|
HC HERPES SIMPLEX VIRUS CULTURE
|
Facility
|
IP
|
$104.04
|
|
|
Service Code
|
CPT 87255
|
| Hospital Charge Code |
30600116
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$65.55 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.63
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$72.83
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.63
|
| Rate for Payer: Priority Health SBD |
$65.55
|
|
|
HC HERPES SIMPLEX VIRUS (HSV-2)
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600271
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$52.64 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$31.07
|
| Rate for Payer: BCN Commercial |
$31.07
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$52.64
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.11
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$28.89
|
| Rate for Payer: Priority Health SBD |
$32.77
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$19.76
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC HERPES SIMPLEX VIRUS (HSV-2)
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600271
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health SBD |
$32.77
|
|
|
HC HERPES SIMPLEX VIRUS PCR, BLD
|
Facility
|
IP
|
$48.54
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600340
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$43.69 |
| Rate for Payer: Aetna Commercial |
$41.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.55
|
| Rate for Payer: Cash Price |
$38.83
|
| Rate for Payer: Cofinity Commercial |
$33.98
|
| Rate for Payer: Cofinity Commercial |
$41.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.83
|
| Rate for Payer: Healthscope Commercial |
$43.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.26
|
| Rate for Payer: PHP Commercial |
$41.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.55
|
| Rate for Payer: Priority Health SBD |
$30.58
|
|
|
HC HERPES SIMPLEX VIRUS PCR, BLD
|
Facility
|
OP
|
$48.54
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600340
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$52.64 |
| Rate for Payer: Aetna Commercial |
$41.26
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$31.07
|
| Rate for Payer: BCN Commercial |
$31.07
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$38.83
|
| Rate for Payer: Cash Price |
$38.83
|
| Rate for Payer: Cofinity Commercial |
$41.74
|
| Rate for Payer: Cofinity Commercial |
$33.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$43.69
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.26
|
| Rate for Payer: Nomi Health Commercial |
$52.64
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$41.26
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.11
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$28.89
|
| Rate for Payer: Priority Health SBD |
$30.58
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$19.76
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC HH ALOE VESTA CLEANSER
|
Facility
|
IP
|
$18.07
|
|
| Hospital Charge Code |
27100003
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$16.26 |
| Rate for Payer: Aetna Commercial |
$15.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.75
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$12.65
|
| Rate for Payer: Cofinity Commercial |
$15.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.46
|
| Rate for Payer: Healthscope Commercial |
$16.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.36
|
| Rate for Payer: PHP Commercial |
$15.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.75
|
| Rate for Payer: Priority Health SBD |
$11.38
|
|
|
HC HH ALOE VESTA CLEANSER
|
Facility
|
OP
|
$18.07
|
|
| Hospital Charge Code |
27100003
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$16.26 |
| Rate for Payer: Aetna Commercial |
$15.36
|
| Rate for Payer: Aetna Medicare |
$9.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.75
|
| Rate for Payer: BCBS Complete |
$7.23
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$12.65
|
| Rate for Payer: Cofinity Commercial |
$15.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.46
|
| Rate for Payer: Healthscope Commercial |
$16.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.36
|
| Rate for Payer: PHP Commercial |
$15.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.75
|
| Rate for Payer: Priority Health SBD |
$11.38
|
|
|
HC HH POUCH CLOSURE CLAMP
|
Facility
|
OP
|
$16.83
|
|
| Hospital Charge Code |
27000138
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$15.15 |
| Rate for Payer: Aetna Commercial |
$14.31
|
| Rate for Payer: Aetna Medicare |
$8.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.94
|
| Rate for Payer: BCBS Complete |
$6.73
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cofinity Commercial |
$11.78
|
| Rate for Payer: Cofinity Commercial |
$14.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.46
|
| Rate for Payer: Healthscope Commercial |
$15.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.31
|
| Rate for Payer: PHP Commercial |
$14.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.94
|
| Rate for Payer: Priority Health SBD |
$10.60
|
|
|
HC HH POUCH CLOSURE CLAMP
|
Facility
|
IP
|
$16.83
|
|
| Hospital Charge Code |
27000138
