|
HC LAMBS QUARTERS IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200091
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
|
|
HC LAMELLAR BODY COUNT AMNIOTIC
|
Facility
|
OP
|
$72.83
|
|
|
Service Code
|
CPT 83664
|
| Hospital Charge Code |
30100278
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna Commercial |
$61.91
|
| Rate for Payer: Aetna Medicare |
$20.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.15
|
| Rate for Payer: BCBS Complete |
$10.61
|
| Rate for Payer: BCBS MAPPO |
$19.32
|
| Rate for Payer: BCBS Trust/PPO |
$20.60
|
| Rate for Payer: BCN Commercial |
$20.60
|
| Rate for Payer: BCN Medicare Advantage |
$19.32
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Advantage |
$50.98
|
| Rate for Payer: Cofinity Commercial |
$62.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.32
|
| Rate for Payer: Healthscope Commercial |
$65.55
|
| Rate for Payer: Mclaren Medicaid |
$10.10
|
| Rate for Payer: Mclaren Medicare |
$19.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.29
|
| Rate for Payer: Meridian Medicaid |
$20.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Nomi Health Commercial |
$28.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.62
|
| Rate for Payer: PACE Medicare |
$18.35
|
| Rate for Payer: PACE SWMI |
$19.32
|
| Rate for Payer: PHP Commercial |
$61.91
|
| Rate for Payer: PHP Medicare Advantage |
$19.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19.32
|
| Rate for Payer: Priority Health Medicare |
$19.32
|
| Rate for Payer: Priority Health SBD |
$45.88
|
| Rate for Payer: Priority Health Tiered Network |
$15.46
|
| Rate for Payer: Railroad Medicare Medicare |
$19.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.98
|
| Rate for Payer: UHC Core |
$28.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19.32
|
| Rate for Payer: UHC Exchange |
$28.98
|
| Rate for Payer: UHC Medicaid |
$10.10
|
| Rate for Payer: UHCCP Medicaid |
$10.10
|
| Rate for Payer: VA VA |
$19.32
|
|
|
HC LAMELLAR BODY COUNT AMNIOTIC
|
Facility
|
IP
|
$72.83
|
|
|
Service Code
|
CPT 83664
|
| Hospital Charge Code |
30100278
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna Commercial |
$61.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.34
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Advantage |
$50.98
|
| Rate for Payer: Cofinity Commercial |
$62.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Healthscope Commercial |
$65.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.62
|
| Rate for Payer: PHP Commercial |
$61.91
|
| Rate for Payer: Priority Health SBD |
$45.88
|
|
|
HC LAMICTAL LEVEL
|
Facility
|
IP
|
$55.18
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
30100054
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.76 |
| Max. Negotiated Rate |
$49.66 |
| Rate for Payer: Aetna Commercial |
$46.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.87
|
| Rate for Payer: Cash Price |
$44.14
|
| Rate for Payer: Cofinity Advantage |
$38.63
|
| Rate for Payer: Cofinity Commercial |
$47.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.14
|
| Rate for Payer: Healthscope Commercial |
$49.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.38
|
| Rate for Payer: PHP Commercial |
$46.90
|
| Rate for Payer: Priority Health SBD |
$34.76
|
|
|
HC LAMICTAL LEVEL
|
Facility
|
OP
|
$55.18
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
30100054
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.93 |
| Max. Negotiated Rate |
$49.66 |
| Rate for Payer: Aetna Commercial |
$46.90
|
| Rate for Payer: Aetna Medicare |
$13.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.56
|
| Rate for Payer: BCBS Complete |
$7.28
|
| Rate for Payer: BCBS MAPPO |
$13.25
|
| Rate for Payer: BCBS Trust/PPO |
$14.13
|
| Rate for Payer: BCN Commercial |
$14.13
|
| Rate for Payer: BCN Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$44.14
|
| Rate for Payer: Cash Price |
$44.14
|
| Rate for Payer: Cofinity Advantage |
$38.63
|
| Rate for Payer: Cofinity Commercial |
$47.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$49.66
|
| Rate for Payer: Mclaren Medicaid |
$6.93
|
| Rate for Payer: Mclaren Medicare |
$13.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.91
|
