|
HC MYRINGOTOMY ASPIR&EUSTACHIAN TUBE NFLTJ
|
Facility
|
IP
|
$616.00
|
|
|
Service Code
|
CPT 69420
|
| Hospital Charge Code |
76100484
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$388.08 |
| Max. Negotiated Rate |
$554.40 |
| Rate for Payer: Aetna Commercial |
$523.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.40
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Cofinity Commercial |
$431.20
|
| Rate for Payer: Cofinity Commercial |
$529.76
|
| Rate for Payer: Healthscope Commercial |
$554.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$523.60
|
| Rate for Payer: PHP Commercial |
$523.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$431.20
|
| Rate for Payer: Priority Health SBD |
$388.08
|
|
|
HC MYRINGOTOMY ASPIR&EUSTACHIAN TUBE NFLTJ
|
Facility
|
OP
|
$616.00
|
|
|
Service Code
|
CPT 69420
|
| Hospital Charge Code |
76100484
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.62 |
| Max. Negotiated Rate |
$554.40 |
| Rate for Payer: Aetna Commercial |
$523.60
|
| Rate for Payer: Aetna Medicare |
$226.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$271.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$271.68
|
| Rate for Payer: BCBS Complete |
$124.84
|
| Rate for Payer: BCBS MAPPO |
$217.34
|
| Rate for Payer: BCBS Trust/PPO |
$70.62
|
| Rate for Payer: BCN Medicare Advantage |
$217.34
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Cofinity Commercial |
$431.20
|
| Rate for Payer: Cofinity Commercial |
$529.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.34
|
| Rate for Payer: Healthscope Commercial |
$554.40
|
| Rate for Payer: Mclaren Medicaid |
$118.88
|
| Rate for Payer: Mclaren Medicare |
$217.34
|
| Rate for Payer: Meridian Medicaid |
$124.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$249.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$523.60
|
| Rate for Payer: PACE Medicare |
$206.47
|
| Rate for Payer: PACE SWMI |
$217.34
|
| Rate for Payer: PHP Commercial |
$523.60
|
| Rate for Payer: PHP Medicare Advantage |
$217.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$118.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$431.20
|
| Rate for Payer: Priority Health Medicare |
$217.34
|
| Rate for Payer: Priority Health SBD |
$388.08
|
| Rate for Payer: Railroad Medicare Medicare |
$217.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$217.34
|
| Rate for Payer: UHC Exchange |
$119.84
|
| Rate for Payer: UHC Medicare Advantage |
$223.86
|
| Rate for Payer: VA VA |
$217.34
|
|
|
HC NAIL BED REPAIR
|
Facility
|
IP
|
$742.77
|
|
|
Service Code
|
CPT 11760
|
| Hospital Charge Code |
45000077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$467.95 |
| Max. Negotiated Rate |
$668.49 |
| Rate for Payer: Aetna Commercial |
$631.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$482.80
|
| Rate for Payer: Cash Price |
$594.22
|
| Rate for Payer: Cofinity Commercial |
$519.94
|
| Rate for Payer: Cofinity Commercial |
$638.78
|
| Rate for Payer: Healthscope Commercial |
$668.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$631.35
|
| Rate for Payer: PHP Commercial |
$631.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$519.94
|
| Rate for Payer: Priority Health SBD |
$467.95
|
|
|
HC NAIL BED REPAIR
|
Facility
|
OP
|
$742.77
|
|
|
Service Code
|
CPT 11760
|
| Hospital Charge Code |
45000077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.73 |
| Max. Negotiated Rate |
$1,757.43 |
| Rate for Payer: Aetna Commercial |
$631.35
|
| Rate for Payer: Aetna Medicare |
$581.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$482.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$698.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$698.54
|
| Rate for Payer: BCBS Complete |
$320.99
|
| Rate for Payer: BCBS MAPPO |
$558.83
|
| Rate for Payer: BCBS Trust/PPO |
$219.20
|
| Rate for Payer: BCN Medicare Advantage |
$558.83
|
| Rate for Payer: Cash Price |
$594.22
|
| Rate for Payer: Cash Price |
$594.22
|
| Rate for Payer: Cofinity Commercial |
$638.78
|
| Rate for Payer: Cofinity Commercial |
$519.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.83
|
| Rate for Payer: Healthscope Commercial |
$668.49
|
| Rate for Payer: Mclaren Medicaid |
$305.68
|
| Rate for Payer: Mclaren Medicare |
$558.83
|
| Rate for Payer: Meridian Medicaid |
$320.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$631.35
|
| Rate for Payer: PACE Medicare |
$530.89
|
| Rate for Payer: PACE SWMI |
$558.83
|
| Rate for Payer: PHP Commercial |
$631.35
|
| Rate for Payer: PHP Medicare Advantage |
