|
HC INCISION AND DRAINAGE TISSUE ABSCESS SUBFACIAL
|
Facility
|
OP
|
$2,004.12
|
|
| Hospital Charge Code |
36100439
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$801.65 |
| Max. Negotiated Rate |
$1,803.71 |
| Rate for Payer: Aetna Commercial |
$1,703.50
|
| Rate for Payer: Aetna Medicare |
$1,002.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,302.68
|
| Rate for Payer: BCBS Complete |
$801.65
|
| Rate for Payer: Cash Price |
$1,603.30
|
| Rate for Payer: Cofinity Commercial |
$1,402.88
|
| Rate for Payer: Cofinity Commercial |
$1,723.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,402.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,603.30
|
| Rate for Payer: Healthscope Commercial |
$1,803.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,703.50
|
| Rate for Payer: PHP Commercial |
$1,703.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,302.68
|
| Rate for Payer: Priority Health SBD |
$1,262.60
|
|
|
HC INCISION & DRAIN ABSCESS PERITONSILLAR
|
Facility
|
OP
|
$628.32
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
76100474
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.95 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$534.07
|
| Rate for Payer: Aetna Medicare |
$236.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$408.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$284.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$284.40
|
| Rate for Payer: BCBS Complete |
$128.05
|
| Rate for Payer: BCBS MAPPO |
$227.52
|
| Rate for Payer: BCBS Trust/PPO |
$441.82
|
| Rate for Payer: BCN Commercial |
$441.82
|
| Rate for Payer: BCN Medicare Advantage |
$227.52
|
| Rate for Payer: Cash Price |
$502.66
|
| Rate for Payer: Cash Price |
$502.66
|
| Rate for Payer: Cash Price |
$502.66
|
| Rate for Payer: Cofinity Commercial |
$540.36
|
| Rate for Payer: Cofinity Commercial |
$439.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$439.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$502.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$227.52
|
| Rate for Payer: Healthscope Commercial |
$565.49
|
| Rate for Payer: Mclaren Medicaid |
$121.95
|
| Rate for Payer: Mclaren Medicare |
$227.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$238.90
|
| Rate for Payer: Meridian Medicaid |
$128.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$261.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$534.07
|
| Rate for Payer: Nomi Health Commercial |
$477.79
|
| Rate for Payer: PACE Medicare |
$216.14
|
| Rate for Payer: PACE SWMI |
$227.52
|
| Rate for Payer: PHP Commercial |
$534.07
|
| Rate for Payer: PHP Medicare Advantage |
$227.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$408.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$715.11
|
| Rate for Payer: Priority Health Medicare |
$227.52
|
| Rate for Payer: Priority Health Narrow Network |
$572.09
|
| Rate for Payer: Priority Health SBD |
$395.84
|
| Rate for Payer: Railroad Medicare Medicare |
$227.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.90
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$227.52
|
| Rate for Payer: UHC Medicare Advantage |
$227.52
|
| Rate for Payer: UHCCP Medicaid |
$128.09
|
| Rate for Payer: VA VA |
$227.52
|
|
|
HC INCISION & DRAIN ABSCESS PERITONSILLAR
|
Facility
|
IP
|
$628.32
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
76100474
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$395.84 |
| Max. Negotiated Rate |
$565.49 |
| Rate for Payer: Aetna Commercial |
$534.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$408.41
|
| Rate for Payer: Cash Price |
$502.66
|
| Rate for Payer: Cofinity Commercial |
$439.82
|
| Rate for Payer: Cofinity Commercial |
$540.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$439.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$502.66
|
| Rate for Payer: Healthscope Commercial |
$565.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$534.07
|
| Rate for Payer: PHP Commercial |
$534.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$408.41
|
| Rate for Payer: Priority Health SBD |
$395.84
|
|
|
HC INCISION & DRAINAGE COMPLEX PO WOUND INFECTION
|
Facility
|
IP
|
$7,970.00
|
|
|
Service Code
|
CPT 10180
|
| Hospital Charge Code |
76100528
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,021.10 |
| Max. Negotiated Rate |
$7,173.00 |
| Rate for Payer: Aetna Commercial |
$6,774.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,180.50
|
| Rate for Payer: Cash Price |
$6,376.00
|