| Rate for Payer: Meridian Medicaid |
$13.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.90
|
| Rate for Payer: Nomi Health Commercial |
$19.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.38
|
| Rate for Payer: PACE Medicare |
$12.59
|
| Rate for Payer: PACE SWMI |
$13.25
|
| Rate for Payer: PHP Commercial |
$46.90
|
| Rate for Payer: PHP Medicare Advantage |
$13.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.25
|
| Rate for Payer: Priority Health Medicare |
$13.25
|
| Rate for Payer: Priority Health SBD |
$34.76
|
| Rate for Payer: Priority Health Tiered Network |
$10.60
|
| Rate for Payer: Railroad Medicare Medicare |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.88
|
| Rate for Payer: UHC Core |
$19.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.25
|
| Rate for Payer: UHC Exchange |
$19.88
|
| Rate for Payer: UHC Medicaid |
$6.93
|
| Rate for Payer: UHCCP Medicaid |
$6.93
|
| Rate for Payer: VA VA |
$13.25
|
|
|
HC LARGSC W/NJX VOCAL CORD THER W/MICRO/TELESCOPE
|
Facility
|
OP
|
$10,689.60
|
|
|
Service Code
|
CPT 31571
|
| Hospital Charge Code |
76100432
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,942.91 |
| Max. Negotiated Rate |
$12,013.78 |
| Rate for Payer: Aetna Commercial |
$9,086.16
|
| Rate for Payer: Aetna Medicare |
$3,863.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,948.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,643.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,643.68
|
| Rate for Payer: BCBS Complete |
$2,040.25
|
| Rate for Payer: BCBS MAPPO |
$3,714.94
|
| Rate for Payer: BCBS Trust/PPO |
$3,079.17
|
| Rate for Payer: BCN Commercial |
$3,079.17
|
| Rate for Payer: BCN Medicare Advantage |
$3,714.94
|
| Rate for Payer: Cash Price |
$8,551.68
|
| Rate for Payer: Cash Price |
$8,551.68
|
| Rate for Payer: Cash Price |
$8,551.68
|
| Rate for Payer: Cofinity Advantage |
$7,482.72
|
| Rate for Payer: Cofinity Commercial |
$9,193.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,551.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,714.94
|
| Rate for Payer: Healthscope Commercial |
$9,620.64
|
| Rate for Payer: Mclaren Medicaid |
$1,942.91
|
| Rate for Payer: Mclaren Medicare |
$3,714.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,900.69
|
| Rate for Payer: Meridian Medicaid |
$3,900.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,272.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,086.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,086.16
|
| Rate for Payer: Nomi Health Commercial |
$11,144.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,017.20
|
| Rate for Payer: PACE Medicare |
$3,529.19
|
| Rate for Payer: PACE SWMI |
$3,714.94
|
| Rate for Payer: PHP Commercial |
$9,086.16
|
| Rate for Payer: PHP Medicare Advantage |
$3,714.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,942.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,013.78
|
| Rate for Payer: Priority Health Medicare |
$3,714.94
|
| Rate for Payer: Priority Health SBD |
$6,734.45
|
| Rate for Payer: Priority Health Tiered Network |
$9,611.02
|
| Rate for Payer: Railroad Medicare Medicare |
$3,714.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,948.24
|
| Rate for Payer: UHC Core |
$5,569.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,714.94
|
| Rate for Payer: UHC Exchange |
$4,201.01
|
| Rate for Payer: UHC Medicaid |
$1,942.91
|
| Rate for Payer: UHCCP Medicaid |
$1,942.91
|
| Rate for Payer: VA VA |
$3,714.94
|
|
|
HC LARGSC W/NJX VOCAL CORD THER W/MICRO/TELESCOPE
|
Facility
|
IP
|
$10,689.60
|
|
|
Service Code
|
CPT 31571
|
| Hospital Charge Code |
76100432
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,734.45 |
| Max. Negotiated Rate |
$9,620.64 |
| Rate for Payer: Aetna Commercial |
$9,086.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,948.24
|
| Rate for Payer: Cash Price |
$8,551.68
|
| Rate for Payer: Cofinity Advantage |
$7,482.72
|
| Rate for Payer: Cofinity Commercial |
$9,193.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,551.68
|
| Rate for Payer: Healthscope Commercial |
$9,620.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,086.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,017.20
|
| Rate for Payer: PHP Commercial |