$558.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$519.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,757.43
|
| Rate for Payer: Priority Health Medicare |
$558.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,405.94
|
| Rate for Payer: Priority Health SBD |
$467.95
|
| Rate for Payer: Railroad Medicare Medicare |
$558.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.83
|
| Rate for Payer: UHC Exchange |
$107.73
|
| Rate for Payer: UHC Medicare Advantage |
$575.59
|
| Rate for Payer: VA VA |
$558.83
|
|
|
HC NAIL PROCEDURE
|
Facility
|
IP
|
$266.48
|
|
| Hospital Charge Code |
45000047
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$167.88 |
| Max. Negotiated Rate |
$239.83 |
| Rate for Payer: Aetna Commercial |
$226.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.21
|
| Rate for Payer: Cash Price |
$213.18
|
| Rate for Payer: Cofinity Commercial |
$186.54
|
| Rate for Payer: Cofinity Commercial |
$229.17
|
| Rate for Payer: Healthscope Commercial |
$239.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$226.51
|
| Rate for Payer: PHP Commercial |
$226.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.54
|
| Rate for Payer: Priority Health SBD |
$167.88
|
|
|
HC NAIL PROCEDURE
|
Facility
|
OP
|
$266.48
|
|
| Hospital Charge Code |
45000047
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$106.59 |
| Max. Negotiated Rate |
$239.83 |
| Rate for Payer: Aetna Commercial |
$226.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.21
|
| Rate for Payer: BCBS Complete |
$106.59
|
| Rate for Payer: Cash Price |
$213.18
|
| Rate for Payer: Cofinity Commercial |
$186.54
|
| Rate for Payer: Cofinity Commercial |
$229.17
|
| Rate for Payer: Healthscope Commercial |
$239.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$226.51
|
| Rate for Payer: PHP Commercial |
$226.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.54
|
| Rate for Payer: Priority Health SBD |
$167.88
|
|
|
HC NA PHOSPHATE PER MCI
|
Facility
|
IP
|
$321.66
|
|
|
Service Code
|
HCPCS A9563
|
| Hospital Charge Code |
34400004
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$202.65 |
| Max. Negotiated Rate |
$289.49 |
| Rate for Payer: Aetna Commercial |
$273.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.08
|
| Rate for Payer: Cash Price |
$257.33
|
| Rate for Payer: Cofinity Commercial |
$225.16
|
| Rate for Payer: Cofinity Commercial |
$276.63
|
| Rate for Payer: Healthscope Commercial |
$289.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$273.41
|
| Rate for Payer: PHP Commercial |
$273.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.16
|
| Rate for Payer: Priority Health SBD |
$202.65
|
|
|
HC NA PHOSPHATE PER MCI
|
Facility
|
OP
|
$321.66
|
|
|
Service Code
|
HCPCS A9563
|
| Hospital Charge Code |
34400004
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$289.49 |
| Rate for Payer: Aetna Commercial |
$273.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.08
|
| Rate for Payer: BCBS Complete |
$128.66
|
| Rate for Payer: BCBS Trust/PPO |
$38.57
|
| Rate for Payer: Cash Price |
$257.33
|
| Rate for Payer: Cash Price |
$257.33
|
| Rate for Payer: Cofinity Commercial |
$225.16
|
| Rate for Payer: Cofinity Commercial |
$276.63
|
| Rate for Payer: Healthscope Commercial |
$289.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$273.41
|
| Rate for Payer: PHP Commercial |
$273.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.16
|
| Rate for Payer: Priority Health SBD |
$202.65
|
|
|
HC NASAL BONES COMP MIN 3 VW
|
Facility
|
OP
|
$194.91
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
32000011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.00 |
| Max. Negotiated Rate |
$251.86 |
| Rate for Payer: Aetna Commercial |
$165.67
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.08
|
| Rate for Payer: BCBS Complete |
$46.45
|
| Rate for Payer: BCBS MAPPO |
$80.86
|
| Rate for Payer: BCBS Trust/PPO |
$49.65
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$155.93
|
| Rate for Payer: Cash Price |
$155.93
|
| Rate for Payer: Cofinity Commercial |
$167.62
|
| Rate for Payer: Cofinity Commercial |
$136.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$175.42
|
| Rate for Payer: Mclaren Medicaid |
$44.23
|
| Rate for Payer: Mclaren Medicare |
$80.86
|
| Rate for Payer: Meridian Medicaid |
$46.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.67
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$165.67
|
| Rate for Payer: PHP Medicare Advantage |
$80.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$251.86