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$15.15 |
| Rate for Payer: Aetna Commercial |
$14.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.94
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cofinity Commercial |
$11.78
|
| Rate for Payer: Cofinity Commercial |
$14.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.46
|
| Rate for Payer: Healthscope Commercial |
$15.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.31
|
| Rate for Payer: PHP Commercial |
$14.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.94
|
| Rate for Payer: Priority Health SBD |
$10.60
|
|
|
HC HH WET ONES
|
Facility
|
IP
|
$16.05
|
|
| Hospital Charge Code |
27000170
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.11 |
| Max. Negotiated Rate |
$14.44 |
| Rate for Payer: Aetna Commercial |
$13.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.43
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cofinity Commercial |
$11.24
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.84
|
| Rate for Payer: Healthscope Commercial |
$14.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.64
|
| Rate for Payer: PHP Commercial |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.43
|
| Rate for Payer: Priority Health SBD |
$10.11
|
|
|
HC HH WET ONES
|
Facility
|
OP
|
$16.05
|
|
| Hospital Charge Code |
27000170
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$14.44 |
| Rate for Payer: Aetna Commercial |
$13.64
|
| Rate for Payer: Aetna Medicare |
$8.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.43
|
| Rate for Payer: BCBS Complete |
$6.42
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cofinity Commercial |
$11.24
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.84
|
| Rate for Payer: Healthscope Commercial |
$14.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.64
|
| Rate for Payer: PHP Commercial |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.43
|
| Rate for Payer: Priority Health SBD |
$10.11
|
|
|
HC HIAA SEROTONIN URINE
|
Facility
|
IP
|
$44.74
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
30100248
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.19 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna Commercial |
$38.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.08
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cofinity Commercial |
$31.32
|
| Rate for Payer: Cofinity Commercial |
$38.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.79
|
| Rate for Payer: Healthscope Commercial |
$40.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.03
|
| Rate for Payer: PHP Commercial |
$38.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.08
|
| Rate for Payer: Priority Health SBD |
$28.19
|
|
|
HC HIAA SEROTONIN URINE
|
Facility
|
OP
|
$44.74
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
30100248
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.91 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna Commercial |
$38.03
|
| Rate for Payer: Aetna Medicare |
$13.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.12
|
| Rate for Payer: BCBS Complete |
$7.26
|
| Rate for Payer: BCBS MAPPO |
$12.90
|
| Rate for Payer: BCBS Trust/PPO |
$11.43
|
| Rate for Payer: BCN Commercial |
$11.43
|
| Rate for Payer: BCN Medicare Advantage |
$12.90
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cofinity Commercial |
$38.48
|
| Rate for Payer: Cofinity Commercial |
$31.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.90
|
| Rate for Payer: Healthscope Commercial |
$40.27
|
| Rate for Payer: Mclaren Medicaid |
$6.91
|
| Rate for Payer: Mclaren Medicare |
$12.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.54
|
| Rate for Payer: Meridian Medicaid |
$7.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.03
|
| Rate for Payer: Nomi Health Commercial |
$19.35
|
| Rate for Payer: PACE Medicare |
$12.26
|
| Rate for Payer: PACE SWMI |
$12.90
|
| Rate for Payer: PHP Commercial |
$38.03
|
| Rate for Payer: PHP Medicare Advantage |
$12.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.27
|
| Rate for Payer: Priority Health Medicare |
$12.90
|
| Rate for Payer: Priority Health Narrow Network |
$10.62
|
| Rate for Payer: Priority Health SBD |
$28.19
|
| Rate for Payer: Railroad Medicare Medicare |
$12.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.90
|
| Rate for Payer: UHC Medicare Advantage |
$12.90
|
| Rate for Payer: UHCCP Medicaid |
$7.26
|
| Rate for Payer: VA VA |
$12.90
|
|
|
HC HIB PRP-OMP VACC 3 DOSE IM
|
Facility
|
OP
|
$42.17
|
|
|
Service Code
|
CPT 90647
|
| Hospital Charge Code |
63600180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$83.06 |
| Rate for Payer: Aetna Commercial |
$35.84
|
| Rate for Payer: Aetna Medicare |
$21.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.41
|
| Rate for Payer: BCBS Complete |
$16.87
|
| Rate for Payer: BCBS Trust/PPO |
$83.06
|
| Rate for Payer: BCN Commercial |
$83.06
|
| Rate for Payer: Cash Price |
$33.74
|
| Rate for Payer: Cash Price |
$33.74
|
| Rate for Payer: Cofinity Commercial |
$29.52
|
| Rate for Payer: Cofinity Commercial |
$36.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.74
|
| Rate for Payer: Healthscope Commercial |
$37.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.84
|
| Rate for Payer: PHP Commercial |
