|
HC SELECT SPECIALTY CATHETER INSERTION
|
Facility
|
IP
|
$1,686.32
|
|
| Hospital Charge Code |
36100565
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,062.38 |
| Max. Negotiated Rate |
$1,517.69 |
| Rate for Payer: Aetna Commercial |
$1,433.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,096.11
|
| Rate for Payer: Cash Price |
$1,349.06
|
| Rate for Payer: Cofinity Commercial |
$1,180.42
|
| Rate for Payer: Cofinity Commercial |
$1,450.24
|
| Rate for Payer: Healthscope Commercial |
$1,517.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,433.37
|
| Rate for Payer: PHP Commercial |
$1,433.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,180.42
|
| Rate for Payer: Priority Health SBD |
$1,062.38
|
|
|
HC SELENIUM LEVEL
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 84255
|
| Hospital Charge Code |
30100420
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health SBD |
$32.13
|
|
|
HC SELENIUM LEVEL
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 84255
|
| Hospital Charge Code |
30100420
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$26.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.91
|
| Rate for Payer: BCBS Complete |
$14.66
|
| Rate for Payer: BCBS MAPPO |
$25.53
|
| Rate for Payer: BCBS Trust/PPO |
$19.99
|
| Rate for Payer: BCN Medicare Advantage |
$25.53
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.53
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$13.96
|
| Rate for Payer: Mclaren Medicare |
$25.53
|
| Rate for Payer: Meridian Medicaid |
$14.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Medicare |
$24.25
|
| Rate for Payer: PACE SWMI |
$25.53
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$25.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health Medicare |
$25.53
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: Railroad Medicare Medicare |
$25.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.64
|
| Rate for Payer: UHC Core |
$43.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.53
|
| Rate for Payer: UHC Exchange |
$25.53
|
| Rate for Payer: UHC Medicare Advantage |
$26.30
|
| Rate for Payer: VA VA |
$25.53
|
|
|
HC SELF-ADMINISTRABLE DRUG
|
Facility
|
OP
|
$0.51
|
|
| Hospital Charge Code |
63700003
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Aetna Commercial |
$0.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.33
|
| Rate for Payer: BCBS Complete |
$0.20
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cofinity Commercial |
$0.36
|
| Rate for Payer: Cofinity Commercial |
$0.44
|
| Rate for Payer: Healthscope Commercial |
$0.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.43
|
| Rate for Payer: PHP Commercial |
$0.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.36
|
| Rate for Payer: Priority Health SBD |
$0.32
|
|
|
HC SELF-ADMINISTRABLE DRUG
|
Facility
|
IP
|
$0.51
|
|
| Hospital Charge Code |
63700003
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Aetna Commercial |
$0.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.33
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cofinity Commercial |
$0.36
|
| Rate for Payer: Cofinity Commercial |
$0.44
|
| Rate for Payer: Healthscope Commercial |
$0.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.43
|
| Rate for Payer: PHP Commercial |
$0.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.36
|
| Rate for Payer: Priority Health SBD |
$0.32
|
|
|
HC SELF-MGMT EDUC & TRAIN 1 PT PER 30 MIN
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT 98960
|
| Hospital Charge Code |
94200039
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$130.49 |
| Rate for Payer: Aetna Commercial |
$39.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.55
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS Trust/PPO |
$130.49
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$40.42
|
| Rate for Payer: Cofinity Commercial |
$32.90
|
| Rate for Payer: Healthscope Commercial |
$42.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.95
|
| Rate for Payer: PHP Commercial |
$39.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.90
|
| Rate for Payer: Priority Health SBD |
$29.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.13
|
| Rate for Payer: UHC Exchange |
$30.12
|
|
|
HC SELF-MGMT EDUC & TRAIN 1 PT PER 30 MIN
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT 98960
|
| Hospital Charge Code |
94200039
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$29.61 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna Commercial |
$39.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.55
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$32.90
|
| Rate for Payer: Cofinity Commercial |
$40.42
|
| Rate for Payer: Healthscope Commercial |
$42.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.95
|
| Rate for Payer: PHP Commercial |
$39.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.90
|
| Rate for Payer: Priority Health SBD |
$29.61
|
|
|
HC SEMEN EXAM FERTILITY
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 89320
|
| Hospital Charge Code |
30000006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$71.19 |