$9,086.16
|
| Rate for Payer: Priority Health SBD |
$6,734.45
|
|
|
HC LA RO SSB SJOGRENS AB
|
Facility
|
IP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200160
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.60 |
| Max. Negotiated Rate |
$32.28 |
| Rate for Payer: Aetna Commercial |
$30.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.32
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Advantage |
$25.11
|
| Rate for Payer: Cofinity Commercial |
$30.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Healthscope Commercial |
$32.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: PHP Commercial |
$30.49
|
| Rate for Payer: Priority Health SBD |
$22.60
|
|
|
HC LA RO SSB SJOGRENS AB
|
Facility
|
OP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200160
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$32.28 |
| Rate for Payer: Aetna Commercial |
$30.49
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$9.85
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$19.12
|
| Rate for Payer: BCN Commercial |
$19.12
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Advantage |
$25.11
|
| Rate for Payer: Cofinity Commercial |
$30.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$32.28
|
| Rate for Payer: Mclaren Medicaid |
$9.38
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Nomi Health Commercial |
$26.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$30.49
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.93
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$22.60
|
| Rate for Payer: Priority Health Tiered Network |
$14.34
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.90
|
| Rate for Payer: UHC Core |
$26.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.93
|
| Rate for Payer: UHC Exchange |
$26.90
|
| Rate for Payer: UHC Medicaid |
$9.38
|
| Rate for Payer: UHCCP Medicaid |
$9.38
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC LARYNGOSCOPY
|
Facility
|
OP
|
$2,616.10
|
|
| Hospital Charge Code |
36000113
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,046.44 |
| Max. Negotiated Rate |
$2,354.49 |
| Rate for Payer: Aetna Commercial |
$2,223.68
|
| Rate for Payer: Aetna Medicare |
$1,308.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,700.46
|
| Rate for Payer: BCBS Complete |
$1,046.44
|
| Rate for Payer: Cash Price |
$2,092.88
|
| Rate for Payer: Cofinity Advantage |
$1,831.27
|
| Rate for Payer: Cofinity Commercial |
$2,249.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,092.88
|
| Rate for Payer: Healthscope Commercial |
$2,354.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,092.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,223.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,962.08
|
| Rate for Payer: PHP Commercial |
$2,223.68
|
| Rate for Payer: Priority Health SBD |
$1,648.14
|
|
|
HC LARYNGOSCOPY
|
Facility
|
IP
|
$2,616.10
|
|
| Hospital Charge Code |
36000113
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,648.14 |
| Max. Negotiated Rate |
$2,354.49 |
| Rate for Payer: Aetna Commercial |
$2,223.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,700.46
|
| Rate for Payer: Cash Price |
$2,092.88
|
| Rate for Payer: Cofinity Advantage |
$1,831.27
|
| Rate for Payer: Cofinity Commercial |
$2,249.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,092.88
|
| Rate for Payer: Healthscope Commercial |
$2,354.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,223.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,962.08
|
| Rate for Payer: PHP Commercial |
$2,223.68
|
| Rate for Payer: Priority Health SBD |
$1,648.14
|
|
|
HC LARYNGOSCOPY DIRECT OPERATIVE W BIOPSY
|
Facility
|
IP
|
$4,890.90
|
|
|
Service Code
|
CPT 31235
|
| Hospital Charge Code |
76100522
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,081.27 |
| Max. Negotiated Rate |
$4,401.81 |
| Rate for Payer: Aetna Commercial |
$4,157.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,179.09
|
| Rate for Payer: Cash Price |
$3,912.72
|
| Rate for Payer: Cofinity Advantage |
$3,423.63
|
| Rate for Payer: Cofinity Commercial |
$4,206.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,912.72
|
| Rate for Payer: Healthscope Commercial |