|
| Rate for Payer: Priority Health Medicare |
$80.86
|
| Rate for Payer: Priority Health Narrow Network |
$201.49
|
| Rate for Payer: Priority Health SBD |
$122.79
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$37.00
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC NASAL BONES COMP MIN 3 VW
|
Facility
|
IP
|
$194.91
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
32000011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$122.79 |
| Max. Negotiated Rate |
$175.42 |
| Rate for Payer: Aetna Commercial |
$165.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.69
|
| Rate for Payer: Cash Price |
$155.93
|
| Rate for Payer: Cofinity Commercial |
$136.44
|
| Rate for Payer: Cofinity Commercial |
$167.62
|
| Rate for Payer: Healthscope Commercial |
$175.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.67
|
| Rate for Payer: PHP Commercial |
$165.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.44
|
| Rate for Payer: Priority Health SBD |
$122.79
|
|
|
HC NASAL ENDOSCOPY DX
|
Facility
|
OP
|
$250.88
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
76100183
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.60 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: Aetna Commercial |
$213.25
|
| Rate for Payer: Aetna Medicare |
$183.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$220.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$220.31
|
| Rate for Payer: BCBS Complete |
$101.24
|
| Rate for Payer: BCBS MAPPO |
$176.25
|
| Rate for Payer: BCBS Trust/PPO |
$55.60
|
| Rate for Payer: BCN Medicare Advantage |
$176.25
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cofinity Commercial |
$175.62
|
| Rate for Payer: Cofinity Commercial |
$215.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.25
|
| Rate for Payer: Healthscope Commercial |
$225.79
|
| Rate for Payer: Mclaren Medicaid |
$96.41
|
| Rate for Payer: Mclaren Medicare |
$176.25
|
| Rate for Payer: Meridian Medicaid |
$101.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$185.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$202.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$213.25
|
| Rate for Payer: PACE Medicare |
$167.44
|
| Rate for Payer: PACE SWMI |
$176.25
|
| Rate for Payer: PHP Commercial |
$213.25
|
| Rate for Payer: PHP Medicare Advantage |
$176.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$536.00
|
| Rate for Payer: Priority Health Medicare |
$176.25
|
| Rate for Payer: Priority Health Narrow Network |
$428.80
|
| Rate for Payer: Priority Health SBD |
$158.05
|
| Rate for Payer: Railroad Medicare Medicare |
$176.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.25
|
| Rate for Payer: UHC Exchange |
$63.20
|
| Rate for Payer: UHC Medicare Advantage |
$181.54
|
| Rate for Payer: VA VA |
$176.25
|
|
|
HC NASAL ENDOSCOPY DX
|
Facility
|
IP
|
$250.88
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
76100183
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.05 |
| Max. Negotiated Rate |
$225.79 |
| Rate for Payer: Aetna Commercial |
$213.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.07
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cofinity Commercial |
$175.62
|
| Rate for Payer: Cofinity Commercial |
$215.76
|
| Rate for Payer: Healthscope Commercial |
$225.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$213.25
|
| Rate for Payer: PHP Commercial |
$213.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.62
|
| Rate for Payer: Priority Health SBD |
$158.05
|
|
|
HC NASAL/SINUS ENDSC SURG W/BX POLYPEC/DBRD SPX
|
Facility
|
OP
|
$4,350.00
|
|
|
Service Code
|
CPT 31237
|
| Hospital Charge Code |
76100454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.84 |
| Max. Negotiated Rate |
$4,793.34 |
| Rate for Payer: Aetna Commercial |
$3,697.50
|
| Rate for Payer: Aetna Medicare |
$1,570.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,827.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,887.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,887.76
|
| Rate for Payer: BCBS Complete |
$867.46
|
| Rate for Payer: BCBS MAPPO |
$1,510.21
|
| Rate for Payer: BCBS Trust/PPO |
$759.35
|
| Rate for Payer: BCN Medicare Advantage |
$1,510.21
|
| Rate for Payer: Cash Price |
$3,480.00
|
| Rate for Payer: Cash Price |
$3,480.00
|
| Rate for Payer: Cofinity Commercial |
$3,741.00
|
| Rate for Payer: Cofinity Commercial |
$3,045.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,510.21
|
| Rate for Payer: Healthscope Commercial |
$3,915.00
|
| Rate for Payer: Mclaren Medicaid |
$826.08
