|
HC ETHANOL CONFIRM URINE
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100614
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.45
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$107.10
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health SBD |
$96.39
|
|
|
HC ETHANOL CONFIRM URINE
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100614
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$96.39 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.45
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$107.10
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health SBD |
$96.39
|
|
|
HC ETHOSUXIMIDE/ZARONTIN LEVEL
|
Facility
|
OP
|
$57.12
|
|
|
Service Code
|
CPT 80168
|
| Hospital Charge Code |
30100029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.76 |
| Max. Negotiated Rate |
$51.41 |
| Rate for Payer: Aetna Commercial |
$48.55
|
| Rate for Payer: Aetna Medicare |
$16.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.13
|
| 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 |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$16.34
|
| Rate for Payer: BCN Medicare Advantage |
$16.34
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$49.12
|
| Rate for Payer: Cofinity Commercial |
$39.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.34
|
| Rate for Payer: Healthscope Commercial |
$51.41
|
| Rate for Payer: Mclaren Medicaid |
$8.76
|
| 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 |
$9.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.55
|
| Rate for Payer: PACE Medicare |
$15.52
|
| Rate for Payer: PACE SWMI |
$16.34
|
| Rate for Payer: PHP Commercial |
$48.55
|
| Rate for Payer: PHP Medicare Advantage |
$16.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.13
|
| Rate for Payer: Priority Health Medicare |
$16.34
|
| Rate for Payer: Priority Health SBD |
$35.99
|
| Rate for Payer: Railroad Medicare Medicare |
$16.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.34
|
| Rate for Payer: UHC Medicare Advantage |
$16.34
|
| Rate for Payer: UHCCP Medicaid |
$9.20
|
| Rate for Payer: VA VA |
$16.34
|
|
|
HC ETHOSUXIMIDE/ZARONTIN LEVEL
|
Facility
|
IP
|
$57.12
|
|
|
Service Code
|
CPT 80168
|
| Hospital Charge Code |
30100029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.99 |
| Max. Negotiated Rate |
$51.41 |
| Rate for Payer: Aetna Commercial |
$48.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.13
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$39.98
|
| Rate for Payer: Cofinity Commercial |
$49.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.70
|
| Rate for Payer: Healthscope Commercial |
$51.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.55
|
| Rate for Payer: PHP Commercial |
$48.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.13
|
| Rate for Payer: Priority Health SBD |
$35.99
|
|
|
HC ETHYLENE GLYCOL
|
Facility
|
IP
|
$164.22
|
|
|
Service Code
|
CPT 82693
|
| Hospital Charge Code |
30100197
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$103.46 |
| Max. Negotiated Rate |
$147.80 |
| Rate for Payer: Aetna Commercial |
$139.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.74
|
| Rate for Payer: Cash Price |
$131.38
|
| Rate for Payer: Cofinity Commercial |
$114.95
|
| Rate for Payer: Cofinity Commercial |
$141.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$114.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.38
|
| Rate for Payer: Healthscope Commercial |
$147.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.59
|
| Rate for Payer: PHP Commercial |
$139.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.74
|
| Rate for Payer: Priority Health SBD |
$103.46
|
|
|
HC ETHYLENE GLYCOL
|
Facility
|
OP
|
$164.22
|
|
|
Service Code
|
CPT 82693
|
| Hospital Charge Code |
30100197
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.99 |
| Max. Negotiated Rate |
$147.80 |
| Rate for Payer: Aetna Commercial |
$139.59
|
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.74
|
| 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 |
$8.39
|
| Rate for Payer: BCBS MAPPO |
$14.90
|
| Rate for Payer: BCN Medicare Advantage |
$14.90
|
| Rate for Payer: Cash Price |
$131.38
|
| Rate for Payer: Cash Price |
$131.38
|
| Rate for Payer: Cofinity Commercial |
$141.23
|
| Rate for Payer: Cofinity Commercial |
$114.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$114.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.90
|
| Rate for Payer: Healthscope Commercial |
$147.80
|
| Rate for Payer: Mclaren Medicaid |
$7.99
|
| 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 |
$8.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.59
|
| Rate for Payer: PACE Medicare |
$14.15
|
| Rate for Payer: PACE SWMI |
$14.90
|
| Rate for Payer: PHP Commercial |