$4,401.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,157.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,668.18
|
| Rate for Payer: PHP Commercial |
$4,157.27
|
| Rate for Payer: Priority Health SBD |
$3,081.27
|
|
|
HC LARYNGOSCOPY DIRECT OPERATIVE W BIOPSY
|
Facility
|
OP
|
$4,890.90
|
|
|
Service Code
|
CPT 31235
|
| Hospital Charge Code |
76100522
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$760.35 |
| Max. Negotiated Rate |
$5,735.32 |
| Rate for Payer: Aetna Commercial |
$4,157.27
|
| Rate for Payer: Aetna Medicare |
$1,844.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,179.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,216.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,216.88
|
| Rate for Payer: BCBS Complete |
$974.01
|
| Rate for Payer: BCBS MAPPO |
$1,773.50
|
| Rate for Payer: BCBS Trust/PPO |
$760.35
|
| Rate for Payer: BCN Commercial |
$760.35
|
| Rate for Payer: BCN Medicare Advantage |
$1,773.50
|
| Rate for Payer: Cash Price |
$3,912.72
|
| Rate for Payer: Cash Price |
$3,912.72
|
| Rate for Payer: Cash Price |
$3,912.72
|
| Rate for Payer: Cofinity Advantage |
$3,423.63
|
| Rate for Payer: Cofinity Commercial |
$4,206.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,912.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,773.50
|
| Rate for Payer: Healthscope Commercial |
$4,401.81
|
| Rate for Payer: Mclaren Medicaid |
$927.54
|
| Rate for Payer: Mclaren Medicare |
$1,773.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,862.17
|
| Rate for Payer: Meridian Medicaid |
$1,862.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,039.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,950.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,157.27
|
| Rate for Payer: Nomi Health Commercial |
$5,320.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,668.18
|
| Rate for Payer: PACE Medicare |
$1,684.83
|
| Rate for Payer: PACE SWMI |
$1,773.50
|
| Rate for Payer: PHP Commercial |
$4,157.27
|
| Rate for Payer: PHP Medicare Advantage |
$1,773.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$927.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,735.32
|
| Rate for Payer: Priority Health Medicare |
$1,773.50
|
| Rate for Payer: Priority Health SBD |
$3,081.27
|
| Rate for Payer: Priority Health Tiered Network |
$4,588.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1,773.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,179.09
|
| Rate for Payer: UHC Core |
$2,548.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,773.50
|
| Rate for Payer: UHC Exchange |
$1,922.12
|
| Rate for Payer: UHC Medicaid |
$927.54
|
| Rate for Payer: UHCCP Medicaid |
$927.54
|
| Rate for Payer: VA VA |
$1,773.50
|
|
|
HC LARYNGOSCOPY FIBEROPTIC
|
Facility
|
IP
|
$379.73
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
36100443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$239.23 |
| Max. Negotiated Rate |
$341.76 |
| Rate for Payer: Aetna Commercial |
$322.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.82
|
| Rate for Payer: Cash Price |
$303.78
|
| Rate for Payer: Cofinity Advantage |
$265.81
|
| Rate for Payer: Cofinity Commercial |
$326.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.78
|
| Rate for Payer: Healthscope Commercial |
$341.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$284.80
|
| Rate for Payer: PHP Commercial |
$322.77
|
| Rate for Payer: Priority Health SBD |
$239.23
|
|
|
HC LARYNGOSCOPY FIBEROPTIC
|
Facility
|
OP
|
$379.73
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
36100443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.02 |
| Max. Negotiated Rate |
$643.18 |
| Rate for Payer: Aetna Commercial |
$322.77
|
| Rate for Payer: Aetna Medicare |
$206.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$248.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$248.61
|
| Rate for Payer: BCBS Complete |
$109.23
|
| Rate for Payer: BCBS MAPPO |
$198.89
|
| Rate for Payer: BCBS Trust/PPO |
$148.53
|
| Rate for Payer: BCN Commercial |
$148.53
|
| Rate for Payer: BCN Medicare Advantage |
$198.89
|
| Rate for Payer: Cash Price |
$303.78
|
| Rate for Payer: Cash Price |
$303.78
|
| Rate for Payer: Cash Price |
$303.78
|
| Rate for Payer: Cofinity Advantage |
$265.81
|
