|
HC SIGMOIDOSCOPY WITH BIOPSY
|
Facility
|
OP
|
$1,240.03
|
|
|
Service Code
|
CPT 45331
|
| Hospital Charge Code |
36000111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.40 |
| Max. Negotiated Rate |
$2,470.91 |
| Rate for Payer: Aetna Commercial |
$1,054.03
|
| Rate for Payer: Aetna Medicare |
$845.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$806.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,016.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,016.54
|
| Rate for Payer: BCBS Complete |
$467.12
|
| Rate for Payer: BCBS MAPPO |
$813.23
|
| Rate for Payer: BCBS Trust/PPO |
$648.77
|
| Rate for Payer: BCN Medicare Advantage |
$813.23
|
| Rate for Payer: Cash Price |
$992.02
|
| Rate for Payer: Cash Price |
$992.02
|
| Rate for Payer: Cofinity Commercial |
$868.02
|
| Rate for Payer: Cofinity Commercial |
$1,066.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$813.23
|
| Rate for Payer: Healthscope Commercial |
$1,116.03
|
| Rate for Payer: Mclaren Medicaid |
$444.84
|
| Rate for Payer: Mclaren Medicare |
$813.23
|
| Rate for Payer: Meridian Medicaid |
$467.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$853.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$935.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,054.03
|
| Rate for Payer: PACE Medicare |
$772.57
|
| Rate for Payer: PACE SWMI |
$813.23
|
| Rate for Payer: PHP Commercial |
$1,054.03
|
| Rate for Payer: PHP Medicare Advantage |
$813.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$868.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,470.91
|
| Rate for Payer: Priority Health Medicare |
$813.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,976.73
|
| Rate for Payer: Priority Health SBD |
$781.22
|
| Rate for Payer: Railroad Medicare Medicare |
$813.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$813.23
|
| Rate for Payer: UHC Exchange |
$70.40
|
| Rate for Payer: UHC Medicare Advantage |
$837.63
|
| Rate for Payer: VA VA |
$813.23
|
|
|
HC SIGNAL AVERAGE EKG
|
Facility
|
OP
|
$247.91
|
|
|
Service Code
|
CPT 93278
|
| Hospital Charge Code |
73100004
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$29.77 |
| Max. Negotiated Rate |
$223.12 |
| Rate for Payer: Aetna Commercial |
$210.72
|
| Rate for Payer: Aetna Medicare |
$56.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.04
|
| Rate for Payer: BCBS Complete |
$31.26
|
| Rate for Payer: BCBS MAPPO |
$54.43
|
| Rate for Payer: BCBS Trust/PPO |
$76.77
|
| Rate for Payer: BCN Medicare Advantage |
$54.43
|
| Rate for Payer: Cash Price |
$198.33
|
| Rate for Payer: Cash Price |
$198.33
|
| Rate for Payer: Cofinity Commercial |
$213.20
|
| Rate for Payer: Cofinity Commercial |
$173.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.43
|
| Rate for Payer: Healthscope Commercial |
$223.12
|
| Rate for Payer: Mclaren Medicaid |
$29.77
|
| Rate for Payer: Mclaren Medicare |
$54.43
|
| Rate for Payer: Meridian Medicaid |
$31.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$210.72
|
| Rate for Payer: PACE Medicare |
$51.71
|
| Rate for Payer: PACE SWMI |
$54.43
|
| Rate for Payer: PHP Commercial |
$210.72
|
| Rate for Payer: PHP Medicare Advantage |
$54.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.33
|
| Rate for Payer: Priority Health Medicare |
$54.43
|
| Rate for Payer: Priority Health Narrow Network |
$138.66
|
| Rate for Payer: Priority Health SBD |
$156.18
|
| Rate for Payer: Railroad Medicare Medicare |
$54.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.43
|
| Rate for Payer: UHC Exchange |
$31.11
|
| Rate for Payer: UHC Medicare Advantage |
$56.06
|
| Rate for Payer: VA VA |
$54.43
|
|
|
HC SIGNAL AVERAGE EKG
|
Facility
|
IP
|
$247.91
|
|
|
Service Code
|
CPT 93278
|
| Hospital Charge Code |
73100004
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$156.18 |
| Max. Negotiated Rate |
$223.12 |
| Rate for Payer: Aetna Commercial |
$210.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.14
|
| Rate for Payer: Cash Price |
$198.33
|
| Rate for Payer: Cofinity Commercial |
$173.54
|
| Rate for Payer: Cofinity Commercial |
$213.20
|
| Rate for Payer: Healthscope Commercial |
$223.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$210.72