$139.59
|
| Rate for Payer: PHP Medicare Advantage |
$14.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.74
|
| Rate for Payer: Priority Health Medicare |
$14.90
|
| Rate for Payer: Priority Health SBD |
$103.46
|
| Rate for Payer: Railroad Medicare Medicare |
$14.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.90
|
| Rate for Payer: UHC Medicare Advantage |
$14.90
|
| Rate for Payer: UHCCP Medicaid |
$8.39
|
| Rate for Payer: VA VA |
$14.90
|
|
|
HC ETHYL GLUCURONIDE SCREEN W/REFLEX, URINE
|
Facility
|
OP
|
$128.42
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100749
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$174.92 |
| Rate for Payer: Aetna Commercial |
$109.16
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.47
|
| 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 |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$102.74
|
| Rate for Payer: Cash Price |
$102.74
|
| Rate for Payer: Cofinity Commercial |
$89.89
|
| Rate for Payer: Cofinity Commercial |
$110.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$89.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$115.58
|
| 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 |
$109.16
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$109.16
|
| 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 |
$83.47
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$80.90
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.92
|
| 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 ETHYL GLUCURONIDE SCREEN W/REFLEX, URINE
|
Facility
|
IP
|
$128.42
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100749
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$80.90 |
| Max. Negotiated Rate |
$115.58 |
| Rate for Payer: Aetna Commercial |
$109.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.47
|
| Rate for Payer: Cash Price |
$102.74
|
| Rate for Payer: Cofinity Commercial |
$110.44
|
| Rate for Payer: Cofinity Commercial |
$89.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$89.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.74
|
| Rate for Payer: Healthscope Commercial |
$115.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.16
|
| Rate for Payer: PHP Commercial |
$109.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.47
|
| Rate for Payer: Priority Health SBD |
$80.90
|
|
|
HC ETONOGESTREL IMPLANT SYSTEM
|
Facility
|
IP
|
$1,546.41
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
63600148
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$974.24 |
| Max. Negotiated Rate |
$1,391.77 |
| Rate for Payer: Aetna Commercial |
$1,314.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,005.17
|
| Rate for Payer: Cash Price |
$1,237.13
|
| Rate for Payer: Cofinity Commercial |
$1,082.49
|
| Rate for Payer: Cofinity Commercial |
$1,329.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,082.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,237.13
|
| Rate for Payer: Healthscope Commercial |
$1,391.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,314.45
|
| Rate for Payer: PHP Commercial |
$1,314.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,005.17
|
| Rate for Payer: Priority Health SBD |
$974.24
|
|
|
HC ETONOGESTREL IMPLANT SYSTEM
|
Facility
|
OP
|
$1,546.41
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
63600148
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$618.56 |
| Max. Negotiated Rate |
$1,391.77 |
| Rate for Payer: Aetna Commercial |
$1,314.45
|
| Rate for Payer: Aetna Medicare |
$773.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,005.17
|
| Rate for Payer: BCBS Complete |
$618.56
|
| Rate for Payer: Cash Price |
$1,237.13
|
| Rate for Payer: Cofinity Commercial |
$1,082.49
|
| Rate for Payer: Cofinity Commercial |
$1,329.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,082.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,237.13
|
| Rate for Payer: Healthscope Commercial |
$1,391.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,314.45
|
| Rate for Payer: PHP Commercial |
$1,314.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,005.17
|
| Rate for Payer: Priority Health SBD |
$974.24
|
|
|
HC EUFLEXXA INJ PER DOSE
|
Facility
|
OP
|
$300.99
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
63600145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.27 |
| Max. Negotiated Rate |
$316.54 |
| Rate for Payer: Aetna Commercial |
$255.84
|
| Rate for Payer: Aetna Medicare |
$116.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$140.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$140.56
|
| Rate for Payer: BCBS Complete |
$63.29
|
| Rate for Payer: BCBS MAPPO |
$112.45
|
| Rate for Payer: BCN Medicare Advantage |
$112.45
|
| Rate for Payer: Cash Price |
$240.79
