|
HC HDR 2-12 CHANNELS
|
Facility
|
IP
|
$2,254.25
|
|
|
Service Code
|
CPT 77771
|
| Hospital Charge Code |
33300056
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,420.18 |
| Max. Negotiated Rate |
$2,028.83 |
| Rate for Payer: Aetna Commercial |
$1,916.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,465.26
|
| Rate for Payer: Cash Price |
$1,803.40
|
| Rate for Payer: Cofinity Advantage |
$1,577.97
|
| Rate for Payer: Cofinity Commercial |
$1,938.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,803.40
|
| Rate for Payer: Healthscope Commercial |
$2,028.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,916.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,690.69
|
| Rate for Payer: PHP Commercial |
$1,916.11
|
| Rate for Payer: Priority Health SBD |
$1,420.18
|
|
|
HC HDR IR 192 BRACHY SOURCE NSTRD
|
Facility
|
OP
|
$573.66
|
|
|
Service Code
|
HCPCS C1717
|
| Hospital Charge Code |
27800090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$182.34 |
| Max. Negotiated Rate |
$1,127.50 |
| Rate for Payer: Aetna Commercial |
$487.61
|
| Rate for Payer: Aetna Medicare |
$362.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.81
|
| Rate for Payer: BCBS Complete |
$191.48
|
| Rate for Payer: BCBS MAPPO |
$348.65
|
| Rate for Payer: BCN Medicare Advantage |
$348.65
|
| Rate for Payer: Cash Price |
$458.93
|
| Rate for Payer: Cash Price |
$458.93
|
| Rate for Payer: Cofinity Advantage |
$401.56
|
| Rate for Payer: Cofinity Commercial |
$493.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.65
|
| Rate for Payer: Healthscope Commercial |
$516.29
|
| Rate for Payer: Mclaren Medicaid |
$182.34
|
| Rate for Payer: Mclaren Medicare |
$348.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$366.08
|
| Rate for Payer: Meridian Medicaid |
$366.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$383.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$487.61
|
| Rate for Payer: Nomi Health Commercial |
$1,045.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$430.25
|
| Rate for Payer: PACE Medicare |
$331.22
|
| Rate for Payer: PACE SWMI |
$348.65
|
| Rate for Payer: PHP Commercial |
$487.61
|
| Rate for Payer: PHP Medicare Advantage |
$348.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$182.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,127.50
|
| Rate for Payer: Priority Health Medicare |
$348.65
|
| Rate for Payer: Priority Health SBD |
$361.41
|
| Rate for Payer: Priority Health Tiered Network |
$902.00
|
| Rate for Payer: Railroad Medicare Medicare |
$348.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$372.88
|
| Rate for Payer: UHC Core |
$298.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$348.65
|
| Rate for Payer: UHC Exchange |
$225.45
|
| Rate for Payer: UHC Medicaid |
$182.34
|
| Rate for Payer: UHCCP Medicaid |
$182.34
|
| Rate for Payer: VA VA |
$348.65
|
|
|
HC HDR IR 192 BRACHY SOURCE NSTRD
|
Facility
|
IP
|
$573.66
|
|
|
Service Code
|
HCPCS C1717
|
| Hospital Charge Code |
27800090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$361.41 |
| Max. Negotiated Rate |
$516.29 |
| Rate for Payer: Aetna Commercial |
$487.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.88
|
| Rate for Payer: Cash Price |
$458.93
|
| Rate for Payer: Cofinity Advantage |
$401.56
|
| Rate for Payer: Cofinity Commercial |
$493.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.93
|
| Rate for Payer: Healthscope Commercial |
$516.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$487.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$430.25
|
| Rate for Payer: PHP Commercial |
$487.61
|
| Rate for Payer: Priority Health SBD |
$361.41
|
|
|
HC HDR OVER 12 CHANNELS
|
Facility
|
OP
|
$2,487.67
|
|
|
Service Code
|
CPT 77772
|
| Hospital Charge Code |
33300057
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$362.95 |
| Max. Negotiated Rate |
$2,244.23 |
| Rate for Payer: Aetna Commercial |
$2,114.52
|
| Rate for Payer: Aetna Medicare |
$721.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,616.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$867.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$867.46