|
| Rate for Payer: Mclaren Medicare |
$1,510.21
|
| Rate for Payer: Meridian Medicaid |
$867.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,585.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,736.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,697.50
|
| Rate for Payer: PACE Medicare |
$1,434.70
|
| Rate for Payer: PACE SWMI |
$1,510.21
|
| Rate for Payer: PHP Commercial |
$3,697.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,510.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$826.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,045.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,793.34
|
| Rate for Payer: Priority Health Medicare |
$1,510.21
|
| Rate for Payer: Priority Health Narrow Network |
$3,834.67
|
| Rate for Payer: Priority Health SBD |
$2,740.50
|
| Rate for Payer: Railroad Medicare Medicare |
$1,510.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,510.21
|
| Rate for Payer: UHC Exchange |
$156.84
|
| Rate for Payer: UHC Medicare Advantage |
$1,555.52
|
| Rate for Payer: VA VA |
$1,510.21
|
|
|
HC NASAL/SINUS ENDSC SURG W/BX POLYPEC/DBRD SPX
|
Facility
|
IP
|
$4,350.00
|
|
|
Service Code
|
CPT 31237
|
| Hospital Charge Code |
76100454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,740.50 |
| Max. Negotiated Rate |
$3,915.00 |
| Rate for Payer: Aetna Commercial |
$3,697.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,827.50
|
| Rate for Payer: Cash Price |
$3,480.00
|
| Rate for Payer: Cofinity Commercial |
$3,045.00
|
| Rate for Payer: Cofinity Commercial |
$3,741.00
|
| Rate for Payer: Healthscope Commercial |
$3,915.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,697.50
|
| Rate for Payer: PHP Commercial |
$3,697.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,045.00
|
| Rate for Payer: Priority Health SBD |
$2,740.50
|
|
|
HC NASOPHARYNGOSCOPY
|
Facility
|
IP
|
$250.88
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
76100177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.05 |
| Max. Negotiated Rate |
$225.79 |
| Rate for Payer: Aetna Commercial |
$213.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.07
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cofinity Commercial |
$175.62
|
| Rate for Payer: Cofinity Commercial |
$215.76
|
| Rate for Payer: Healthscope Commercial |
$225.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$213.25
|
| Rate for Payer: PHP Commercial |
$213.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.62
|
| Rate for Payer: Priority Health SBD |
$158.05
|
|
|
HC NASOPHARYNGOSCOPY
|
Facility
|
OP
|
$250.88
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
76100177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.00 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: Aetna Commercial |
$213.25
|
| Rate for Payer: Aetna Medicare |
$183.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$220.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$220.31
|
| Rate for Payer: BCBS Complete |
$101.24
|
| Rate for Payer: BCBS MAPPO |
$176.25
|
| Rate for Payer: BCBS Trust/PPO |
$356.47
|
| Rate for Payer: BCN Medicare Advantage |
$176.25
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cofinity Commercial |
$215.76
|
| Rate for Payer: Cofinity Commercial |
$175.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.25
|
| Rate for Payer: Healthscope Commercial |
$225.79
|
| Rate for Payer: Mclaren Medicaid |
$96.41
|
| Rate for Payer: Mclaren Medicare |
$176.25
|
| Rate for Payer: Meridian Medicaid |
$101.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$185.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$202.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$213.25
|
| Rate for Payer: PACE Medicare |
$167.44
|
| Rate for Payer: PACE SWMI |
$176.25
|
| Rate for Payer: PHP Commercial |
$213.25
|
| Rate for Payer: PHP Medicare Advantage |
$176.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$536.00
|
| Rate for Payer: Priority Health Medicare |
$176.25
|
| Rate for Payer: Priority Health Narrow Network |
$428.80
|
| Rate for Payer: Priority Health SBD |
$158.05
|
| Rate for Payer: Railroad Medicare Medicare |
$176.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.25
|
| Rate for Payer: UHC Exchange |
$37.00
|
| Rate for Payer: UHC Medicare Advantage |
$181.54
|
| Rate for Payer: VA VA |
$176.25
|
|
|
HC NASOTRACHEAL SUCTION
|
Facility
|
OP
|
$243.69
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
41000001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$46.82 |
| Max. Negotiated Rate |
$585.27 |