| Rate for Payer: Cofinity Commercial |
$5,579.00
|
| Rate for Payer: Cofinity Commercial |
$6,854.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,579.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,376.00
|
| Rate for Payer: Healthscope Commercial |
$7,173.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,774.50
|
| Rate for Payer: PHP Commercial |
$6,774.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,180.50
|
| Rate for Payer: Priority Health SBD |
$5,021.10
|
|
|
HC INCISION & DRAINAGE COMPLEX PO WOUND INFECTION
|
Facility
|
OP
|
$7,970.00
|
|
|
Service Code
|
CPT 10180
|
| Hospital Charge Code |
76100528
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.05 |
| Max. Negotiated Rate |
$8,813.49 |
| Rate for Payer: Aetna Commercial |
$6,774.50
|
| Rate for Payer: Aetna Medicare |
$2,916.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,180.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,505.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,505.22
|
| Rate for Payer: BCBS Complete |
$1,578.19
|
| Rate for Payer: BCBS MAPPO |
$2,804.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,524.96
|
| Rate for Payer: BCN Commercial |
$1,524.96
|
| Rate for Payer: BCN Medicare Advantage |
$2,804.18
|
| Rate for Payer: Cash Price |
$6,376.00
|
| Rate for Payer: Cash Price |
$6,376.00
|
| Rate for Payer: Cash Price |
$6,376.00
|
| Rate for Payer: Cofinity Commercial |
$6,854.20
|
| Rate for Payer: Cofinity Commercial |
$5,579.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,579.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,376.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,804.18
|
| Rate for Payer: Healthscope Commercial |
$7,173.00
|
| Rate for Payer: Mclaren Medicaid |
$1,503.04
|
| Rate for Payer: Mclaren Medicare |
$2,804.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,944.39
|
| Rate for Payer: Meridian Medicaid |
$1,578.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,224.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,774.50
|
| Rate for Payer: Nomi Health Commercial |
$5,888.78
|
| Rate for Payer: PACE Medicare |
$2,663.97
|
| Rate for Payer: PACE SWMI |
$2,804.18
|
| Rate for Payer: PHP Commercial |
$6,774.50
|
| Rate for Payer: PHP Medicare Advantage |
$2,804.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,503.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,180.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,813.49
|
| Rate for Payer: Priority Health Medicare |
$2,804.18
|
| Rate for Payer: Priority Health Narrow Network |
$7,050.79
|
| Rate for Payer: Priority Health SBD |
$5,021.10
|
| Rate for Payer: Railroad Medicare Medicare |
$2,804.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.05
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,804.18
|
| Rate for Payer: UHC Medicare Advantage |
$2,804.18
|
| Rate for Payer: UHCCP Medicaid |
$1,578.75
|
| Rate for Payer: VA VA |
$2,804.18
|
|
|
HC INCISION & DRAINAGE OF TONSIL ABSCESS
|
Facility
|
IP
|
$663.00
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
76100491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$417.69 |
| Max. Negotiated Rate |
$596.70 |
| Rate for Payer: Aetna Commercial |
$563.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.95
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cofinity Commercial |
$464.10
|
| Rate for Payer: Cofinity Commercial |
$570.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$464.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$530.40
|
| Rate for Payer: Healthscope Commercial |
$596.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.55
|
| Rate for Payer: PHP Commercial |
$563.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.95
|
| Rate for Payer: Priority Health SBD |
$417.69
|
|
|
HC INCISION & DRAINAGE OF TONSIL ABSCESS
|
Facility
|
OP
|
$663.00
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
76100491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.95 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$563.55
|
| Rate for Payer: Aetna Medicare |
$236.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$284.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$284.40
|
| Rate for Payer: BCBS Complete |
$128.05
|
| Rate for Payer: BCBS MAPPO |
$227.52
|
| Rate for Payer: BCBS Trust/PPO |
$441.82
|
| Rate for Payer: BCN Commercial |
$441.82
|
| Rate for Payer: BCN Medicare Advantage |
$227.52
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cofinity Commercial |
$570.18