|
| Rate for Payer: BCBS Complete |
$381.13
|
| Rate for Payer: BCBS MAPPO |
$693.97
|
| Rate for Payer: BCBS Trust/PPO |
$507.13
|
| Rate for Payer: BCN Commercial |
$507.13
|
| Rate for Payer: BCN Medicare Advantage |
$693.97
|
| Rate for Payer: Cash Price |
$1,990.14
|
| Rate for Payer: Cash Price |
$1,990.14
|
| Rate for Payer: Cash Price |
$1,990.14
|
| Rate for Payer: Cofinity Advantage |
$1,741.37
|
| Rate for Payer: Cofinity Commercial |
$2,139.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,990.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$693.97
|
| Rate for Payer: Healthscope Commercial |
$2,238.90
|
| Rate for Payer: Mclaren Medicaid |
$362.95
|
| Rate for Payer: Mclaren Medicare |
$693.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$728.67
|
| Rate for Payer: Meridian Medicaid |
$728.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$798.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$763.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,114.52
|
| Rate for Payer: Nomi Health Commercial |
$2,081.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,865.75
|
| Rate for Payer: PACE Medicare |
$659.27
|
| Rate for Payer: PACE SWMI |
$693.97
|
| Rate for Payer: PHP Commercial |
$2,114.52
|
| Rate for Payer: PHP Medicare Advantage |
$693.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,244.23
|
| Rate for Payer: Priority Health Medicare |
$693.97
|
| Rate for Payer: Priority Health SBD |
$1,567.23
|
| Rate for Payer: Priority Health Tiered Network |
$1,795.38
|
| Rate for Payer: Railroad Medicare Medicare |
$693.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,616.99
|
| Rate for Payer: UHC Core |
$1,296.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$693.97
|
| Rate for Payer: UHC Exchange |
$977.65
|
| Rate for Payer: UHC Medicaid |
$362.95
|
| Rate for Payer: UHCCP Medicaid |
$362.95
|
| Rate for Payer: VA VA |
$693.97
|
|
|
HC HDR OVER 12 CHANNELS
|
Facility
|
IP
|
$2,487.67
|
|
|
Service Code
|
CPT 77772
|
| Hospital Charge Code |
33300057
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,567.23 |
| Max. Negotiated Rate |
$2,238.90 |
| Rate for Payer: Aetna Commercial |
$2,114.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,616.99
|
| Rate for Payer: Cash Price |
$1,990.14
|
| Rate for Payer: Cofinity Advantage |
$1,741.37
|
| Rate for Payer: Cofinity Commercial |
$2,139.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,990.14
|
| Rate for Payer: Healthscope Commercial |
$2,238.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,114.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,865.75
|
| Rate for Payer: PHP Commercial |
$2,114.52
|
| Rate for Payer: Priority Health SBD |
$1,567.23
|
|
|
HC HDR SKIN SURFACE 1 CHANNEL
|
Facility
|
IP
|
$491.40
|
|
|
Service Code
|
CPT 77767
|
| Hospital Charge Code |
33300053
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$309.58 |
| Max. Negotiated Rate |
$442.26 |
| Rate for Payer: Aetna Commercial |
$417.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.41
|
| Rate for Payer: Cash Price |
$393.12
|
| Rate for Payer: Cofinity Advantage |
$343.98
|
| Rate for Payer: Cofinity Commercial |
$422.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.12
|
| Rate for Payer: Healthscope Commercial |
$442.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$417.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$368.55
|
| Rate for Payer: PHP Commercial |
$417.69
|
| Rate for Payer: Priority Health SBD |
$309.58
|
|
|
HC HDR SKIN SURFACE 1 CHANNEL
|
Facility
|
OP
|
$491.40
|
|
|
Service Code
|
CPT 77767
|
| Hospital Charge Code |
33300053
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$140.41 |
| Max. Negotiated Rate |
$1,242.83 |
| Rate for Payer: Aetna Commercial |
$417.69
|
| Rate for Payer: Aetna Medicare |
$399.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$480.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$480.39
|
| Rate for Payer: BCBS Complete |
$211.06
|
| Rate for Payer: BCBS MAPPO |
$384.31
|
| Rate for Payer: BCBS Trust/PPO |
$140.41
|
| Rate for Payer: BCN Commercial |
$140.41