|
| Rate for Payer: PHP Commercial |
$210.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.54
|
| Rate for Payer: Priority Health SBD |
$156.18
|
|
|
HC SILICA CLOTTING TIME ASSAY
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
30500099
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health SBD |
$16.06
|
|
|
HC SILICA CLOTTING TIME ASSAY
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
30500099
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.29 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$6.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.51
|
| Rate for Payer: BCBS Complete |
$3.45
|
| Rate for Payer: BCBS MAPPO |
$6.01
|
| Rate for Payer: BCBS Trust/PPO |
$4.71
|
| Rate for Payer: BCN Medicare Advantage |
$6.01
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.01
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$3.29
|
| Rate for Payer: Mclaren Medicare |
$6.01
|
| Rate for Payer: Meridian Medicaid |
$3.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PACE Medicare |
$5.71
|
| Rate for Payer: PACE SWMI |
$6.01
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: PHP Medicare Advantage |
$6.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health Medicare |
$6.01
|
| Rate for Payer: Priority Health SBD |
$16.06
|
| Rate for Payer: Railroad Medicare Medicare |
$6.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.21
|
| Rate for Payer: UHC Core |
$10.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.01
|
| Rate for Payer: UHC Exchange |
$6.01
|
| Rate for Payer: UHC Medicare Advantage |
$6.19
|
| Rate for Payer: VA VA |
$6.01
|
|
|
HC SILVADENE 400 GM
|
Facility
|
OP
|
$248.55
|
|
| Hospital Charge Code |
27100016
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$99.42 |
| Max. Negotiated Rate |
$223.70 |
| Rate for Payer: Aetna Commercial |
$211.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.56
|
| Rate for Payer: BCBS Complete |
$99.42
|
| Rate for Payer: Cash Price |
$198.84
|
| Rate for Payer: Cofinity Commercial |
$173.98
|
| Rate for Payer: Cofinity Commercial |
$213.75
|
| Rate for Payer: Healthscope Commercial |
$223.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$211.27
|
| Rate for Payer: PHP Commercial |
$211.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.98
|
| Rate for Payer: Priority Health SBD |
$156.59
|
|
|
HC SILVADENE 400 GM
|
Facility
|
IP
|
$248.55
|
|
| Hospital Charge Code |
27100016
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$156.59 |
| Max. Negotiated Rate |
$223.70 |
| Rate for Payer: Aetna Commercial |
$211.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.56
|
| Rate for Payer: Cash Price |
$198.84
|
| Rate for Payer: Cofinity Commercial |
$173.98
|
| Rate for Payer: Cofinity Commercial |
$213.75
|
| Rate for Payer: Healthscope Commercial |
$223.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$211.27
|
| Rate for Payer: PHP Commercial |
$211.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.98
|
| Rate for Payer: Priority Health SBD |
$156.59
|
|
|
HC SILVADENE 85 GM
|
Facility
|
OP
|
$102.57
|
|
| Hospital Charge Code |
27100017
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$41.03 |
| Max. Negotiated Rate |
$92.31 |
| Rate for Payer: Aetna Commercial |
$87.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.67
|
| Rate for Payer: BCBS Complete |
$41.03
|
| Rate for Payer: Cash Price |
$82.06
|
| Rate for Payer: Cofinity Commercial |
$71.80
|
| Rate for Payer: Cofinity Commercial |
$88.21
|
| Rate for Payer: Healthscope Commercial |
$92.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.18
|
| Rate for Payer: PHP Commercial |
$87.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.80
|
| Rate for Payer: Priority Health SBD |
$64.62
|
|
|
HC SILVADENE 85 GM
|
Facility
|
IP
|
$102.57
|
|
| Hospital Charge Code |
27100017
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$64.62 |
| Max. Negotiated Rate |
$92.31 |
| Rate for Payer: Aetna Commercial |
$87.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.67
|
| Rate for Payer: Cash Price |
$82.06
|
| Rate for Payer: Cofinity Commercial |
$71.80
|
| Rate for Payer: Cofinity Commercial |
$88.21
|