| Max. Negotiated Rate |
$101.70 |
| Rate for Payer: Aetna Commercial |
$96.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.45
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$79.10
|
| Rate for Payer: Cofinity Commercial |
$97.18
|
| Rate for Payer: Healthscope Commercial |
$101.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.05
|
| Rate for Payer: PHP Commercial |
$96.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
| Rate for Payer: Priority Health SBD |
$71.19
|
|
|
HC SEMEN EXAM FERTILITY
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 89320
|
| Hospital Charge Code |
30000006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$101.70 |
| Rate for Payer: Aetna Commercial |
$96.05
|
| Rate for Payer: Aetna Medicare |
$12.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.39
|
| Rate for Payer: BCBS Complete |
$7.07
|
| Rate for Payer: BCBS MAPPO |
$12.31
|
| Rate for Payer: BCBS Trust/PPO |
$9.64
|
| Rate for Payer: BCN Medicare Advantage |
$12.31
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$97.18
|
| Rate for Payer: Cofinity Commercial |
$79.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.31
|
| Rate for Payer: Healthscope Commercial |
$101.70
|
| Rate for Payer: Mclaren Medicaid |
$6.73
|
| Rate for Payer: Mclaren Medicare |
$12.31
|
| Rate for Payer: Meridian Medicaid |
$7.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.05
|
| Rate for Payer: PACE Medicare |
$11.69
|
| Rate for Payer: PACE SWMI |
$12.31
|
| Rate for Payer: PHP Commercial |
$96.05
|
| Rate for Payer: PHP Medicare Advantage |
$12.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
| Rate for Payer: Priority Health Medicare |
$12.31
|
| Rate for Payer: Priority Health SBD |
$71.19
|
| Rate for Payer: Railroad Medicare Medicare |
$12.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.77
|
| Rate for Payer: UHC Core |
$20.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.31
|
| Rate for Payer: UHC Exchange |
$12.31
|
| Rate for Payer: UHC Medicare Advantage |
$12.68
|
| Rate for Payer: VA VA |
$12.31
|
|
|
HC SEMEN EXAM VASECTOMY
|
Facility
|
OP
|
$75.40
|
|
|
Service Code
|
CPT 89321
|
| Hospital Charge Code |
30000007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$67.86 |
| Rate for Payer: Aetna Commercial |
$64.09
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$9.44
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Cofinity Commercial |
$64.84
|
| Rate for Payer: Cofinity Commercial |
$52.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$67.86
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.09
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$64.09
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.78
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$47.50
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.46
|
| Rate for Payer: UHC Core |
$20.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC SEMEN EXAM VASECTOMY
|
Facility
|
IP
|
$75.40
|
|
|
Service Code
|
CPT 89321
|
| Hospital Charge Code |
30000007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$67.86 |
| Rate for Payer: Aetna Commercial |
$64.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.01
|
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Cofinity Commercial |
$64.84
|
| Rate for Payer: Cofinity Commercial |
$52.78
|
| Rate for Payer: Healthscope Commercial |
$67.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.09
|
| Rate for Payer: PHP Commercial |
$64.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.78
|
| Rate for Payer: Priority Health SBD |
$47.50
|
|
|
HC SENSOR CDI 550 ART SHUNT
|
Facility
|
OP
|
$375.00
|
|
| Hospital Charge Code |
27000655
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Aetna Commercial |
$318.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.75
|
| Rate for Payer: BCBS Complete |
$150.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cofinity Commercial |
$262.50
|
| Rate for Payer: Cofinity Commercial |
$322.50
|
| Rate for Payer: Healthscope Commercial |
$337.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$318.75
|
| Rate for Payer: PHP Commercial |
$318.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.50
|
| Rate for Payer: Priority Health SBD |
$236.25
|
|
|
HC SENSOR CDI 550 ART SHUNT
|
Facility
|
IP
|
$375.00
|
|
| Hospital Charge Code |
27000655
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$236.25 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Aetna Commercial |
$318.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.75
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cofinity Commercial |
$262.50
|
| Rate for Payer: Cofinity Commercial |
$322.50
|
| Rate for Payer: Healthscope Commercial |
$337.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$318.75
|
| Rate for Payer: PHP Commercial |
$318.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.50
|
| Rate for Payer: Priority Health SBD |
$236.25
|
|
|
HC SENSOR PAD LEVEL DETECTOR
|
Facility
|
OP
|
$17.25
|
|
| Hospital Charge Code |
27000656
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$15.52 |