$35.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.41
|
| Rate for Payer: Priority Health SBD |
$26.57
|
|
|
HC HIB PRP-OMP VACC 3 DOSE IM
|
Facility
|
IP
|
$42.17
|
|
|
Service Code
|
CPT 90647
|
| Hospital Charge Code |
63600180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.57 |
| Max. Negotiated Rate |
$37.95 |
| Rate for Payer: Aetna Commercial |
$35.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.41
|
| Rate for Payer: Cash Price |
$33.74
|
| Rate for Payer: Cofinity Commercial |
$29.52
|
| Rate for Payer: Cofinity Commercial |
$36.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.74
|
| Rate for Payer: Healthscope Commercial |
$37.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.84
|
| Rate for Payer: PHP Commercial |
$35.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.41
|
| Rate for Payer: Priority Health SBD |
$26.57
|
|
|
HC HIGH FLOW JET VENT
|
Facility
|
OP
|
$1,043.46
|
|
| Hospital Charge Code |
27000699
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$417.38 |
| Max. Negotiated Rate |
$939.11 |
| Rate for Payer: Aetna Commercial |
$886.94
|
| Rate for Payer: Aetna Medicare |
$521.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$678.25
|
| Rate for Payer: BCBS Complete |
$417.38
|
| Rate for Payer: Cash Price |
$834.77
|
| Rate for Payer: Cofinity Commercial |
$730.42
|
| Rate for Payer: Cofinity Commercial |
$897.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$730.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$834.77
|
| Rate for Payer: Healthscope Commercial |
$939.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$886.94
|
| Rate for Payer: PHP Commercial |
$886.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$678.25
|
| Rate for Payer: Priority Health SBD |
$657.38
|
|
|
HC HIGH FLOW JET VENT
|
Facility
|
IP
|
$1,043.46
|
|
| Hospital Charge Code |
27000699
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$657.38 |
| Max. Negotiated Rate |
$939.11 |
| Rate for Payer: Aetna Commercial |
$886.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$678.25
|
| Rate for Payer: Cash Price |
$834.77
|
| Rate for Payer: Cofinity Commercial |
$730.42
|
| Rate for Payer: Cofinity Commercial |
$897.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$730.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$834.77
|
| Rate for Payer: Healthscope Commercial |
$939.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$886.94
|
| Rate for Payer: PHP Commercial |
$886.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$678.25
|
| Rate for Payer: Priority Health SBD |
$657.38
|
|
|
HC HIGH FLOW OXYGEN THERAPY
|
Facility
|
OP
|
$217.39
|
|
| Hospital Charge Code |
27000632
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$86.96 |
| Max. Negotiated Rate |
$195.65 |
| Rate for Payer: Aetna Commercial |
$184.78
|
| Rate for Payer: Aetna Medicare |
$108.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.30
|
| Rate for Payer: BCBS Complete |
$86.96
|
| Rate for Payer: Cash Price |
$173.91
|
| Rate for Payer: Cofinity Commercial |
$152.17
|
| Rate for Payer: Cofinity Commercial |
$186.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.91
|
| Rate for Payer: Healthscope Commercial |
$195.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.78
|
| Rate for Payer: PHP Commercial |
$184.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.30
|
| Rate for Payer: Priority Health SBD |
$136.96
|
|
|
HC HIGH FLOW OXYGEN THERAPY
|
Facility
|
IP
|
$217.39
|
|
| Hospital Charge Code |
27000632
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$136.96 |
| Max. Negotiated Rate |
$195.65 |
| Rate for Payer: Aetna Commercial |
$184.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.30
|
| Rate for Payer: Cash Price |
$173.91
|
| Rate for Payer: Cofinity Commercial |
$152.17
|
| Rate for Payer: Cofinity Commercial |
$186.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.91
|
| Rate for Payer: Healthscope Commercial |
$195.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.78
|
| Rate for Payer: PHP Commercial |
$184.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.30
|
| Rate for Payer: Priority Health SBD |
$136.96
|
|
|
HC HINGE EXTENSION/FLEX WRIST/F
|
Facility
|
OP
|
$1,541.87
|
|
|
Service Code
|
HCPCS L3900
|
| Hospital Charge Code |
27400048
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$616.75 |
| Max. Negotiated Rate |
$4,809.43 |
| Rate for Payer: Aetna Commercial |
$1,310.59
|
| Rate for Payer: Aetna Medicare |
$770.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,002.22
|
| Rate for Payer: BCBS Complete |
$616.75
|
| Rate for Payer: BCBS Trust/PPO |
$4,809.43
|
| Rate for Payer: BCN Commercial |
$4,809.43
|
| Rate for Payer: Cash Price |
$1,233.50
|
| Rate for Payer: Cash Price |
$1,233.50
|
| Rate for Payer: Cofinity Commercial |
$1,326.01
|
| Rate for Payer: Cofinity Commercial |
$1,079.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,079.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,233.50
|
| Rate for Payer: Healthscope Commercial |
$1,387.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,310.59
|
| Rate for Payer: PHP Commercial |
$1,310.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,002.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,776.32