|
| Rate for Payer: BCN Medicare Advantage |
$384.31
|
| Rate for Payer: Cash Price |
$393.12
|
| Rate for Payer: Cash Price |
$393.12
|
| Rate for Payer: Cash Price |
$393.12
|
| Rate for Payer: Cofinity Advantage |
$343.98
|
| Rate for Payer: Cofinity Commercial |
$422.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$384.31
|
| Rate for Payer: Healthscope Commercial |
$442.26
|
| Rate for Payer: Mclaren Medicaid |
$200.99
|
| Rate for Payer: Mclaren Medicare |
$384.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$403.53
|
| Rate for Payer: Meridian Medicaid |
$403.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$441.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$422.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$417.69
|
| Rate for Payer: Nomi Health Commercial |
$1,152.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$368.55
|
| Rate for Payer: PACE Medicare |
$365.09
|
| Rate for Payer: PACE SWMI |
$384.31
|
| Rate for Payer: PHP Commercial |
$417.69
|
| Rate for Payer: PHP Medicare Advantage |
$384.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,242.83
|
| Rate for Payer: Priority Health Medicare |
$384.31
|
| Rate for Payer: Priority Health SBD |
$309.58
|
| Rate for Payer: Priority Health Tiered Network |
$994.26
|
| Rate for Payer: Railroad Medicare Medicare |
$384.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$319.41
|
| Rate for Payer: UHC Core |
$256.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$384.31
|
| Rate for Payer: UHC Exchange |
$193.12
|
| Rate for Payer: UHC Medicaid |
$200.99
|
| Rate for Payer: UHCCP Medicaid |
$200.99
|
| Rate for Payer: VA VA |
$384.31
|
|
|
HC HDR SKIN SURFACE 2 OR MORE CHANNELS
|
Facility
|
OP
|
$552.83
|
|
|
Service Code
|
CPT 77768
|
| Hospital Charge Code |
33300054
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$140.41 |
| Max. Negotiated Rate |
$1,242.83 |
| Rate for Payer: Aetna Commercial |
$469.91
|
| Rate for Payer: Aetna Medicare |
$399.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$359.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$480.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$480.39
|
| Rate for Payer: BCBS Complete |
$211.06
|
| Rate for Payer: BCBS MAPPO |
$384.31
|
| Rate for Payer: BCBS Trust/PPO |
$140.41
|
| Rate for Payer: BCN Commercial |
$140.41
|
| Rate for Payer: BCN Medicare Advantage |
$384.31
|
| Rate for Payer: Cash Price |
$442.26
|
| Rate for Payer: Cash Price |
$442.26
|
| Rate for Payer: Cash Price |
$442.26
|
| Rate for Payer: Cofinity Advantage |
$386.98
|
| Rate for Payer: Cofinity Commercial |
$475.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$442.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$384.31
|
| Rate for Payer: Healthscope Commercial |
$497.55
|
| Rate for Payer: Mclaren Medicaid |
$200.99
|
| Rate for Payer: Mclaren Medicare |
$384.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$403.53
|
| Rate for Payer: Meridian Medicaid |
$403.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$441.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$422.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.91
|
| Rate for Payer: Nomi Health Commercial |
$1,152.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$414.62
|
| Rate for Payer: PACE Medicare |
$365.09
|
| Rate for Payer: PACE SWMI |
$384.31
|
| Rate for Payer: PHP Commercial |
$469.91
|
| Rate for Payer: PHP Medicare Advantage |
$384.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,242.83
|
| Rate for Payer: Priority Health Medicare |
$384.31
|
| Rate for Payer: Priority Health SBD |
$348.28
|
| Rate for Payer: Priority Health Tiered Network |
$994.26
|
| Rate for Payer: Railroad Medicare Medicare |
$384.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$359.34
|
| Rate for Payer: UHC Core |
$288.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$384.31
|
| Rate for Payer: UHC Exchange |
$217.26
|
| Rate for Payer: UHC Medicaid |
$200.99
|
| Rate for Payer: UHCCP Medicaid |
$200.99
|
| Rate for Payer: VA VA |
$384.31
|
|
|
HC HDR SKIN SURFACE 2 OR MORE CHANNELS
|
Facility
|
IP
|
$552.83
|
|
|
Service Code