| Rate for Payer: Cofinity Commercial |
$326.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.89
|
| Rate for Payer: Healthscope Commercial |
$341.76
|
| Rate for Payer: Mclaren Medicaid |
$104.02
|
| Rate for Payer: Mclaren Medicare |
$198.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$208.83
|
| Rate for Payer: Meridian Medicaid |
$208.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$218.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.77
|
| Rate for Payer: Nomi Health Commercial |
$596.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$284.80
|
| Rate for Payer: PACE Medicare |
$188.95
|
| Rate for Payer: PACE SWMI |
$198.89
|
| Rate for Payer: PHP Commercial |
$322.77
|
| Rate for Payer: PHP Medicare Advantage |
$198.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$643.18
|
| Rate for Payer: Priority Health Medicare |
$198.89
|
| Rate for Payer: Priority Health SBD |
$239.23
|
| Rate for Payer: Priority Health Tiered Network |
$514.54
|
| Rate for Payer: Railroad Medicare Medicare |
$198.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.82
|
| Rate for Payer: UHC Core |
$197.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$198.89
|
| Rate for Payer: UHC Exchange |
$149.23
|
| Rate for Payer: UHC Medicaid |
$104.02
|
| Rate for Payer: UHCCP Medicaid |
$104.02
|
| Rate for Payer: VA VA |
$198.89
|
|
|
HC LARYNGOSCOPY FLX/RGD TELESCOP W/STROBOSCOP
|
Facility
|
IP
|
$1,144.44
|
|
|
Service Code
|
CPT 31579
|
| Hospital Charge Code |
76100455
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$721.00 |
| Max. Negotiated Rate |
$1,030.00 |
| Rate for Payer: Aetna Commercial |
$972.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$743.89
|
| Rate for Payer: Cash Price |
$915.55
|
| Rate for Payer: Cofinity Advantage |
$801.11
|
| Rate for Payer: Cofinity Commercial |
$984.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$915.55
|
| Rate for Payer: Healthscope Commercial |
$1,030.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$972.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$858.33
|
| Rate for Payer: PHP Commercial |
$972.77
|
| Rate for Payer: Priority Health SBD |
$721.00
|
|
|
HC LARYNGOSCOPY FLX/RGD TELESCOP W/STROBOSCOP
|
Facility
|
OP
|
$1,144.44
|
|
|
Service Code
|
CPT 31579
|
| Hospital Charge Code |
76100455
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.82 |
| Max. Negotiated Rate |
$1,260.30 |
| Rate for Payer: Aetna Commercial |
$972.77
|
| Rate for Payer: Aetna Medicare |
$405.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$743.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.14
|
| Rate for Payer: BCBS Complete |
$214.03
|
| Rate for Payer: BCBS MAPPO |
$389.71
|
| Rate for Payer: BCBS Trust/PPO |
$225.00
|
| Rate for Payer: BCN Commercial |
$225.00
|
| Rate for Payer: BCN Medicare Advantage |
$389.71
|
| Rate for Payer: Cash Price |
$915.55
|
| Rate for Payer: Cash Price |
$915.55
|
| Rate for Payer: Cash Price |
$915.55
|
| Rate for Payer: Cofinity Advantage |
$801.11
|
| Rate for Payer: Cofinity Commercial |
$984.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$915.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.71
|
| Rate for Payer: Healthscope Commercial |
$1,030.00
|
| Rate for Payer: Mclaren Medicaid |
$203.82
|
| Rate for Payer: Mclaren Medicare |
$389.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.20
|
| Rate for Payer: Meridian Medicaid |
$409.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$428.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$972.77
|
| Rate for Payer: Nomi Health Commercial |
$1,169.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$858.33
|
| Rate for Payer: PACE Medicare |
$370.22
|
| Rate for Payer: PACE SWMI |
$389.71
|
| Rate for Payer: PHP Commercial |
$972.77
|
| Rate for Payer: PHP Medicare Advantage |
$389.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$203.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,260.30
|
| Rate for Payer: Priority Health Medicare |
$389.71
|
| Rate for Payer: Priority Health SBD |
$721.00
|
| Rate for Payer: Priority Health Tiered Network |
$1,008.24
|
| Rate for Payer: Railroad Medicare Medicare |
$389.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$743.89
|