|
| Rate for Payer: Cofinity Commercial |
$464.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$464.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$530.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$227.52
|
| Rate for Payer: Healthscope Commercial |
$596.70
|
| Rate for Payer: Mclaren Medicaid |
$121.95
|
| Rate for Payer: Mclaren Medicare |
$227.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$238.90
|
| Rate for Payer: Meridian Medicaid |
$128.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$261.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.55
|
| Rate for Payer: Nomi Health Commercial |
$477.79
|
| Rate for Payer: PACE Medicare |
$216.14
|
| Rate for Payer: PACE SWMI |
$227.52
|
| Rate for Payer: PHP Commercial |
$563.55
|
| Rate for Payer: PHP Medicare Advantage |
$227.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$715.11
|
| Rate for Payer: Priority Health Medicare |
$227.52
|
| Rate for Payer: Priority Health Narrow Network |
$572.09
|
| Rate for Payer: Priority Health SBD |
$417.69
|
| Rate for Payer: Railroad Medicare Medicare |
$227.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.90
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$227.52
|
| Rate for Payer: UHC Medicare Advantage |
$227.52
|
| Rate for Payer: UHCCP Medicaid |
$128.09
|
| Rate for Payer: VA VA |
$227.52
|
|
|
HC INCISION DRAIN HEMATOMA SEROMA
|
Facility
|
IP
|
$1,861.05
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
36100003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,172.46 |
| Max. Negotiated Rate |
$1,674.94 |
| Rate for Payer: Aetna Commercial |
$1,581.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,209.68
|
| Rate for Payer: Cash Price |
$1,488.84
|
| Rate for Payer: Cofinity Commercial |
$1,302.74
|
| Rate for Payer: Cofinity Commercial |
$1,600.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,302.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,488.84
|
| Rate for Payer: Healthscope Commercial |
$1,674.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,581.89
|
| Rate for Payer: PHP Commercial |
$1,581.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,209.68
|
| Rate for Payer: Priority Health SBD |
$1,172.46
|
|
|
HC INCISION DRAIN HEMATOMA SEROMA
|
Facility
|
OP
|
$1,861.05
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
36100003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$124.19 |
| Max. Negotiated Rate |
$4,989.41 |
| Rate for Payer: Aetna Commercial |
$1,581.89
|
| Rate for Payer: Aetna Medicare |
$1,650.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,209.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$965.26
|
| Rate for Payer: BCN Commercial |
$965.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$1,488.84
|
| Rate for Payer: Cash Price |
$1,488.84
|
| Rate for Payer: Cash Price |
$1,488.84
|
| Rate for Payer: Cofinity Commercial |
$1,600.50
|
| Rate for Payer: Cofinity Commercial |
$1,302.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,302.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,488.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$1,674.94
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,581.89
|
| Rate for Payer: Nomi Health Commercial |
$3,333.71
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$1,581.89
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,209.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,989.41
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,991.53
|
| Rate for Payer: Priority Health SBD |
$1,172.46
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.19
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$893.75
|
| Rate for Payer: VA VA |
$1,587.48
|
|
|
HC INCISION & DRAIN PILONIDAL CYST COMPL
|
Facility
|
OP
|
$970.69
|
|
|
Service Code
|
CPT 10081
|
| Hospital Charge Code |
76100314
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$181.43 |
| Max. Negotiated Rate |
$2,166.65 |
| Rate for Payer: Aetna Commercial |
$825.09
|
| Rate for Payer: Aetna Medicare |
$716.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$630.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$861.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$861.70
|
| Rate for Payer: BCBS Complete |
$387.97
|
| Rate for Payer: BCBS MAPPO |
$689.36
|
| Rate for Payer: BCBS Trust/PPO |
$417.74
|
| Rate for Payer: BCN Commercial |
$417.74
|
| Rate for Payer: BCN Medicare Advantage |
$689.36
|
| Rate for Payer: Cash Price |
$776.55
|
| Rate for Payer: Cash Price |