|
CPT 77768
|
| Hospital Charge Code |
33300054
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$348.28 |
| Max. Negotiated Rate |
$497.55 |
| Rate for Payer: Aetna Commercial |
$469.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$359.34
|
| Rate for Payer: Cash Price |
$442.26
|
| Rate for Payer: Cofinity Advantage |
$386.98
|
| Rate for Payer: Cofinity Commercial |
$475.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$442.26
|
| Rate for Payer: Healthscope Commercial |
$497.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$414.62
|
| Rate for Payer: PHP Commercial |
$469.91
|
| Rate for Payer: Priority Health SBD |
$348.28
|
|
|
HC HEALTH & BEHAV ASSESS OR REASSESS
|
Facility
|
OP
|
$125.23
|
|
|
Service Code
|
CPT 96156
|
| Hospital Charge Code |
91400009
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$52.94 |
| Max. Negotiated Rate |
$327.36 |
| Rate for Payer: Aetna Commercial |
$106.45
|
| Rate for Payer: Aetna Medicare |
$105.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$126.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$126.53
|
| Rate for Payer: BCBS Complete |
$55.59
|
| Rate for Payer: BCBS MAPPO |
$101.22
|
| Rate for Payer: BCN Medicare Advantage |
$101.22
|
| Rate for Payer: Cash Price |
$100.18
|
| Rate for Payer: Cash Price |
$100.18
|
| Rate for Payer: Cofinity Advantage |
$87.66
|
| Rate for Payer: Cofinity Commercial |
$107.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.22
|
| Rate for Payer: Healthscope Commercial |
$112.71
|
| Rate for Payer: Mclaren Medicaid |
$52.94
|
| Rate for Payer: Mclaren Medicare |
$101.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.28
|
| Rate for Payer: Meridian Medicaid |
$106.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.45
|
| Rate for Payer: Nomi Health Commercial |
$303.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.92
|
| Rate for Payer: PACE Medicare |
$96.16
|
| Rate for Payer: PACE SWMI |
$101.22
|
| Rate for Payer: PHP Commercial |
$106.45
|
| Rate for Payer: PHP Medicare Advantage |
$101.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$327.36
|
| Rate for Payer: Priority Health Medicare |
$101.22
|
| Rate for Payer: Priority Health SBD |
$78.89
|
| Rate for Payer: Priority Health Tiered Network |
$261.89
|
| Rate for Payer: Railroad Medicare Medicare |
$101.22
|
| Rate for Payer: UHC Medicaid |
$52.94
|
| Rate for Payer: UHCCP Medicaid |
$52.94
|
| Rate for Payer: VA VA |
$101.22
|
|
|
HC HEALTH & BEHAV ASSESS OR REASSESS
|
Facility
|
IP
|
$125.23
|
|
|
Service Code
|
CPT 96156
|
| Hospital Charge Code |
91400009
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$78.89 |
| Max. Negotiated Rate |
$112.71 |
| Rate for Payer: Cash Price |
$100.18
|
| Rate for Payer: Aetna Commercial |
$106.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.40
|
| Rate for Payer: Cofinity Advantage |
$87.66
|
| Rate for Payer: Cofinity Commercial |
$107.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.18
|
| Rate for Payer: Healthscope Commercial |
$112.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.92
|
| Rate for Payer: PHP Commercial |
$106.45
|
| Rate for Payer: Priority Health SBD |
$78.89
|
|
|
HC HEALTH & BEHAV INTERVENT INDIV EA ADD 15 MIN
|
Facility
|
IP
|
$62.61
|
|
|
Service Code
|
CPT 96159
|
| Hospital Charge Code |
91400011
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$39.44 |
| Max. Negotiated Rate |
$56.35 |
| Rate for Payer: Aetna Commercial |
$53.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.70
|
| Rate for Payer: Cash Price |
$50.09
|
| Rate for Payer: Cofinity Advantage |
$43.83
|
| Rate for Payer: Cofinity Commercial |
$53.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.09
|
| Rate for Payer: Healthscope Commercial |
$56.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.96
|
| Rate for Payer: PHP Commercial |
$53.22
|
| Rate for Payer: Priority Health SBD |
$39.44
|
|
|
HC HEALTH & BEHAV INTERVENT INDIV EA ADD 15 MIN
|
Facility
|
OP
|
$62.61
|
|
|
Service Code
|
CPT 96159
|
| Hospital Charge Code |
91400011
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$25.04 |
