCBS MAPPO |
$44.89
|
| Rate for Payer: BCBS Trust/PPO |
$47.87
|
| Rate for Payer: BCN Commercial |
$47.87
|
| Rate for Payer: BCN Medicare Advantage |
$44.89
|
| Rate for Payer: Cash Price |
$209.74
|
| Rate for Payer: Cash Price |
$209.74
|
| Rate for Payer: Cofinity Advantage |
$183.53
|
| Rate for Payer: Cofinity Commercial |
$225.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.89
|
| Rate for Payer: Healthscope Commercial |
$235.96
|
| Rate for Payer: Mclaren Medicaid |
$23.48
|
| Rate for Payer: Mclaren Medicare |
$44.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.13
|
| Rate for Payer: Meridian Medicaid |
$47.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$49.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.85
|
| Rate for Payer: Nomi Health Commercial |
$134.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.63
|
| Rate for Payer: PACE Medicare |
$42.65
|
| Rate for Payer: PACE SWMI |
$44.89
|
| Rate for Payer: PHP Commercial |
$222.85
|
| Rate for Payer: PHP Medicare Advantage |
$44.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$44.89
|
| Rate for Payer: Priority Health Medicare |
$44.89
|
| Rate for Payer: Priority Health SBD |
$165.17
|
| Rate for Payer: Priority Health Tiered Network |
$35.91
|
| Rate for Payer: Railroad Medicare Medicare |
$44.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.34
|
| Rate for Payer: UHC Core |
$67.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$44.89
|
| Rate for Payer: UHC Exchange |
$67.34
|
| Rate for Payer: UHC Medicaid |
$23.48
|
| Rate for Payer: UHCCP Medicaid |
$23.48
|
| Rate for Payer: VA VA |
$44.89
|
|
|
HC FRAGILE X FOLLOW UP
|
Facility
|
IP
|
$262.18
|
|
|
Service Code
|
CPT 81244
|
| Hospital Charge Code |
30000113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$165.17 |
| Max. Negotiated Rate |
$235.96 |
| Rate for Payer: Aetna Commercial |
$222.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.42
|
| Rate for Payer: Cash Price |
$209.74
|
| Rate for Payer: Cofinity Advantage |
$183.53
|
| Rate for Payer: Cofinity Commercial |
$225.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.74
|
| Rate for Payer: Healthscope Commercial |
$235.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.63
|
| Rate for Payer: PHP Commercial |
$222.85
|
| Rate for Payer: Priority Health SBD |
$165.17
|
|
|
HC FREE FATTY ACIDS
|
Facility
|
OP
|
$63.46
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
30100201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.82 |
| Max. Negotiated Rate |
$57.11 |
| Rate for Payer: Aetna Commercial |
$53.94
|
| Rate for Payer: Aetna Medicare |
$19.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.46
|
| Rate for Payer: BCBS Complete |
$10.31
|
| Rate for Payer: BCBS MAPPO |
$18.77
|
| Rate for Payer: BCBS Trust/PPO |
$20.02
|
| Rate for Payer: BCN Commercial |
$20.02
|
| Rate for Payer: BCN Medicare Advantage |
$18.77
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cofinity Advantage |
$44.42
|
| Rate for Payer: Cofinity Commercial |
$54.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.77
|
| Rate for Payer: Healthscope Commercial |
$57.11
|
| Rate for Payer: Mclaren Medicaid |
$9.82
|
| Rate for Payer: Mclaren Medicare |
$18.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.71
|
| Rate for Payer: Meridian Medicaid |
$19.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.94
|
| Rate for Payer: Nomi Health Commercial |
$28.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.59
|
| Rate for Payer: PACE Medicare |
$17.83
|
| Rate for Payer: PACE SWMI |
$18.77
|
| Rate for Payer: PHP Commercial |
$53.94
|
| Rate for Payer: PHP Medicare Advantage |
$18.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18.77
|
| Rate for Payer: Priority Health Medicare |
$18.77
|
| Rate for Payer: Priority Health SBD |
$39.98
|
| Rate for Payer: Priority Health Tiered Network |
$15.02
|
| Rate for Payer: Railroad Medicare Medicare |
$18.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.16
|
| Rate for Payer: UHC Core |
$28.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.77
|
| Rate for Payer: UHC Exchange |
$28.16
|
| Rate for Payer: UHC Medicaid |
$9.82
|
| Rate for Payer: UHCCP Medicaid |
$9.82
|
| Rate for Payer: VA VA |
$18.77
|
|