$776.55
|
| Rate for Payer: Cash Price |
$776.55
|
| Rate for Payer: Cofinity Commercial |
$834.79
|
| Rate for Payer: Cofinity Commercial |
$679.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$679.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$776.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.36
|
| Rate for Payer: Healthscope Commercial |
$873.62
|
| Rate for Payer: Mclaren Medicaid |
$369.50
|
| Rate for Payer: Mclaren Medicare |
$689.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$723.83
|
| Rate for Payer: Meridian Medicaid |
$387.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$792.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$825.09
|
| Rate for Payer: Nomi Health Commercial |
$1,447.66
|
| Rate for Payer: PACE Medicare |
$654.89
|
| Rate for Payer: PACE SWMI |
$689.36
|
| Rate for Payer: PHP Commercial |
$825.09
|
| Rate for Payer: PHP Medicare Advantage |
$689.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,166.65
|
| Rate for Payer: Priority Health Medicare |
$689.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,733.32
|
| Rate for Payer: Priority Health SBD |
$611.53
|
| Rate for Payer: Railroad Medicare Medicare |
$689.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.43
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$689.36
|
| Rate for Payer: UHC Medicare Advantage |
$689.36
|
| Rate for Payer: UHCCP Medicaid |
$388.11
|
| Rate for Payer: VA VA |
$689.36
|
|
|
HC INCISION & DRAIN PILONIDAL CYST COMPL
|
Facility
|
IP
|
$970.69
|
|
|
Service Code
|
CPT 10081
|
| Hospital Charge Code |
76100314
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$611.53 |
| Max. Negotiated Rate |
$873.62 |
| Rate for Payer: Aetna Commercial |
$825.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$630.95
|
| Rate for Payer: Cash Price |
$776.55
|
| Rate for Payer: Cofinity Commercial |
$679.48
|
| Rate for Payer: Cofinity Commercial |
$834.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$679.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$776.55
|
| Rate for Payer: Healthscope Commercial |
$873.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$825.09
|
| Rate for Payer: PHP Commercial |
$825.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.95
|
| Rate for Payer: Priority Health SBD |
$611.53
|
|
|
HC INCISION EXT THROMBOSED HEMORRHOID
|
Facility
|
OP
|
$297.93
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
45000066
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$116.47 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$253.24
|
| Rate for Payer: Aetna Medicare |
$247.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.86
|
| Rate for Payer: BCBS Complete |
$134.11
|
| Rate for Payer: BCBS MAPPO |
$238.29
|
| Rate for Payer: BCBS Trust/PPO |
$119.26
|
| Rate for Payer: BCN Commercial |
$119.26
|
| Rate for Payer: BCN Medicare Advantage |
$238.29
|
| Rate for Payer: Cash Price |
$238.34
|
| Rate for Payer: Cash Price |
$238.34
|
| Rate for Payer: Cash Price |
$238.34
|
| Rate for Payer: Cofinity Commercial |
$208.55
|
| Rate for Payer: Cofinity Commercial |
$256.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$208.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.29
|
| Rate for Payer: Healthscope Commercial |
$268.14
|
| Rate for Payer: Mclaren Medicaid |
$127.72
|
| Rate for Payer: Mclaren Medicare |
$238.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.20
|
| Rate for Payer: Meridian Medicaid |
$134.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.24
|
| Rate for Payer: Nomi Health Commercial |
$500.41
|
| Rate for Payer: PACE Medicare |
$226.38
|
| Rate for Payer: PACE SWMI |
$238.29
|
| Rate for Payer: PHP Commercial |
$253.24
|
| Rate for Payer: PHP Medicare Advantage |
$238.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$748.94
|
| Rate for Payer: Priority Health Medicare |
$238.29
|
| Rate for Payer: Priority Health Narrow Network |
$599.15
|
| Rate for Payer: Priority Health SBD |
$187.70
|
| Rate for Payer: Railroad Medicare Medicare |
$238.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.47
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.29
|
| Rate for Payer: UHC Medicare Advantage |
$238.29
|
| Rate for Payer: UHCCP Medicaid |
$134.16
|
| Rate for Payer: VA VA |
$238.29
|
|
|
HC INCISION EXT THROMBOSED HEMORRHOID
|
Facility
|
IP
|
$297.93
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
45000066
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$187.70 |