| Rate for Payer: UHC Core |
$596.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$389.71
|
| Rate for Payer: UHC Exchange |
$449.76
|
| Rate for Payer: UHC Medicaid |
$203.82
|
| Rate for Payer: UHCCP Medicaid |
$203.82
|
| Rate for Payer: VA VA |
$389.71
|
|
|
HC LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX
|
Facility
|
IP
|
$577.42
|
|
|
Service Code
|
CPT 31505
|
| Hospital Charge Code |
76100411
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$363.77 |
| Max. Negotiated Rate |
$519.68 |
| Rate for Payer: Aetna Commercial |
$490.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.32
|
| Rate for Payer: Cash Price |
$461.94
|
| Rate for Payer: Cofinity Advantage |
$404.19
|
| Rate for Payer: Cofinity Commercial |
$496.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.94
|
| Rate for Payer: Healthscope Commercial |
$519.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$433.06
|
| Rate for Payer: PHP Commercial |
$490.81
|
| Rate for Payer: Priority Health SBD |
$363.77
|
|
|
HC LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX
|
Facility
|
OP
|
$577.42
|
|
|
Service Code
|
CPT 31505
|
| Hospital Charge Code |
76100411
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$643.18 |
| Rate for Payer: Aetna Commercial |
$490.81
|
| Rate for Payer: Aetna Medicare |
$206.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$248.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$248.61
|
| Rate for Payer: BCBS Complete |
$109.23
|
| Rate for Payer: BCBS MAPPO |
$198.89
|
| Rate for Payer: BCBS Trust/PPO |
$57.60
|
| Rate for Payer: BCN Commercial |
$57.60
|
| Rate for Payer: BCN Medicare Advantage |
$198.89
|
| Rate for Payer: Cash Price |
$461.94
|
| Rate for Payer: Cash Price |
$461.94
|
| Rate for Payer: Cash Price |
$461.94
|
| Rate for Payer: Cofinity Advantage |
$404.19
|
| Rate for Payer: Cofinity Commercial |
$496.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.89
|
| Rate for Payer: Healthscope Commercial |
$519.68
|
| Rate for Payer: Mclaren Medicaid |
$104.02
|
| Rate for Payer: Mclaren Medicare |
$198.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$208.83
|
| Rate for Payer: Meridian Medicaid |
$208.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$218.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.81
|
| Rate for Payer: Nomi Health Commercial |
$596.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$433.06
|
| Rate for Payer: PACE Medicare |
$188.95
|
| Rate for Payer: PACE SWMI |
$198.89
|
| Rate for Payer: PHP Commercial |
$490.81
|
| Rate for Payer: PHP Medicare Advantage |
$198.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$643.18
|
| Rate for Payer: Priority Health Medicare |
$198.89
|
| Rate for Payer: Priority Health SBD |
$363.77
|
| Rate for Payer: Priority Health Tiered Network |
$514.54
|
| Rate for Payer: Railroad Medicare Medicare |
$198.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$375.32
|
| Rate for Payer: UHC Core |
$300.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$198.89
|
| Rate for Payer: UHC Exchange |
$226.93
|
| Rate for Payer: UHC Medicaid |
$104.02
|
| Rate for Payer: UHCCP Medicaid |
$104.02
|
| Rate for Payer: VA VA |
$198.89
|
|
|
HC LASER CATHETER
|
Facility
|
IP
|
$5,038.11
|
|
|
Service Code
|
HCPCS C1885
|
| Hospital Charge Code |
27200054
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,174.01 |
| Max. Negotiated Rate |
$4,534.30 |
| Rate for Payer: Aetna Commercial |
$4,282.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,274.77
|
| Rate for Payer: Cash Price |
$4,030.49
|
| Rate for Payer: Cofinity Advantage |
$3,526.68
|
| Rate for Payer: Cofinity Commercial |
$4,332.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,030.49
|
| Rate for Payer: Healthscope Commercial |
$4,534.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,282.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,778.58
|
| Rate for Payer: PHP Commercial |
$4,282.39
|
| Rate for Payer: Priority Health SBD |
$3,174.01
|
|
|
HC LASER CATHETER
|
Facility
|
OP
|
$5,038.11
|
|
|
Service Code
|
HCPCS C1885
|
| Hospital Charge Code |
27200054
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,979.98 |
| Max. Negotiated Rate |
$4,534.30 |