| Rate for Payer: Aetna Commercial |
$207.14
|
| Rate for Payer: Aetna Medicare |
$197.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$237.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$237.22
|
| Rate for Payer: BCBS Complete |
$109.01
|
| Rate for Payer: BCBS MAPPO |
$189.78
|
| Rate for Payer: BCBS Trust/PPO |
$84.37
|
| Rate for Payer: BCN Medicare Advantage |
$189.78
|
| Rate for Payer: Cash Price |
$194.95
|
| Rate for Payer: Cash Price |
$194.95
|
| Rate for Payer: Cofinity Commercial |
$209.57
|
| Rate for Payer: Cofinity Commercial |
$170.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.78
|
| Rate for Payer: Healthscope Commercial |
$219.32
|
| Rate for Payer: Mclaren Medicaid |
$103.81
|
| Rate for Payer: Mclaren Medicare |
$189.78
|
| Rate for Payer: Meridian Medicaid |
$109.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$199.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.14
|
| Rate for Payer: PACE Medicare |
$180.29
|
| Rate for Payer: PACE SWMI |
$189.78
|
| Rate for Payer: PHP Commercial |
$207.14
|
| Rate for Payer: PHP Medicare Advantage |
$189.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$585.27
|
| Rate for Payer: Priority Health Medicare |
$189.78
|
| Rate for Payer: Priority Health Narrow Network |
$468.22
|
| Rate for Payer: Priority Health SBD |
$153.52
|
| Rate for Payer: Railroad Medicare Medicare |
$189.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.78
|
| Rate for Payer: UHC Exchange |
$46.82
|
| Rate for Payer: UHC Medicare Advantage |
$195.47
|
| Rate for Payer: VA VA |
$189.78
|
|
|
HC NASOTRACHEAL SUCTION
|
Facility
|
IP
|
$243.69
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
41000001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$153.52 |
| Max. Negotiated Rate |
$219.32 |
| Rate for Payer: Aetna Commercial |
$207.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.40
|
| Rate for Payer: Cash Price |
$194.95
|
| Rate for Payer: Cofinity Commercial |
$170.58
|
| Rate for Payer: Cofinity Commercial |
$209.57
|
| Rate for Payer: Healthscope Commercial |
$219.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.14
|
| Rate for Payer: PHP Commercial |
$207.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.58
|
| Rate for Payer: Priority Health SBD |
$153.52
|
|
|
HC NCCU OBSERVATION PER HOUR
|
Facility
|
IP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200021
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$84.63 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.31
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Cofinity Commercial |
$94.03
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health SBD |
$84.63
|
|
|
HC NCCU OBSERVATION PER HOUR
|
Facility
|
OP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200021
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$53.73 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.31
|
| Rate for Payer: BCBS Complete |
$53.73
|
| Rate for Payer: BCBS Trust/PPO |
$108.91
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$94.03
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Meridian Medicaid |
$1,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health SBD |
$84.63
|
|
|
HC NCS 11-12 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$2,232.45
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
92200032
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,406.44 |
| Max. Negotiated Rate |
$2,009.20 |
| Rate for Payer: Aetna Commercial |
$1,897.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,451.09
|
| Rate for Payer: Cash Price |
$1,785.96
|
| Rate for Payer: Cofinity Commercial |
$1,562.72
|
| Rate for Payer: Cofinity Commercial |
$1,919.91
|
| Rate for Payer: Healthscope Commercial |
$2,009.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,897.58
|
| Rate for Payer: PHP Commercial |
$1,897.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,562.72
|
| Rate for Payer: Priority Health SBD |
$1,406.44
|
|
|
HC NCS 11-12 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$2,232.45
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
92200032
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$242.31 |
| Max. Negotiated Rate |
$2,009.20 |
| Rate for Payer: Aetna Commercial |
$1,897.58
|
| Rate for Payer: Aetna Medicare |
$495.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,451.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$596.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$596.14
|
| Rate for Payer: BCBS Complete |
$273.94
|
| Rate for Payer: BCBS MAPPO |