| Max. Negotiated Rate |
$268.14 |
| Rate for Payer: Aetna Commercial |
$253.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.65
|
| Rate for Payer: Cash Price |
$238.34
|
| Rate for Payer: Cofinity Commercial |
$208.55
|
| Rate for Payer: Cofinity Commercial |
$256.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$208.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.34
|
| Rate for Payer: Healthscope Commercial |
$268.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.24
|
| Rate for Payer: PHP Commercial |
$253.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.65
|
| Rate for Payer: Priority Health SBD |
$187.70
|
|
|
HC INCISION OF LABIAL FRENUM FRENOTOMY
|
Facility
|
OP
|
$1,377.00
|
|
|
Service Code
|
CPT 40806
|
| Hospital Charge Code |
76100459
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$30.67 |
| Max. Negotiated Rate |
$1,568.21 |
| Rate for Payer: Aetna Commercial |
$1,170.45
|
| Rate for Payer: Aetna Medicare |
$518.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$895.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$623.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$623.69
|
| Rate for Payer: BCBS Complete |
$280.81
|
| Rate for Payer: BCBS MAPPO |
$498.95
|
| Rate for Payer: BCBS Trust/PPO |
$72.22
|
| Rate for Payer: BCN Commercial |
$72.22
|
| Rate for Payer: BCN Medicare Advantage |
$498.95
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Cofinity Commercial |
$963.90
|
| Rate for Payer: Cofinity Commercial |
$1,184.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$963.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$498.95
|
| Rate for Payer: Healthscope Commercial |
$1,239.30
|
| Rate for Payer: Mclaren Medicaid |
$267.44
|
| Rate for Payer: Mclaren Medicare |
$498.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$523.90
|
| Rate for Payer: Meridian Medicaid |
$280.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$573.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,170.45
|
| Rate for Payer: Nomi Health Commercial |
$1,047.80
|
| Rate for Payer: PACE Medicare |
$474.00
|
| Rate for Payer: PACE SWMI |
$498.95
|
| Rate for Payer: PHP Commercial |
$1,170.45
|
| Rate for Payer: PHP Medicare Advantage |
$498.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$895.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,568.21
|
| Rate for Payer: Priority Health Medicare |
$498.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,254.57
|
| Rate for Payer: Priority Health SBD |
$867.51
|
| Rate for Payer: Railroad Medicare Medicare |
$498.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.67
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$498.95
|
| Rate for Payer: UHC Medicare Advantage |
$498.95
|
| Rate for Payer: UHCCP Medicaid |
$280.91
|
| Rate for Payer: VA VA |
$498.95
|
|
|
HC INCISION OF LABIAL FRENUM FRENOTOMY
|
Facility
|
IP
|
$1,377.00
|
|
|
Service Code
|
CPT 40806
|
| Hospital Charge Code |
76100459
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$867.51 |
| Max. Negotiated Rate |
$1,239.30 |
| Rate for Payer: Aetna Commercial |
$1,170.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$895.05
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Cofinity Commercial |
$1,184.22
|
| Rate for Payer: Cofinity Commercial |
$963.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$963.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.60
|
| Rate for Payer: Healthscope Commercial |
$1,239.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,170.45
|
| Rate for Payer: PHP Commercial |
$1,170.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$895.05
|
| Rate for Payer: Priority Health SBD |
$867.51
|
|
|
HC INCISION OF URETHRA
|
Facility
|
IP
|
$2,797.64
|
|
|
Service Code
|
CPT 53020
|
| Hospital Charge Code |
76100296
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,762.51 |
| Max. Negotiated Rate |
$2,517.88 |
| Rate for Payer: Aetna Commercial |
$2,377.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,818.47
|
| Rate for Payer: Cash Price |
$2,238.11
|
| Rate for Payer: Cofinity Commercial |
$1,958.35
|
| Rate for Payer: Cofinity Commercial |
$2,405.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,958.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,238.11
|
| Rate for Payer: Healthscope Commercial |
$2,517.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,377.99
|
| Rate for Payer: PHP Commercial |
$2,377.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,818.47
|