| Rate for Payer: Healthscope Commercial |
$92.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.18
|
| Rate for Payer: PHP Commercial |
$87.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.80
|
| Rate for Payer: Priority Health SBD |
$64.62
|
|
|
HC SILVER 4X4
|
Facility
|
IP
|
$64.13
|
|
| Hospital Charge Code |
27000146
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$57.72 |
| Rate for Payer: Aetna Commercial |
$54.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.68
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cofinity Commercial |
$44.89
|
| Rate for Payer: Cofinity Commercial |
$55.15
|
| Rate for Payer: Healthscope Commercial |
$57.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.51
|
| Rate for Payer: PHP Commercial |
$54.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.89
|
| Rate for Payer: Priority Health SBD |
$40.40
|
|
|
HC SILVER 4X4
|
Facility
|
OP
|
$64.13
|
|
| Hospital Charge Code |
27000146
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$57.72 |
| Rate for Payer: Aetna Commercial |
$54.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.68
|
| Rate for Payer: BCBS Complete |
$25.65
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cofinity Commercial |
$44.89
|
| Rate for Payer: Cofinity Commercial |
$55.15
|
| Rate for Payer: Healthscope Commercial |
$57.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.51
|
| Rate for Payer: PHP Commercial |
$54.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.89
|
| Rate for Payer: Priority Health SBD |
$40.40
|
|
|
HC SILVER HAWK CATHETER
|
Facility
|
IP
|
$8,575.06
|
|
|
Service Code
|
HCPCS C1888
|
| Hospital Charge Code |
27200070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,402.29 |
| Max. Negotiated Rate |
$7,717.55 |
| Rate for Payer: Aetna Commercial |
$7,288.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,573.79
|
| Rate for Payer: Cash Price |
$6,860.05
|
| Rate for Payer: Cofinity Commercial |
$6,002.54
|
| Rate for Payer: Cofinity Commercial |
$7,374.55
|
| Rate for Payer: Healthscope Commercial |
$7,717.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,288.80
|
| Rate for Payer: PHP Commercial |
$7,288.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,002.54
|
| Rate for Payer: Priority Health SBD |
$5,402.29
|
|
|
HC SILVER HAWK CATHETER
|
Facility
|
OP
|
$8,575.06
|
|
|
Service Code
|
HCPCS C1888
|
| Hospital Charge Code |
27200070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,430.02 |
| Max. Negotiated Rate |
$7,717.55 |
| Rate for Payer: Aetna Commercial |
$7,288.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,573.79
|
| Rate for Payer: BCBS Complete |
$3,430.02
|
| Rate for Payer: Cash Price |
$6,860.05
|
| Rate for Payer: Cofinity Commercial |
$6,002.54
|
| Rate for Payer: Cofinity Commercial |
$7,374.55
|
| Rate for Payer: Healthscope Commercial |
$7,717.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,288.80
|
| Rate for Payer: PHP Commercial |
$7,288.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,002.54
|
| Rate for Payer: Priority Health SBD |
$5,402.29
|
|
|
HC SILVER ROPE
|
Facility
|
IP
|
$53.51
|
|
| Hospital Charge Code |
27000147
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.71 |
| Max. Negotiated Rate |
$48.16 |
| Rate for Payer: Aetna Commercial |
$45.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.78
|
| Rate for Payer: Cash Price |
$42.81
|
| Rate for Payer: Cofinity Commercial |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$46.02
|
| Rate for Payer: Healthscope Commercial |
$48.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.48
|
| Rate for Payer: PHP Commercial |
$45.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.46
|
| Rate for Payer: Priority Health SBD |
$33.71
|
|
|
HC SILVER ROPE
|
Facility
|
OP
|
$53.51
|
|
| Hospital Charge Code |
27000147
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.40 |
| Max. Negotiated Rate |
$48.16 |
| Rate for Payer: Aetna Commercial |
$45.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.78
|
| Rate for Payer: BCBS Complete |
$21.40
|
| Rate for Payer: Cash Price |
$42.81
|
| Rate for Payer: Cofinity Commercial |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$46.02