|
| Rate for Payer: Cash Price |
$240.79
|
| Rate for Payer: Cofinity Commercial |
$258.85
|
| Rate for Payer: Cofinity Commercial |
$210.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$210.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.45
|
| Rate for Payer: Healthscope Commercial |
$270.89
|
| Rate for Payer: Mclaren Medicaid |
$60.27
|
| Rate for Payer: Mclaren Medicare |
$112.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$118.07
|
| Rate for Payer: Meridian Medicaid |
$63.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.84
|
| Rate for Payer: PACE Medicare |
$106.83
|
| Rate for Payer: PACE SWMI |
$112.45
|
| Rate for Payer: PHP Commercial |
$255.84
|
| Rate for Payer: PHP Medicare Advantage |
$112.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.64
|
| Rate for Payer: Priority Health Medicare |
$112.45
|
| Rate for Payer: Priority Health SBD |
$189.62
|
| Rate for Payer: Railroad Medicare Medicare |
$112.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.45
|
| Rate for Payer: UHC Medicare Advantage |
$112.45
|
| Rate for Payer: UHCCP Medicaid |
$63.31
|
| Rate for Payer: VA VA |
$112.45
|
|
|
HC EUFLEXXA INJ PER DOSE
|
Facility
|
IP
|
$300.99
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
63600145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$189.62 |
| Max. Negotiated Rate |
$270.89 |
| Rate for Payer: Aetna Commercial |
$255.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.64
|
| Rate for Payer: Cash Price |
$240.79
|
| Rate for Payer: Cofinity Commercial |
$210.69
|
| Rate for Payer: Cofinity Commercial |
$258.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$210.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.79
|
| Rate for Payer: Healthscope Commercial |
$270.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.84
|
| Rate for Payer: PHP Commercial |
$255.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.64
|
| Rate for Payer: Priority Health SBD |
$189.62
|
|
|
HC EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
IP
|
$92.19
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
76100113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.08 |
| Max. Negotiated Rate |
$82.97 |
| Rate for Payer: Aetna Commercial |
$78.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.92
|
| Rate for Payer: Cash Price |
$73.75
|
| Rate for Payer: Cofinity Commercial |
$64.53
|
| Rate for Payer: Cofinity Commercial |
$79.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.75
|
| Rate for Payer: Healthscope Commercial |
$82.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.36
|
| Rate for Payer: PHP Commercial |
$78.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.92
|
| Rate for Payer: Priority Health SBD |
$58.08
|
|
|
HC EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
OP
|
$92.19
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
76100113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.08 |
| Max. Negotiated Rate |
$353.86 |
| Rate for Payer: Aetna Commercial |
$78.36
|
| Rate for Payer: Aetna Medicare |
$130.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.14
|
| Rate for Payer: BCBS Complete |
$70.75
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| Rate for Payer: Cash Price |
$73.75
|
| Rate for Payer: Cash Price |
$73.75
|
| Rate for Payer: Cofinity Commercial |
$79.28
|
| Rate for Payer: Cofinity Commercial |
$64.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.71
|
| Rate for Payer: Healthscope Commercial |
$82.97
|
| Rate for Payer: Mclaren Medicaid |
$67.38
|
| Rate for Payer: Mclaren Medicare |
$125.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.00
|
| Rate for Payer: Meridian Medicaid |
$70.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.36
|
| Rate for Payer: PACE Medicare |
$119.42
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Commercial |
$78.36
|
| Rate for Payer: PHP Medicare Advantage |
$125.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.92
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: Priority Health SBD |
$58.08
|
| Rate for Payer: Railroad Medicare Medicare |
$125.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.71
|
| Rate for Payer: UHC Medicare Advantage |
$125.71
|
| Rate for Payer: UHCCP Medicaid |
$70.77
|
| Rate for Payer: VA VA |
$125.71
|
|
|
HC EVAL APHASIA PER HR
|
Facility
|
IP
|
$261.73
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
44400013
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$164.89 |
| Max. Negotiated Rate |
$235.56 |
| Rate for Payer: Aetna Commercial |
$222.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.12
|
| Rate for Payer: Cash Price |
$209.38
|
| Rate for Payer: Cofinity Commercial |
$183.21
|
| Rate for Payer: Cofinity Commercial |