| Rate for Payer: Aetna Commercial |
$4,282.39
|
| Rate for Payer: Aetna Medicare |
$2,519.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,274.77
|
| Rate for Payer: BCBS Complete |
$2,015.24
|
| Rate for Payer: Cash Price |
$4,030.49
|
| Rate for Payer: Cofinity Advantage |
$3,526.68
|
| Rate for Payer: Cofinity Commercial |
$4,332.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,030.49
|
| Rate for Payer: Healthscope Commercial |
$4,534.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,030.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,282.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,778.58
|
| Rate for Payer: PHP Commercial |
$4,282.39
|
| Rate for Payer: Priority Health SBD |
$3,174.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,274.77
|
| Rate for Payer: UHC Core |
$2,624.86
|
| Rate for Payer: UHC Exchange |
$1,979.98
|
|
|
HC LATEX IGE
|
Facility
|
IP
|
$36.51
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200044
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$32.86 |
| Rate for Payer: Aetna Commercial |
$31.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.73
|
| Rate for Payer: Cash Price |
$29.21
|
| Rate for Payer: Cofinity Advantage |
$25.56
|
| Rate for Payer: Cofinity Commercial |
$31.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.21
|
| Rate for Payer: Healthscope Commercial |
$32.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.38
|
| Rate for Payer: PHP Commercial |
$31.03
|
| Rate for Payer: Priority Health SBD |
$23.00
|
|
|
HC LATEX IGE
|
Facility
|
OP
|
$36.51
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200044
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$32.86 |
| Rate for Payer: Aetna Commercial |
$31.03
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$29.21
|
| Rate for Payer: Cash Price |
$29.21
|
| Rate for Payer: Cofinity Advantage |
$25.56
|
| Rate for Payer: Cofinity Commercial |
$31.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$32.86
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.03
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.38
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$31.03
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$23.00
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC LAYR CLOS WND REST BODY <2.5 CM
|
Facility
|
IP
|
$508.61
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
76100228
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$320.42 |
| Max. Negotiated Rate |
$457.75 |
| Rate for Payer: Aetna Commercial |
$432.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.60
|
| Rate for Payer: Cash Price |
$406.89
|
| Rate for Payer: Cofinity Advantage |
$356.03
|
| Rate for Payer: Cofinity Commercial |
$437.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$406.89
|
| Rate for Payer: Healthscope Commercial |
$457.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$381.46
|
| Rate for Payer: PHP Commercial |
$432.32
|
| Rate for Payer: Priority Health SBD |
$320.42
|
|
|
HC LAYR CLOS WND REST BODY <2.5 CM
|
Facility
|
OP
|
$508.61
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
76100228
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$199.88 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Commercial |
$432.32
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$335.41
|
| Rate for Payer: BCN Commercial |
$335.41
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$406.89
|
| Rate for Payer: Cash Price |
$406.89
|
| Rate for Payer: Cash Price |
$406.89
|
| Rate for Payer: Cofinity Advantage |
$356.03
|
| Rate for Payer: Cofinity Commercial |
$437.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$406.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$457.75
|
| Rate for Payer: Mclaren Medicaid |
$211.84
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.32
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$381.46
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$432.32
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health SBD |
$320.42
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.60
|
| Rate for Payer: UHC Core |
$264.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Exchange |
$199.88
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