|
| Rate for Payer: Healthscope Commercial |
$48.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.48
|
| Rate for Payer: PHP Commercial |
$45.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.46
|
| Rate for Payer: Priority Health SBD |
$33.71
|
|
|
HC SIMIAN B AB
|
Facility
|
IP
|
$89.30
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
30200333
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$56.26 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$75.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.04
|
| Rate for Payer: Cash Price |
$71.44
|
| Rate for Payer: Cofinity Commercial |
$62.51
|
| Rate for Payer: Cofinity Commercial |
$76.80
|
| Rate for Payer: Healthscope Commercial |
$80.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.90
|
| Rate for Payer: PHP Commercial |
$75.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.51
|
| Rate for Payer: Priority Health SBD |
$56.26
|
|
|
HC SIMIAN B AB
|
Facility
|
OP
|
$89.30
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
30200333
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$75.90
|
| Rate for Payer: Aetna Medicare |
$13.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.10
|
| Rate for Payer: BCBS Complete |
$7.40
|
| Rate for Payer: BCBS MAPPO |
$12.88
|
| Rate for Payer: BCBS Trust/PPO |
$10.09
|
| Rate for Payer: BCN Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$71.44
|
| Rate for Payer: Cash Price |
$71.44
|
| Rate for Payer: Cofinity Commercial |
$62.51
|
| Rate for Payer: Cofinity Commercial |
$76.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.88
|
| Rate for Payer: Healthscope Commercial |
$80.37
|
| Rate for Payer: Mclaren Medicaid |
$7.05
|
| Rate for Payer: Mclaren Medicare |
$12.88
|
| Rate for Payer: Meridian Medicaid |
$7.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.90
|
| Rate for Payer: PACE Medicare |
$12.24
|
| Rate for Payer: PACE SWMI |
$12.88
|
| Rate for Payer: PHP Commercial |
$75.90
|
| Rate for Payer: PHP Medicare Advantage |
$12.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.51
|
| Rate for Payer: Priority Health Medicare |
$12.88
|
| Rate for Payer: Priority Health SBD |
$56.26
|
| Rate for Payer: Railroad Medicare Medicare |
$12.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.46
|
| Rate for Payer: UHC Core |
$21.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.88
|
| Rate for Payer: UHC Exchange |
$12.88
|
| Rate for Payer: UHC Medicare Advantage |
$13.27
|
| Rate for Payer: VA VA |
$12.88
|
|
|
HC SIMPLE CYSTOMETROGRAM
|
Facility
|
IP
|
$354.07
|
|
|
Service Code
|
CPT 51725
|
| Hospital Charge Code |
76100189
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$223.06 |
| Max. Negotiated Rate |
$318.66 |
| Rate for Payer: Aetna Commercial |
$300.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.15
|
| Rate for Payer: Cash Price |
$283.26
|
| Rate for Payer: Cofinity Commercial |
$247.85
|
| Rate for Payer: Cofinity Commercial |
$304.50
|
| Rate for Payer: Healthscope Commercial |
$318.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$300.96
|
| Rate for Payer: PHP Commercial |
$300.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.85
|
| Rate for Payer: Priority Health SBD |
$223.06
|
|
|
HC SIMPLE CYSTOMETROGRAM
|
Facility
|
OP
|
$354.07
|
|
|
Service Code
|
CPT 51725
|
| Hospital Charge Code |
76100189
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.95 |
| Max. Negotiated Rate |
$318.66 |
| Rate for Payer: Aetna Commercial |
$300.96
|
| Rate for Payer: Aetna Medicare |
$228.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$274.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$274.89
|
| Rate for Payer: BCBS Complete |
$126.32
|
| Rate for Payer: BCBS MAPPO |
$219.91
|
| Rate for Payer: BCBS Trust/PPO |
$69.95
|
| Rate for Payer: BCN Medicare Advantage |
$219.91
|
| Rate for Payer: Cash Price |
$283.26
|
| Rate for Payer: Cash Price |
$283.26
|
| Rate for Payer: Cofinity Commercial |
$304.50
|
| Rate for Payer: Cofinity Commercial |
$247.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.91
|
| Rate for Payer: Healthscope Commercial |
$318.66
|
| Rate for Payer: Mclaren Medicaid |
$120.29
|
| Rate for Payer: Mclaren Medicare |