| Max. Negotiated Rate |
$56.35 |
| Rate for Payer: Aetna Commercial |
$53.22
|
| Rate for Payer: Aetna Medicare |
$31.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.70
|
| Rate for Payer: BCBS Complete |
$25.04
|
| Rate for Payer: Cash Price |
$50.09
|
| Rate for Payer: Cofinity Advantage |
$43.83
|
| Rate for Payer: Cofinity Commercial |
$53.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.09
|
| Rate for Payer: Healthscope Commercial |
$56.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.96
|
| Rate for Payer: PHP Commercial |
$53.22
|
| Rate for Payer: Priority Health SBD |
$39.44
|
|
|
HC HEALTH & BEHAV INTERVENT INDIV INIT 30 MIN
|
Facility
|
OP
|
$125.23
|
|
|
Service Code
|
CPT 96158
|
| Hospital Charge Code |
91400010
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$78.89 |
| Max. Negotiated Rate |
$571.94 |
| Rate for Payer: Aetna Commercial |
$106.45
|
| Rate for Payer: Aetna Medicare |
$183.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$221.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$221.07
|
| Rate for Payer: BCBS Complete |
$97.13
|
| Rate for Payer: BCBS MAPPO |
$176.86
|
| Rate for Payer: BCN Medicare Advantage |
$176.86
|
| Rate for Payer: Cash Price |
$100.18
|
| Rate for Payer: Cash Price |
$100.18
|
| Rate for Payer: Cofinity Advantage |
$87.66
|
| Rate for Payer: Cofinity Commercial |
$107.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.86
|
| Rate for Payer: Healthscope Commercial |
$112.71
|
| Rate for Payer: Mclaren Medicaid |
$92.50
|
| Rate for Payer: Mclaren Medicare |
$176.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.70
|
| Rate for Payer: Meridian Medicaid |
$185.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$203.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$194.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.45
|
| Rate for Payer: Nomi Health Commercial |
$530.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.92
|
| Rate for Payer: PACE Medicare |
$168.02
|
| Rate for Payer: PACE SWMI |
$176.86
|
| Rate for Payer: PHP Commercial |
$106.45
|
| Rate for Payer: PHP Medicare Advantage |
$176.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$571.94
|
| Rate for Payer: Priority Health Medicare |
$176.86
|
| Rate for Payer: Priority Health SBD |
$78.89
|
| Rate for Payer: Priority Health Tiered Network |
$457.55
|
| Rate for Payer: Railroad Medicare Medicare |
$176.86
|
| Rate for Payer: UHC Medicaid |
$92.50
|
| Rate for Payer: UHCCP Medicaid |
$92.50
|
| Rate for Payer: VA VA |
$176.86
|
|
|
HC HEALTH & BEHAV INTERVENT INDIV INIT 30 MIN
|
Facility
|
IP
|
$125.23
|
|
|
Service Code
|
CPT 96158
|
| Hospital Charge Code |
91400010
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$78.89 |
| Max. Negotiated Rate |
$112.71 |
| Rate for Payer: Aetna Commercial |
$106.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.40
|
| Rate for Payer: Cash Price |
$100.18
|
| Rate for Payer: Cofinity Advantage |
$87.66
|
| Rate for Payer: Cofinity Commercial |
$107.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.18
|
| Rate for Payer: Healthscope Commercial |
$112.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.92
|
| Rate for Payer: PHP Commercial |
$106.45
|
| Rate for Payer: Priority Health SBD |
$78.89
|
|
|
HC HEARING AID CHECK BINAURAL
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT 92593
|
| Hospital Charge Code |
76100499
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$24.53 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna Medicare |
$31.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: BCBS Complete |
$24.97
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Advantage |
$43.69
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.81
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health SBD |
$39.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.57
|
| Rate for Payer: UHC Core |
$32.52
|
| Rate for Payer: UHC Exchange |
$24.53
|
|
|
HC HEARING AID CHECK BINAURAL
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT 92593
|
| Hospital Charge Code |
76100499