| Rate for Payer: Aetna Commercial |
$14.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.21
|
| Rate for Payer: BCBS Complete |
$6.90
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cofinity Commercial |
$12.08
|
| Rate for Payer: Cofinity Commercial |
$14.84
|
| Rate for Payer: Healthscope Commercial |
$15.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.66
|
| Rate for Payer: PHP Commercial |
$14.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.08
|
| Rate for Payer: Priority Health SBD |
$10.87
|
|
|
HC SENSOR PAD LEVEL DETECTOR
|
Facility
|
IP
|
$17.25
|
|
| Hospital Charge Code |
27000656
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.87 |
| Max. Negotiated Rate |
$15.52 |
| Rate for Payer: Aetna Commercial |
$14.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.21
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cofinity Commercial |
$12.08
|
| Rate for Payer: Cofinity Commercial |
$14.84
|
| Rate for Payer: Healthscope Commercial |
$15.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.66
|
| Rate for Payer: PHP Commercial |
$14.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.08
|
| Rate for Payer: Priority Health SBD |
$10.87
|
|
|
HC SENSORS CEREBRAL OXIMETER
|
Facility
|
OP
|
$240.00
|
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna Commercial |
$204.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.00
|
| Rate for Payer: BCBS Complete |
$96.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cofinity Commercial |
$168.00
|
| Rate for Payer: Cofinity Commercial |
$206.40
|
| Rate for Payer: Healthscope Commercial |
$216.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$204.00
|
| Rate for Payer: PHP Commercial |
$204.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.00
|
| Rate for Payer: Priority Health SBD |
$151.20
|
|
|
HC SENSORS CEREBRAL OXIMETER
|
Facility
|
IP
|
$240.00
|
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$151.20 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna Commercial |
$204.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cofinity Commercial |
$168.00
|
| Rate for Payer: Cofinity Commercial |
$206.40
|
| Rate for Payer: Healthscope Commercial |
$216.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$204.00
|
| Rate for Payer: PHP Commercial |
$204.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.00
|
| Rate for Payer: Priority Health SBD |
$151.20
|
|
|
HC SENSORY INTEGRATION
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 97533
|
| Hospital Charge Code |
42000029
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$56.07 |
| Max. Negotiated Rate |
$80.10 |
| Rate for Payer: Aetna Commercial |
$75.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.85
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cofinity Commercial |
$62.30
|
| Rate for Payer: Cofinity Commercial |
$76.54
|
| Rate for Payer: Healthscope Commercial |
$80.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.65
|
| Rate for Payer: PHP Commercial |
$75.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.30
|
| Rate for Payer: Priority Health SBD |
$56.07
|
|
|
HC SENSORY INTEGRATION
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 97533
|
| Hospital Charge Code |
42000029
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$80.10 |
| Rate for Payer: Aetna Commercial |
$75.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.85
|
| Rate for Payer: BCBS Complete |
$35.60
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cofinity Commercial |
$62.30
|
| Rate for Payer: Cofinity Commercial |
$76.54
|
| Rate for Payer: Healthscope Commercial |
$80.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.65
|
| Rate for Payer: PHP Commercial |
$75.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.30
|
| Rate for Payer: Priority Health SBD |
$56.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.35
|
| Rate for Payer: UHC Exchange |
$61.23
|
|
|
HC SENTINEL NODE INJ NON RADIOACTIVE
|
Facility
|
OP
|
$971.92
|
|
|
Service Code
|
HCPCS 38900
|
| Hospital Charge Code |
36000090
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$133.92 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$826.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$631.75
|
| Rate for Payer: BCBS Complete |
$388.77
|
| Rate for Payer: BCBS Trust/PPO |
$282.38
|
| Rate for Payer: Cash Price |
$777.54
|
| Rate for Payer: Cash Price |
$777.54
|
| Rate for Payer: Cofinity Commercial |
$835.85
|
| Rate for Payer: Cofinity Commercial |
$680.34
|
| Rate for Payer: Healthscope Commercial |
$874.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$826.13
|
| Rate for Payer: PHP Commercial |
$826.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$680.34
|
| Rate for Payer: Priority Health SBD |
$612.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.31
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$133.92
|
|
|
HC SENTINEL NODE INJ NON RADIOACTIVE
|
Facility
|
IP
|
$971.92
|
|
|
Service Code
|
HCPCS 38900
|
| Hospital Charge Code |
36000090
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$612.31 |
| Max. Negotiated Rate |