$219.91
|
| Rate for Payer: Meridian Medicaid |
$126.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$230.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$300.96
|
| Rate for Payer: PACE Medicare |
$208.91
|
| Rate for Payer: PACE SWMI |
$219.91
|
| Rate for Payer: PHP Commercial |
$300.96
|
| Rate for Payer: PHP Medicare Advantage |
$219.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.85
|
| Rate for Payer: Priority Health Medicare |
$219.91
|
| Rate for Payer: Priority Health SBD |
$223.06
|
| Rate for Payer: Railroad Medicare Medicare |
$219.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.91
|
| Rate for Payer: UHC Exchange |
$223.64
|
| Rate for Payer: UHC Medicare Advantage |
$226.51
|
| Rate for Payer: VA VA |
$219.91
|
|
|
HC SIMPLE REP WD FACE,EAR,EYELID,NOSE,LIP,MUC MEMB 2.5CM OR LESS
|
Facility
|
IP
|
$267.34
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
76100274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$168.42 |
| Max. Negotiated Rate |
$240.61 |
| Rate for Payer: Aetna Commercial |
$227.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.77
|
| Rate for Payer: Cash Price |
$213.87
|
| Rate for Payer: Cofinity Commercial |
$187.14
|
| Rate for Payer: Cofinity Commercial |
$229.91
|
| Rate for Payer: Healthscope Commercial |
$240.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.24
|
| Rate for Payer: PHP Commercial |
$227.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.14
|
| Rate for Payer: Priority Health SBD |
$168.42
|
|
|
HC SIMPLE REP WD FACE,EAR,EYELID,NOSE,LIP,MUC MEMB 2.5CM OR LESS
|
Facility
|
OP
|
$267.34
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
76100274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.36 |
| Max. Negotiated Rate |
$541.49 |
| Rate for Payer: Aetna Commercial |
$227.24
|
| Rate for Payer: Aetna Medicare |
$185.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.68
|
| Rate for Payer: BCBS Complete |
$102.32
|
| Rate for Payer: BCBS MAPPO |
$178.14
|
| Rate for Payer: BCBS Trust/PPO |
$79.92
|
| Rate for Payer: BCN Medicare Advantage |
$178.14
|
| Rate for Payer: Cash Price |
$213.87
|
| Rate for Payer: Cash Price |
$213.87
|
| Rate for Payer: Cofinity Commercial |
$229.91
|
| Rate for Payer: Cofinity Commercial |
$187.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.14
|
| Rate for Payer: Healthscope Commercial |
$240.61
|
| Rate for Payer: Mclaren Medicaid |
$97.44
|
| Rate for Payer: Mclaren Medicare |
$178.14
|
| Rate for Payer: Meridian Medicaid |
$102.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$187.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.24
|
| Rate for Payer: PACE Medicare |
$169.23
|
| Rate for Payer: PACE SWMI |
$178.14
|
| Rate for Payer: PHP Commercial |
$227.24
|
| Rate for Payer: PHP Medicare Advantage |
$178.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.49
|
| Rate for Payer: Priority Health Medicare |
$178.14
|
| Rate for Payer: Priority Health Narrow Network |
$433.19
|
| Rate for Payer: Priority Health SBD |
$168.42
|
| Rate for Payer: Railroad Medicare Medicare |
$178.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.14
|
| Rate for Payer: UHC Exchange |
$54.36
|
| Rate for Payer: UHC Medicare Advantage |
$183.48
|
| Rate for Payer: VA VA |
$178.14
|
|
|
HC SIMPLE REP WD SCALP,NECK,AXILLAE,GENITALIA,TRUNK, EXTREMS 2.6 TO 7.5 CM
|
Facility
|
IP
|
$144.23
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
76100114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.86 |
| Max. Negotiated Rate |
$129.81 |
| Rate for Payer: Aetna Commercial |
$122.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.75
|
| Rate for Payer: Cash Price |
$115.38
|
| Rate for Payer: Cofinity Commercial |
$100.96
|
| Rate for Payer: Cofinity Commercial |
$124.04
|
| Rate for Payer: Healthscope Commercial |
$129.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.60
|
| Rate for Payer: PHP Commercial |
$122.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.96
|
| Rate for Payer: Priority Health SBD |
$90.86
|
|
|
HC SIMPLE REP WD SCALP,NECK,AXILLAE,GENITALIA,TRUNK, EXTREMS 2.6 TO 7.5 CM
|
Facility
|
OP
|
$144.23
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