$225.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$183.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.38
|
| Rate for Payer: Healthscope Commercial |
$235.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.47
|
| Rate for Payer: PHP Commercial |
$222.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.12
|
| Rate for Payer: Priority Health SBD |
$164.89
|
|
|
HC EVAL APHASIA PER HR
|
Facility
|
OP
|
$261.73
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
44400013
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$104.69 |
| Max. Negotiated Rate |
$235.56 |
| Rate for Payer: Aetna Commercial |
$222.47
|
| Rate for Payer: Aetna Medicare |
$130.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.12
|
| Rate for Payer: BCBS Complete |
$104.69
|
| Rate for Payer: Cash Price |
$209.38
|
| Rate for Payer: Cash Price |
$209.38
|
| Rate for Payer: Cofinity Commercial |
$225.09
|
| Rate for Payer: Cofinity Commercial |
$183.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$183.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.38
|
| Rate for Payer: Healthscope Commercial |
$235.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.47
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$222.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.12
|
| Rate for Payer: Priority Health SBD |
$164.89
|
| Rate for Payer: UHC Core |
$193.68
|
| Rate for Payer: UHC Exchange |
$193.68
|
|
|
HC EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV 1ST HR
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
CPT 92626
|
| Hospital Charge Code |
47100017
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$429.53 |
| Rate for Payer: Aetna Commercial |
$372.30
|
| Rate for Payer: Aetna Medicare |
$158.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.74
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$152.59
|
| Rate for Payer: BCN Medicare Advantage |
$152.59
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cofinity Commercial |
$306.60
|
| Rate for Payer: Cofinity Commercial |
$376.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$306.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$394.20
|
| Rate for Payer: Mclaren Medicaid |
$81.79
|
| Rate for Payer: Mclaren Medicare |
$152.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.22
|
| Rate for Payer: Meridian Medicaid |
$85.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.30
|
| Rate for Payer: PACE Medicare |
$144.96
|
| Rate for Payer: PACE SWMI |
$152.59
|
| Rate for Payer: PHP Commercial |
$372.30
|
| Rate for Payer: PHP Medicare Advantage |
$152.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.70
|
| Rate for Payer: Priority Health Medicare |
$152.59
|
| Rate for Payer: Priority Health SBD |
$275.94
|
| Rate for Payer: Railroad Medicare Medicare |
$152.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.53
|
| Rate for Payer: UHC Core |
$324.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.59
|
| Rate for Payer: UHC Exchange |
$324.12
|
| Rate for Payer: UHC Medicare Advantage |
$152.59
|
| Rate for Payer: UHCCP Medicaid |
$85.91
|
| Rate for Payer: VA VA |
$152.59
|
|
|
HC EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV 1ST HR
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
CPT 92626
|
| Hospital Charge Code |
47100017
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$275.94 |
| Max. Negotiated Rate |
$394.20 |
| Rate for Payer: Aetna Commercial |
$372.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.70
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cofinity Commercial |
$306.60
|
| Rate for Payer: Cofinity Commercial |
$376.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$306.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.40
|
| Rate for Payer: Healthscope Commercial |
$394.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.30
|
| Rate for Payer: PHP Commercial |
$372.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.70
|
| Rate for Payer: Priority Health SBD |
$275.94
|
|
|
HC EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV EA ADDL 15
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 92627
|
| Hospital Charge Code |
47100018
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$63.75
|
| Rate for Payer: Aetna Medicare |
$37.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.75
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$52.50
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.75
|
| Rate for Payer: PHP Commercial |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.75
|
| Rate for Payer: Priority Health SBD |
$47.25
|
| Rate for Payer: UHC Core |
$55.50
|
| Rate for Payer: UHC Exchange |
$55.50
|
|
|
HC EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV EA ADDL 15