| Rate for Payer: Priority Health SBD |
$1,762.51
|
|
|
HC INCISION OF URETHRA
|
Facility
|
OP
|
$2,797.64
|
|
|
Service Code
|
CPT 53020
|
| Hospital Charge Code |
76100296
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.93 |
| Max. Negotiated Rate |
$6,308.24 |
| Rate for Payer: Aetna Commercial |
$2,377.99
|
| Rate for Payer: Aetna Medicare |
$2,087.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,818.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,508.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,508.86
|
| Rate for Payer: BCBS Complete |
$1,129.59
|
| Rate for Payer: BCBS MAPPO |
$2,007.09
|
| Rate for Payer: BCBS Trust/PPO |
$826.31
|
| Rate for Payer: BCN Commercial |
$826.31
|
| Rate for Payer: BCN Medicare Advantage |
$2,007.09
|
| Rate for Payer: Cash Price |
$2,238.11
|
| Rate for Payer: Cash Price |
$2,238.11
|
| Rate for Payer: Cash Price |
$2,238.11
|
| Rate for Payer: Cofinity Commercial |
$2,405.97
|
| Rate for Payer: Cofinity Commercial |
$1,958.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,958.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,238.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,007.09
|
| Rate for Payer: Healthscope Commercial |
$2,517.88
|
| Rate for Payer: Mclaren Medicaid |
$1,075.80
|
| Rate for Payer: Mclaren Medicare |
$2,007.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,107.44
|
| Rate for Payer: Meridian Medicaid |
$1,129.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,308.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,377.99
|
| Rate for Payer: Nomi Health Commercial |
$4,214.89
|
| Rate for Payer: PACE Medicare |
$1,906.74
|
| Rate for Payer: PACE SWMI |
$2,007.09
|
| Rate for Payer: PHP Commercial |
$2,377.99
|
| Rate for Payer: PHP Medicare Advantage |
$2,007.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,818.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,308.24
|
| Rate for Payer: Priority Health Medicare |
$2,007.09
|
| Rate for Payer: Priority Health Narrow Network |
$5,046.59
|
| Rate for Payer: Priority Health SBD |
$1,762.51
|
| Rate for Payer: Railroad Medicare Medicare |
$2,007.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.93
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,007.09
|
| Rate for Payer: UHC Medicare Advantage |
$2,007.09
|
| Rate for Payer: UHCCP Medicaid |
$1,129.99
|
| Rate for Payer: VA VA |
$2,007.09
|
|
|
HC INDIRECT CALORIMETRY
|
Facility
|
IP
|
$1,166.29
|
|
|
Service Code
|
CPT 94690
|
| Hospital Charge Code |
46000008
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$734.76 |
| Max. Negotiated Rate |
$1,049.66 |
| Rate for Payer: Aetna Commercial |
$991.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$758.09
|
| Rate for Payer: Cash Price |
$933.03
|
| Rate for Payer: Cofinity Commercial |
$1,003.01
|
| Rate for Payer: Cofinity Commercial |
$816.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$816.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$933.03
|
| Rate for Payer: Healthscope Commercial |
$1,049.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$991.35
|
| Rate for Payer: PHP Commercial |
$991.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$758.09
|
| Rate for Payer: Priority Health SBD |
$734.76
|
|
|
HC INDIRECT CALORIMETRY
|
Facility
|
OP
|
$1,166.29
|
|
|
Service Code
|
CPT 94690
|
| Hospital Charge Code |
46000008
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,049.66 |
| Rate for Payer: Aetna Commercial |
$991.35
|
| Rate for Payer: Aetna Medicare |
$60.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$758.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.75
|
| Rate for Payer: BCBS Complete |
$32.75
|
| Rate for Payer: BCBS MAPPO |
$58.20
|
| Rate for Payer: BCBS Trust/PPO |
$199.34
|
| Rate for Payer: BCN Commercial |
$199.34
|
| Rate for Payer: BCN Medicare Advantage |
$58.20
|
| Rate for Payer: Cash Price |
$933.03
|
| Rate for Payer: Cash Price |
$933.03
|
| Rate for Payer: Cofinity Commercial |
$816.40
|
| Rate for Payer: Cofinity Commercial |
$1,003.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$816.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$933.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.20
|
| Rate for Payer: Healthscope Commercial |
$1,049.66
|
| Rate for Payer: Mclaren Medicaid |
$31.20
|
| Rate for Payer: Mclaren Medicare |
$58.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.11
|
| Rate for Payer: Meridian Medicaid |
$32.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$991.35