$476.91
|
| Rate for Payer: BCBS Trust/PPO |
$426.76
|
| Rate for Payer: BCN Medicare Advantage |
$476.91
|
| Rate for Payer: Cash Price |
$1,785.96
|
| Rate for Payer: Cash Price |
$1,785.96
|
| Rate for Payer: Cofinity Commercial |
$1,919.91
|
| Rate for Payer: Cofinity Commercial |
$1,562.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.91
|
| Rate for Payer: Healthscope Commercial |
$2,009.20
|
| Rate for Payer: Mclaren Medicaid |
$260.87
|
| Rate for Payer: Mclaren Medicare |
$476.91
|
| Rate for Payer: Meridian Medicaid |
$273.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$500.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$548.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,897.58
|
| Rate for Payer: PACE Medicare |
$453.06
|
| Rate for Payer: PACE SWMI |
$476.91
|
| Rate for Payer: PHP Commercial |
$1,897.58
|
| Rate for Payer: PHP Medicare Advantage |
$476.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,562.72
|
| Rate for Payer: Priority Health Medicare |
$476.91
|
| Rate for Payer: Priority Health SBD |
$1,406.44
|
| Rate for Payer: Railroad Medicare Medicare |
$476.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$476.91
|
| Rate for Payer: UHC Exchange |
$242.31
|
| Rate for Payer: UHC Medicare Advantage |
$491.22
|
| Rate for Payer: VA VA |
$476.91
|
|
|
HC NCS 1-2 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$484.65
|
|
|
Service Code
|
CPT 95907
|
| Hospital Charge Code |
92200027
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$76.03 |
| Max. Negotiated Rate |
$436.18 |
| Rate for Payer: Aetna Commercial |
$411.95
|
| Rate for Payer: Aetna Medicare |
$144.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.74
|
| Rate for Payer: BCBS Complete |
$79.84
|
| Rate for Payer: BCBS MAPPO |
$138.99
|
| Rate for Payer: BCBS Trust/PPO |
$173.47
|
| Rate for Payer: BCN Medicare Advantage |
$138.99
|
| Rate for Payer: Cash Price |
$387.72
|
| Rate for Payer: Cash Price |
$387.72
|
| Rate for Payer: Cofinity Commercial |
$416.80
|
| Rate for Payer: Cofinity Commercial |
$339.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.99
|
| Rate for Payer: Healthscope Commercial |
$436.18
|
| Rate for Payer: Mclaren Medicaid |
$76.03
|
| Rate for Payer: Mclaren Medicare |
$138.99
|
| Rate for Payer: Meridian Medicaid |
$79.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$411.95
|
| Rate for Payer: PACE Medicare |
$132.04
|
| Rate for Payer: PACE SWMI |
$138.99
|
| Rate for Payer: PHP Commercial |
$411.95
|
| Rate for Payer: PHP Medicare Advantage |
$138.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$436.07
|
| Rate for Payer: Priority Health Medicare |
$138.99
|
| Rate for Payer: Priority Health Narrow Network |
$348.85
|
| Rate for Payer: Priority Health SBD |
$305.33
|
| Rate for Payer: Railroad Medicare Medicare |
$138.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.99
|
| Rate for Payer: UHC Exchange |
$88.41
|
| Rate for Payer: UHC Medicare Advantage |
$143.16
|
| Rate for Payer: VA VA |
$138.99
|
|
|
HC NCS 1-2 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$484.65
|
|
|
Service Code
|
CPT 95907
|
| Hospital Charge Code |
92200027
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$305.33 |
| Max. Negotiated Rate |
$436.18 |
| Rate for Payer: Aetna Commercial |
$411.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.02
|
| Rate for Payer: Cash Price |
$387.72
|
| Rate for Payer: Cofinity Commercial |
$339.26
|
| Rate for Payer: Cofinity Commercial |
$416.80
|
| Rate for Payer: Healthscope Commercial |
$436.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$411.95
|
| Rate for Payer: PHP Commercial |
$411.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.26
|
| Rate for Payer: Priority Health SBD |
$305.33
|
|
|
HC NCS 13 OR MORE STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$2,896.50
|
|
|
Service Code
|
CPT 95913
|
| Hospital Charge Code |
92200033
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,824.80 |
| Max. Negotiated Rate |
$2,606.85 |
| Rate for Payer: Aetna Commercial |
$2,462.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,882.72
|
| Rate for Payer: Cash Price |
$2,317.20
|
| Rate for Payer: Cofinity Commercial |
$2,027.55
|
| Rate for Payer: Cofinity Commercial |
$2,490.99
|
| Rate for Payer: Healthscope Commercial |
$2,606.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,462.02
|
| Rate for Payer: PHP Commercial |
$2,462.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,027.55
|
| Rate for Payer: Priority Health SBD |
$1,824.80
|
|