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$39.32 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Advantage |
$43.69
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.81
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health SBD |
$39.32
|
|
|
HC HEARING AID CHECK MONAURAL
|
Facility
|
IP
|
$55.14
|
|
|
Service Code
|
CPT 92592
|
| Hospital Charge Code |
47100402
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$34.74 |
| Max. Negotiated Rate |
$49.63 |
| Rate for Payer: Aetna Commercial |
$46.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.84
|
| Rate for Payer: Cash Price |
$44.11
|
| Rate for Payer: Cofinity Advantage |
$38.60
|
| Rate for Payer: Cofinity Commercial |
$47.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.11
|
| Rate for Payer: Healthscope Commercial |
$49.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.35
|
| Rate for Payer: PHP Commercial |
$46.87
|
| Rate for Payer: Priority Health SBD |
$34.74
|
|
|
HC HEARING AID CHECK MONAURAL
|
Facility
|
OP
|
$55.14
|
|
|
Service Code
|
CPT 92592
|
| Hospital Charge Code |
47100402
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$21.67 |
| Max. Negotiated Rate |
$49.63 |
| Rate for Payer: Aetna Commercial |
$46.87
|
| Rate for Payer: Aetna Medicare |
$27.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.84
|
| Rate for Payer: BCBS Complete |
$22.06
|
| Rate for Payer: Cash Price |
$44.11
|
| Rate for Payer: Cofinity Advantage |
$38.60
|
| Rate for Payer: Cofinity Commercial |
$47.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.11
|
| Rate for Payer: Healthscope Commercial |
$49.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.35
|
| Rate for Payer: PHP Commercial |
$46.87
|
| Rate for Payer: Priority Health SBD |
$34.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.84
|
| Rate for Payer: UHC Core |
$28.73
|
| Rate for Payer: UHC Exchange |
$21.67
|
|
|
HC HEARING AID EXAM BOTH EARS
|
Facility
|
OP
|
$123.81
|
|
|
Service Code
|
CPT 92591
|
| Hospital Charge Code |
76100504
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$48.66 |
| Max. Negotiated Rate |
$111.43 |
| Rate for Payer: Aetna Commercial |
$105.24
|
| Rate for Payer: Aetna Medicare |
$61.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.48
|
| Rate for Payer: BCBS Complete |
$49.52
|
| Rate for Payer: Cash Price |
$99.05
|
| Rate for Payer: Cofinity Advantage |
$86.67
|
| Rate for Payer: Cofinity Commercial |
$106.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.05
|
| Rate for Payer: Healthscope Commercial |
$111.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.86
|
| Rate for Payer: PHP Commercial |
$105.24
|
| Rate for Payer: Priority Health SBD |
$78.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.48
|
| Rate for Payer: UHC Core |
$64.51
|
| Rate for Payer: UHC Exchange |
$48.66
|
|
|
HC HEARING AID EXAM BOTH EARS
|
Facility
|
IP
|
$123.81
|
|
|
Service Code
|
CPT 92591
|
| Hospital Charge Code |
76100504
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$111.43 |
| Rate for Payer: Aetna Commercial |
$105.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.48
|
| Rate for Payer: Cash Price |
$99.05
|
| Rate for Payer: Cofinity Advantage |
$86.67
|
| Rate for Payer: Cofinity Commercial |
$106.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.05
|
| Rate for Payer: Healthscope Commercial |
$111.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.86
|
| Rate for Payer: PHP Commercial |
$105.24
|
| Rate for Payer: Priority Health SBD |
$78.00
|
|
|
HC HEARING AID EXAM ONE EAR
|
Facility
|
IP
|
$113.40
|
|
|
Service Code
|
CPT 92590
|
| Hospital Charge Code |
76100505
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$71.44 |
| Max. Negotiated Rate |
$102.06 |
| Rate for Payer: Aetna Commercial |
$96.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.71
|
| Rate for Payer: Cash Price |
$90.72
|
| Rate for Payer: Cofinity Advantage |
$79.38
|
| Rate for Payer: Cofinity Commercial |
$97.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.72
|
| Rate for Payer: Healthscope Commercial |
$102.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.05
|
| Rate for Payer: PHP Commercial |