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 92627
|
| Hospital Charge Code |
47100018
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$47.25 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$63.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.75
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$52.50
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.75
|
| Rate for Payer: PHP Commercial |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.75
|
| Rate for Payer: Priority Health SBD |
$47.25
|
|
|
HC EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN
|
Facility
|
OP
|
$39.78
|
|
|
Service Code
|
CPT 92621
|
| Hospital Charge Code |
76100496
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$35.80 |
| Rate for Payer: Aetna Commercial |
$33.81
|
| Rate for Payer: Aetna Medicare |
$19.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.86
|
| Rate for Payer: BCBS Complete |
$15.91
|
| Rate for Payer: Cash Price |
$31.82
|
| Rate for Payer: Cofinity Commercial |
$27.85
|
| Rate for Payer: Cofinity Commercial |
$34.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.82
|
| Rate for Payer: Healthscope Commercial |
$35.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.81
|
| Rate for Payer: PHP Commercial |
$33.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.86
|
| Rate for Payer: Priority Health SBD |
$25.06
|
| Rate for Payer: UHC Core |
$29.44
|
| Rate for Payer: UHC Exchange |
$29.44
|
|
|
HC EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN
|
Facility
|
IP
|
$39.78
|
|
|
Service Code
|
CPT 92621
|
| Hospital Charge Code |
76100496
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$25.06 |
| Max. Negotiated Rate |
$35.80 |
| Rate for Payer: Aetna Commercial |
$33.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.86
|
| Rate for Payer: Cash Price |
$31.82
|
| Rate for Payer: Cofinity Commercial |
$27.85
|
| Rate for Payer: Cofinity Commercial |
$34.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.82
|
| Rate for Payer: Healthscope Commercial |
$35.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.81
|
| Rate for Payer: PHP Commercial |
$33.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.86
|
| Rate for Payer: Priority Health SBD |
$25.06
|
|
|
HC EVAL ORAL SPEECH ADDL 30 MIN
|
Facility
|
IP
|
$116.69
|
|
|
Service Code
|
CPT 92608
|
| Hospital Charge Code |
44400015
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$73.51 |
| Max. Negotiated Rate |
$105.02 |
| Rate for Payer: Aetna Commercial |
$99.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.85
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Cofinity Commercial |
$100.35
|
| Rate for Payer: Cofinity Commercial |
$81.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.35
|
| Rate for Payer: Healthscope Commercial |
$105.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.19
|
| Rate for Payer: PHP Commercial |
$99.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.85
|
| Rate for Payer: Priority Health SBD |
$73.51
|
|
|
HC EVAL ORAL SPEECH ADDL 30 MIN
|
Facility
|
OP
|
$116.69
|
|
|
Service Code
|
CPT 92608
|
| Hospital Charge Code |
44400015
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$46.68 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$99.19
|
| Rate for Payer: Aetna Medicare |
$58.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.85
|
| Rate for Payer: BCBS Complete |
$46.68
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Cofinity Commercial |
$81.68
|
| Rate for Payer: Cofinity Commercial |
$100.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.35
|
| Rate for Payer: Healthscope Commercial |
$105.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.19
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$99.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.85
|
| Rate for Payer: Priority Health SBD |
$73.51
|
| Rate for Payer: UHC Core |
$86.35
|
| Rate for Payer: UHC Exchange |
$86.35
|
|
|
HC EVAL ORAL SPEECH DEVICE
|
Facility
|
IP
|
$302.96
|
|
|
Service Code
|
CPT 92607
|
| Hospital Charge Code |
44400014
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$190.86 |
| Max. Negotiated Rate |
$272.66 |
| Rate for Payer: Aetna Commercial |
$257.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.92
|
| Rate for Payer: Cash Price |
$242.37
|
| Rate for Payer: Cofinity Commercial |
$212.07
|
| Rate for Payer: Cofinity Commercial |
$260.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$212.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.37
|
| Rate for Payer: Healthscope Commercial |
$272.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.52
|
| Rate for Payer: PHP Commercial |
$257.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.92
|
| Rate for Payer: Priority Health SBD |
$190.86
|
|