|
| Rate for Payer: Nomi Health Commercial |
$174.60
|
| Rate for Payer: PACE Medicare |
$55.29
|
| Rate for Payer: PACE SWMI |
$58.20
|
| Rate for Payer: PHP Commercial |
$991.35
|
| Rate for Payer: PHP Medicare Advantage |
$58.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$758.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.90
|
| Rate for Payer: Priority Health Medicare |
$58.20
|
| Rate for Payer: Priority Health Narrow Network |
$146.32
|
| Rate for Payer: Priority Health SBD |
$734.76
|
| Rate for Payer: Railroad Medicare Medicare |
$58.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.20
|
| Rate for Payer: UHC Exchange |
$863.05
|
| Rate for Payer: UHC Medicare Advantage |
$58.20
|
| Rate for Payer: UHCCP Medicaid |
$32.77
|
| Rate for Payer: VA VA |
$58.20
|
|
|
HC INDIUM 111 DTPA PER MCI
|
Facility
|
IP
|
$583.28
|
|
|
Service Code
|
HCPCS A9548
|
| Hospital Charge Code |
34300015
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$367.47 |
| Max. Negotiated Rate |
$524.95 |
| Rate for Payer: Aetna Commercial |
$495.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.13
|
| Rate for Payer: Cash Price |
$466.62
|
| Rate for Payer: Cofinity Commercial |
$408.30
|
| Rate for Payer: Cofinity Commercial |
$501.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$408.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$466.62
|
| Rate for Payer: Healthscope Commercial |
$524.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$495.79
|
| Rate for Payer: PHP Commercial |
$495.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.13
|
| Rate for Payer: Priority Health SBD |
$367.47
|
|
|
HC INDIUM 111 DTPA PER MCI
|
Facility
|
OP
|
$583.28
|
|
|
Service Code
|
HCPCS A9548
|
| Hospital Charge Code |
34300015
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$367.47 |
| Max. Negotiated Rate |
$2,145.87 |
| Rate for Payer: Aetna Commercial |
$495.79
|
| Rate for Payer: Aetna Medicare |
$743.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$894.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$894.11
|
| Rate for Payer: BCBS Complete |
$402.57
|
| Rate for Payer: BCBS MAPPO |
$715.29
|
| Rate for Payer: BCBS Trust/PPO |
$724.61
|
| Rate for Payer: BCN Commercial |
$724.61
|
| Rate for Payer: BCN Medicare Advantage |
$715.29
|
| Rate for Payer: Cash Price |
$466.62
|
| Rate for Payer: Cash Price |
$466.62
|
| Rate for Payer: Cofinity Commercial |
$501.62
|
| Rate for Payer: Cofinity Commercial |
$408.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$408.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$466.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$715.29
|
| Rate for Payer: Healthscope Commercial |
$524.95
|
| Rate for Payer: Mclaren Medicaid |
$383.40
|
| Rate for Payer: Mclaren Medicare |
$715.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$751.05
|
| Rate for Payer: Meridian Medicaid |
$402.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$822.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$495.79
|
| Rate for Payer: Nomi Health Commercial |
$2,145.87
|
| Rate for Payer: PACE Medicare |
$679.53
|
| Rate for Payer: PACE SWMI |
$715.29
|
| Rate for Payer: PHP Commercial |
$495.79
|
| Rate for Payer: PHP Medicare Advantage |
$715.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$383.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,058.61
|
| Rate for Payer: Priority Health Medicare |
$715.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,646.89
|
| Rate for Payer: Priority Health SBD |
$367.47
|
| Rate for Payer: Railroad Medicare Medicare |
$715.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,013.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$715.29
|
| Rate for Payer: UHC Medicare Advantage |
$715.29
|
| Rate for Payer: UHCCP Medicaid |
$402.71
|
| Rate for Payer: VA VA |
$715.29
|
|
|
HC INDIUM 111 PER 0.5 MCI
|
Facility
|
OP
|
$2,661.14
|
|
|
Service Code
|
HCPCS A9547
|
| Hospital Charge Code |
63600040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$414.14 |
| Max. Negotiated Rate |
$2,395.03 |
| Rate for Payer: Aetna Commercial |
$2,261.97
|
| Rate for Payer: Aetna Medicare |
$803.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,729.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$965.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$965.80
|
| Rate for Payer: BCBS Complete |
$434.84
|
| Rate for Payer: BCBS MAPPO |
$772.64
|
| Rate for Payer: BCBS Trust/PPO |
$714.75
|