$96.39
|
| Rate for Payer: Priority Health SBD |
$71.44
|
|
|
HC HEARING AID EXAM ONE EAR
|
Facility
|
OP
|
$113.40
|
|
|
Service Code
|
CPT 92590
|
| Hospital Charge Code |
76100505
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$44.57 |
| Max. Negotiated Rate |
$102.06 |
| Rate for Payer: Aetna Commercial |
$96.39
|
| Rate for Payer: Aetna Medicare |
$56.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.71
|
| Rate for Payer: BCBS Complete |
$45.36
|
| Rate for Payer: Cash Price |
$90.72
|
| Rate for Payer: Cofinity Advantage |
$79.38
|
| Rate for Payer: Cofinity Commercial |
$97.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.72
|
| Rate for Payer: Healthscope Commercial |
$102.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.05
|
| Rate for Payer: PHP Commercial |
$96.39
|
| Rate for Payer: Priority Health SBD |
$71.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.71
|
| Rate for Payer: UHC Core |
$59.08
|
| Rate for Payer: UHC Exchange |
$44.57
|
|
|
HC HEART CATH CORONARIES CABG'S
|
Facility
|
IP
|
$12,456.64
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
48100018
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,847.68 |
| Max. Negotiated Rate |
$11,210.98 |
| Rate for Payer: Aetna Commercial |
$10,588.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,096.82
|
| Rate for Payer: Cash Price |
$9,965.31
|
| Rate for Payer: Cofinity Advantage |
$8,719.65
|
| Rate for Payer: Cofinity Commercial |
$10,712.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,965.31
|
| Rate for Payer: Healthscope Commercial |
$11,210.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,588.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,342.48
|
| Rate for Payer: PHP Commercial |
$10,588.14
|
| Rate for Payer: Priority Health SBD |
$7,847.68
|
|
|
HC HEART CATH CORONARIES CABG'S
|
Facility
|
OP
|
$12,456.64
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
48100018
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,689.43 |
| Max. Negotiated Rate |
$11,210.98 |
| Rate for Payer: Aetna Commercial |
$10,588.14
|
| Rate for Payer: Aetna Medicare |
$3,359.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,096.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,037.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,037.84
|
| Rate for Payer: BCBS Complete |
$1,774.06
|
| Rate for Payer: BCBS MAPPO |
$3,230.27
|
| Rate for Payer: BCBS Trust/PPO |
$3,304.40
|
| Rate for Payer: BCN Commercial |
$3,304.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,230.27
|
| Rate for Payer: Cash Price |
$9,965.31
|
| Rate for Payer: Cash Price |
$9,965.31
|
| Rate for Payer: Cofinity Advantage |
$8,719.65
|
| Rate for Payer: Cofinity Commercial |
$10,712.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,965.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,230.27
|
| Rate for Payer: Healthscope Commercial |
$11,210.98
|
| Rate for Payer: Mclaren Medicaid |
$1,689.43
|
| Rate for Payer: Mclaren Medicare |
$3,230.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,391.78
|
| Rate for Payer: Meridian Medicaid |
$3,391.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,714.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,553.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,588.14
|
| Rate for Payer: Nomi Health Commercial |
$9,690.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,342.48
|
| Rate for Payer: PACE Medicare |
$3,068.76
|
| Rate for Payer: PACE SWMI |
$3,230.27
|
| Rate for Payer: PHP Commercial |
$10,588.14
|
| Rate for Payer: PHP Medicare Advantage |
$3,230.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,689.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,446.41
|
| Rate for Payer: Priority Health Medicare |
$3,230.27
|
| Rate for Payer: Priority Health SBD |
$7,847.68
|
| Rate for Payer: Priority Health Tiered Network |
$8,357.13
|
| Rate for Payer: Railroad Medicare Medicare |
$3,230.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,230.27
|
| Rate for Payer: UHC Medicaid |
$1,689.43
|
| Rate for Payer: UHCCP Medicaid |
$1,689.43
|
| Rate for Payer: VA VA |
$3,230.27
|
|