|
| Rate for Payer: Priority Health Narrow Network |
$1,421.06
|
| Rate for Payer: Priority Health SBD |
$971.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,081.63
|
|
|
HC HINGE EXTENSION/FLEX WRIST/F
|
Facility
|
IP
|
$1,541.87
|
|
|
Service Code
|
HCPCS L3900
|
| Hospital Charge Code |
27400048
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$971.38 |
| Max. Negotiated Rate |
$1,387.68 |
| Rate for Payer: Aetna Commercial |
$1,310.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,002.22
|
| Rate for Payer: Cash Price |
$1,233.50
|
| Rate for Payer: Cofinity Commercial |
$1,079.31
|
| Rate for Payer: Cofinity Commercial |
$1,326.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,079.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,233.50
|
| Rate for Payer: Healthscope Commercial |
$1,387.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,310.59
|
| Rate for Payer: PHP Commercial |
$1,310.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,002.22
|
| Rate for Payer: Priority Health SBD |
$971.38
|
|
|
HC HIPS BIL WITH PELVIS IF PERFORMED 2 VIEWS
|
Facility
|
OP
|
$391.43
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
32000312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.58 |
| Max. Negotiated Rate |
$352.29 |
| Rate for Payer: Aetna Commercial |
$332.72
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$254.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$57.83
|
| Rate for Payer: BCN Commercial |
$57.83
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$313.14
|
| Rate for Payer: Cash Price |
$313.14
|
| Rate for Payer: Cofinity Commercial |
$336.63
|
| Rate for Payer: Cofinity Commercial |
$274.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$274.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$352.29
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$332.72
|
| Rate for Payer: Nomi Health Commercial |
$312.57
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$332.72
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.48
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$261.98
|
| Rate for Payer: Priority Health SBD |
$246.60
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$289.66
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$58.66
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC HIPS BIL WITH PELVIS IF PERFORMED 2 VIEWS
|
Facility
|
IP
|
$391.43
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
32000312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$246.60 |
| Max. Negotiated Rate |
$352.29 |
| Rate for Payer: Aetna Commercial |
$332.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$254.43
|
| Rate for Payer: Cash Price |
$313.14
|
| Rate for Payer: Cofinity Commercial |
$274.00
|
| Rate for Payer: Cofinity Commercial |
$336.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$274.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.14
|
| Rate for Payer: Healthscope Commercial |
$352.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$332.72
|
| Rate for Payer: PHP Commercial |
$332.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.43
|
| Rate for Payer: Priority Health SBD |
$246.60
|
|
|
HC HIPS BIL WITH PELVIS IF PERFORMED 3 TO 4 VIEWS
|
Facility
|
OP
|
$481.76
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
32000313
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.27 |
| Max. Negotiated Rate |
$433.58 |
| Rate for Payer: Aetna Commercial |
$409.50
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$75.43
|
| Rate for Payer: BCN Commercial |
$75.43
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$385.41
|
| Rate for Payer: Cash Price |
$385.41
|
| Rate for Payer: Cofinity Commercial |
$414.31
|
| Rate for Payer: Cofinity Commercial |
$337.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$337.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$433.58
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.50
|
| Rate for Payer: Nomi Health Commercial |
$312.57
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$409.50
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.48
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$261.98
|
| Rate for Payer: Priority Health SBD |
$303.51
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$356.50
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$58.66
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC HIPS BIL WITH PELVIS IF PERFORMED 3 TO 4 VIEWS
|
Facility
|
IP
|
$481.76
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
32000313
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$303.51 |
| Max. Negotiated Rate |
$433.58 |
| Rate for Payer: Aetna Commercial |
$409.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.14
|
| Rate for Payer: Cash Price |
$385.41
|
| Rate for Payer: Cofinity Commercial |
$337.23
|
| Rate for Payer: Cofinity Commercial |
$414.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$337.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.41
|
| Rate for Payer: Healthscope Commercial |
$433.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.50
|
| Rate for Payer: PHP Commercial |
$409.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.14
|
| Rate for Payer: Priority Health SBD |
$303.51
|
|