$874.73 |
| Rate for Payer: Aetna Commercial |
$826.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$631.75
|
| Rate for Payer: Cash Price |
$777.54
|
| Rate for Payer: Cofinity Commercial |
$680.34
|
| Rate for Payer: Cofinity Commercial |
$835.85
|
| Rate for Payer: Healthscope Commercial |
$874.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$826.13
|
| Rate for Payer: PHP Commercial |
$826.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$680.34
|
| Rate for Payer: Priority Health SBD |
$612.31
|
|
|
HC SEQUENTIAL MATERNAL SCRN PART 1
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 84163
|
| Hospital Charge Code |
30100655
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.70 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.50
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$63.00
|
| Rate for Payer: Cofinity Commercial |
$77.40
|
| Rate for Payer: Healthscope Commercial |
$81.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.50
|
| Rate for Payer: PHP Commercial |
$76.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: Priority Health SBD |
$56.70
|
|
|
HC SEQUENTIAL MATERNAL SCRN PART 1
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 84163
|
| Hospital Charge Code |
30100655
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna Medicare |
$15.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.81
|
| Rate for Payer: BCBS Complete |
$8.64
|
| Rate for Payer: BCBS MAPPO |
$15.05
|
| Rate for Payer: BCBS Trust/PPO |
$11.79
|
| Rate for Payer: BCN Medicare Advantage |
$15.05
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$77.40
|
| Rate for Payer: Cofinity Commercial |
$63.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.05
|
| Rate for Payer: Healthscope Commercial |
$81.00
|
| Rate for Payer: Mclaren Medicaid |
$8.23
|
| Rate for Payer: Mclaren Medicare |
$15.05
|
| Rate for Payer: Meridian Medicaid |
$8.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.50
|
| Rate for Payer: PACE Medicare |
$14.30
|
| Rate for Payer: PACE SWMI |
$15.05
|
| Rate for Payer: PHP Commercial |
$76.50
|
| Rate for Payer: PHP Medicare Advantage |
$15.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: Priority Health Medicare |
$15.05
|
| Rate for Payer: Priority Health SBD |
$56.70
|
| Rate for Payer: Railroad Medicare Medicare |
$15.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.06
|
| Rate for Payer: UHC Core |
$25.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.05
|
| Rate for Payer: UHC Exchange |
$15.05
|
| Rate for Payer: UHC Medicare Advantage |
$15.50
|
| Rate for Payer: VA VA |
$15.05
|
|
|
HC SEQUENTIAL MATERNAL SCRN PART 2
|
Facility
|
OP
|
$237.60
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
30100656
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$83.96 |
| Max. Negotiated Rate |
$213.84 |
| Rate for Payer: Aetna Commercial |
$201.96
|
| Rate for Payer: Aetna Medicare |
$159.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.88
|
| Rate for Payer: BCBS Complete |
$88.17
|
| Rate for Payer: BCBS MAPPO |
$153.50
|
| Rate for Payer: BCBS Trust/PPO |
$120.21
|
| Rate for Payer: BCN Medicare Advantage |
$153.50
|
| Rate for Payer: Cash Price |
$190.08
|
| Rate for Payer: Cash Price |
$190.08
|
| Rate for Payer: Cofinity Commercial |
$204.34
|
| Rate for Payer: Cofinity Commercial |
$166.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.50
|
| Rate for Payer: Healthscope Commercial |
$213.84
|
| Rate for Payer: Mclaren Medicaid |
$83.96
|
| Rate for Payer: Mclaren Medicare |
$153.50
|
| Rate for Payer: Meridian Medicaid |
$88.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$161.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.96
|
| Rate for Payer: PACE Medicare |
$145.82
|
| Rate for Payer: PACE SWMI |
$153.50
|
| Rate for Payer: PHP Commercial |
$201.96
|
| Rate for Payer: PHP Medicare Advantage |
$153.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.32
|
| Rate for Payer: Priority Health Medicare |
$153.50
|
| Rate for Payer: Priority Health SBD |
$149.69
|
| Rate for Payer: Railroad Medicare Medicare |
$153.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.20
|
| Rate for Payer: UHC Core |
$184.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.50
|
| Rate for Payer: UHC Exchange |
$153.50
|
| Rate for Payer: UHC Medicare Advantage |
$158.10
|
| Rate for Payer: VA VA |
$153.50
|
|
|
HC SEQUENTIAL MATERNAL SCRN PART 2
|
Facility
|
IP
|
$237.60
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
30100656
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$149.69 |
| Max. Negotiated Rate |
$213.84 |
| Rate for Payer: Aetna Commercial |
$201.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.44
|
| Rate for Payer: Cash Price |
$190.08
|
| Rate for Payer: Cofinity Commercial |
$166.32
|
| Rate for Payer: Cofinity Commercial |
$204.34
|
| Rate for Payer: Healthscope Commercial |
$213.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.96
|
| Rate for Payer: PHP Commercial |
$201.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.32
|
| Rate for Payer: Priority Health SBD |
$149.69
|
|