76100114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.63 |
| Max. Negotiated Rate |
$541.49 |
| Rate for Payer: Aetna Commercial |
$122.60
|
| Rate for Payer: Aetna Medicare |
$185.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.68
|
| Rate for Payer: BCBS Complete |
$102.32
|
| Rate for Payer: BCBS MAPPO |
$178.14
|
| Rate for Payer: BCBS Trust/PPO |
$93.93
|
| Rate for Payer: BCN Medicare Advantage |
$178.14
|
| Rate for Payer: Cash Price |
$115.38
|
| Rate for Payer: Cash Price |
$115.38
|
| Rate for Payer: Cofinity Commercial |
$100.96
|
| Rate for Payer: Cofinity Commercial |
$124.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.14
|
| Rate for Payer: Healthscope Commercial |
$129.81
|
| Rate for Payer: Mclaren Medicaid |
$97.44
|
| Rate for Payer: Mclaren Medicare |
$178.14
|
| Rate for Payer: Meridian Medicaid |
$102.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$187.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.60
|
| Rate for Payer: PACE Medicare |
$169.23
|
| Rate for Payer: PACE SWMI |
$178.14
|
| Rate for Payer: PHP Commercial |
$122.60
|
| Rate for Payer: PHP Medicare Advantage |
$178.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.49
|
| Rate for Payer: Priority Health Medicare |
$178.14
|
| Rate for Payer: Priority Health Narrow Network |
$433.19
|
| Rate for Payer: Priority Health SBD |
$90.86
|
| Rate for Payer: Railroad Medicare Medicare |
$178.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.14
|
| Rate for Payer: UHC Exchange |
$57.63
|
| Rate for Payer: UHC Medicare Advantage |
$183.48
|
| Rate for Payer: VA VA |
$178.14
|
|
|
HC SIMPLE REP WD SCALPNECKAXILLAEGENITALIIATRUNK EXTREMS 7.6 TO 12.5 CM
|
Facility
|
IP
|
$545.57
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
76100437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$343.71 |
| Max. Negotiated Rate |
$491.01 |
| Rate for Payer: Aetna Commercial |
$463.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$354.62
|
| Rate for Payer: Cash Price |
$436.46
|
| Rate for Payer: Cofinity Commercial |
$381.90
|
| Rate for Payer: Cofinity Commercial |
$469.19
|
| Rate for Payer: Healthscope Commercial |
$491.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$463.73
|
| Rate for Payer: PHP Commercial |
$463.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.90
|
| Rate for Payer: Priority Health SBD |
$343.71
|
|
|
HC SIMPLE REP WD SCALPNECKAXILLAEGENITALIIATRUNK EXTREMS 7.6 TO 12.5 CM
|
Facility
|
OP
|
$545.57
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
76100437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.04 |
| Max. Negotiated Rate |
$541.49 |
| Rate for Payer: Aetna Commercial |
$463.73
|
| Rate for Payer: Aetna Medicare |
$185.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$354.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.68
|
| Rate for Payer: BCBS Complete |
$102.32
|
| Rate for Payer: BCBS MAPPO |
$178.14
|
| Rate for Payer: BCBS Trust/PPO |
$122.43
|
| Rate for Payer: BCN Medicare Advantage |
$178.14
|
| Rate for Payer: Cash Price |
$436.46
|
| Rate for Payer: Cash Price |
$436.46
|
| Rate for Payer: Cofinity Commercial |
$469.19
|
| Rate for Payer: Cofinity Commercial |
$381.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.14
|
| Rate for Payer: Healthscope Commercial |
$491.01
|
| Rate for Payer: Mclaren Medicaid |
$97.44
|
| Rate for Payer: Mclaren Medicare |
$178.14
|
| Rate for Payer: Meridian Medicaid |
$102.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$187.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$463.73
|
| Rate for Payer: PACE Medicare |
$169.23
|
| Rate for Payer: PACE SWMI |
$178.14
|
| Rate for Payer: PHP Commercial |
$463.73
|
| Rate for Payer: PHP Medicare Advantage |
$178.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.49
|
| Rate for Payer: Priority Health Medicare |
$178.14
|
| Rate for Payer: Priority Health Narrow Network |
$433.19
|
| Rate for Payer: Priority Health SBD |
$343.71
|
| Rate for Payer: Railroad Medicare Medicare |
$178.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.14
|
| Rate for Payer: UHC Exchange |
$72.04
|
| Rate for Payer: UHC Medicare Advantage |
$183.48
|
| Rate for Payer: VA VA |
$178.14
|
|