| Rate for Payer: BCN Commercial |
$714.75
|
| Rate for Payer: BCN Medicare Advantage |
$772.64
|
| Rate for Payer: Cash Price |
$2,128.91
|
| Rate for Payer: Cash Price |
$2,128.91
|
| Rate for Payer: Cofinity Commercial |
$2,288.58
|
| Rate for Payer: Cofinity Commercial |
$1,862.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,862.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,128.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$772.64
|
| Rate for Payer: Healthscope Commercial |
$2,395.03
|
| Rate for Payer: Mclaren Medicaid |
$414.14
|
| Rate for Payer: Mclaren Medicare |
$772.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$811.27
|
| Rate for Payer: Meridian Medicaid |
$434.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$888.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,261.97
|
| Rate for Payer: Nomi Health Commercial |
$2,317.92
|
| Rate for Payer: PACE Medicare |
$734.01
|
| Rate for Payer: PACE SWMI |
$772.64
|
| Rate for Payer: PHP Commercial |
$2,261.97
|
| Rate for Payer: PHP Medicare Advantage |
$772.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$414.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,729.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,223.67
|
| Rate for Payer: Priority Health Medicare |
$772.64
|
| Rate for Payer: Priority Health Narrow Network |
$1,778.94
|
| Rate for Payer: Priority Health SBD |
$1,676.52
|
| Rate for Payer: Railroad Medicare Medicare |
$772.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,174.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$772.64
|
| Rate for Payer: UHC Medicare Advantage |
$772.64
|
| Rate for Payer: UHCCP Medicaid |
$435.00
|
| Rate for Payer: VA VA |
$772.64
|
|
|
HC INDIUM 111 PER 0.5 MCI
|
Facility
|
IP
|
$2,661.14
|
|
|
Service Code
|
HCPCS A9547
|
| Hospital Charge Code |
63600040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,676.52 |
| Max. Negotiated Rate |
$2,395.03 |
| Rate for Payer: Aetna Commercial |
$2,261.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,729.74
|
| Rate for Payer: Cash Price |
$2,128.91
|
| Rate for Payer: Cofinity Commercial |
$1,862.80
|
| Rate for Payer: Cofinity Commercial |
$2,288.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,862.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,128.91
|
| Rate for Payer: Healthscope Commercial |
$2,395.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,261.97
|
| Rate for Payer: PHP Commercial |
$2,261.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,729.74
|
| Rate for Payer: Priority Health SBD |
$1,676.52
|
|
|
HC INDIVIDUAL SESSION 30 MIN RD G0108
|
Facility
|
OP
|
$164.75
|
|
|
Service Code
|
HCPCS G0108
|
| Hospital Charge Code |
94200029
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$148.28 |
| Rate for Payer: Aetna Commercial |
$140.04
|
| Rate for Payer: Aetna Medicare |
$82.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.09
|
| Rate for Payer: BCBS Complete |
$65.90
|
| Rate for Payer: BCBS Trust/PPO |
$101.89
|
| Rate for Payer: BCN Commercial |
$101.89
|
| Rate for Payer: Cash Price |
$131.80
|
| Rate for Payer: Cash Price |
$131.80
|
| Rate for Payer: Cofinity Commercial |
$141.68
|
| Rate for Payer: Cofinity Commercial |
$115.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.80
|
| Rate for Payer: Healthscope Commercial |
$148.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.04
|
| Rate for Payer: PHP Commercial |
$140.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.00
|
| Rate for Payer: Priority Health Narrow Network |
$27.20
|
| Rate for Payer: Priority Health SBD |
$103.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.75
|
| Rate for Payer: UHC Exchange |
$121.92
|
|
|
HC INDIVIDUAL SESSION 30 MIN RD G0108
|
Facility
|
IP
|
$164.75
|
|
|
Service Code
|
HCPCS G0108
|
| Hospital Charge Code |
94200029
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$103.79 |
| Max. Negotiated Rate |
$148.28 |
| Rate for Payer: Aetna Commercial |
$140.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.09
|
| Rate for Payer: Cash Price |
$131.80
|
| Rate for Payer: Cofinity Commercial |
$115.32
|
| Rate for Payer: Cofinity Commercial |
$141.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.80
|
| Rate for Payer: Healthscope Commercial |
$148.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.04
|
| Rate for Payer: PHP Commercial |
$140.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.09
|
| Rate for Payer: Priority Health SBD |
$103.79
|
|
