|
HC SQ IM CHEMO NON-HORMONAL
|
Facility
|
OP
|
$470.70
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
33100001
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$34.29 |
| Max. Negotiated Rate |
$423.63 |
| Rate for Payer: Aetna Commercial |
$400.10
|
| Rate for Payer: Aetna Medicare |
$65.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.35
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS MAPPO |
$62.68
|
| Rate for Payer: BCBS Trust/PPO |
$296.50
|
| Rate for Payer: BCN Medicare Advantage |
$62.68
|
| Rate for Payer: Cash Price |
$376.56
|
| Rate for Payer: Cash Price |
$376.56
|
| Rate for Payer: Cofinity Commercial |
$404.80
|
| Rate for Payer: Cofinity Commercial |
$329.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.68
|
| Rate for Payer: Healthscope Commercial |
$423.63
|
| Rate for Payer: Mclaren Medicaid |
$34.29
|
| Rate for Payer: Mclaren Medicare |
$62.68
|
| Rate for Payer: Meridian Medicaid |
$36.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$400.10
|
| Rate for Payer: PACE Medicare |
$59.55
|
| Rate for Payer: PACE SWMI |
$62.68
|
| Rate for Payer: PHP Commercial |
$400.10
|
| Rate for Payer: PHP Medicare Advantage |
$62.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.04
|
| Rate for Payer: Priority Health Medicare |
$62.68
|
| Rate for Payer: Priority Health Narrow Network |
$154.43
|
| Rate for Payer: Priority Health SBD |
$296.54
|
| Rate for Payer: Railroad Medicare Medicare |
$62.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.68
|
| Rate for Payer: UHC Exchange |
$70.40
|
| Rate for Payer: UHC Medicare Advantage |
$64.56
|
| Rate for Payer: VA VA |
$62.68
|
|
|
HC SQ OR IM INJECTION
|
Facility
|
OP
|
$146.85
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
51000003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$193.04 |
| Rate for Payer: Aetna Commercial |
$124.82
|
| Rate for Payer: Aetna Medicare |
$65.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.35
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS MAPPO |
$62.68
|
| Rate for Payer: BCBS Trust/PPO |
$38.30
|
| Rate for Payer: BCN Medicare Advantage |
$62.68
|
| Rate for Payer: Cash Price |
$117.48
|
| Rate for Payer: Cash Price |
$117.48
|
| Rate for Payer: Cofinity Commercial |
$126.29
|
| Rate for Payer: Cofinity Commercial |
$102.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.68
|
| Rate for Payer: Healthscope Commercial |
$132.16
|
| Rate for Payer: Mclaren Medicaid |
$34.29
|
| Rate for Payer: Mclaren Medicare |
$62.68
|
| Rate for Payer: Meridian Medicaid |
$36.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.82
|
| Rate for Payer: PACE Medicare |
$59.55
|
| Rate for Payer: PACE SWMI |
$62.68
|
| Rate for Payer: PHP Commercial |
$124.82
|
| Rate for Payer: PHP Medicare Advantage |
$62.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.04
|
| Rate for Payer: Priority Health Medicare |
$62.68
|
| Rate for Payer: Priority Health Narrow Network |
$154.43
|
| Rate for Payer: Priority Health SBD |
$92.52
|
| Rate for Payer: Railroad Medicare Medicare |
$62.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.68
|
| Rate for Payer: UHC Exchange |
$14.08
|
| Rate for Payer: UHC Medicare Advantage |
$64.56
|
| Rate for Payer: VA VA |
$62.68
|
|
|
HC SQ OR IM INJECTION
|
Facility
|
IP
|
$146.85
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
51000003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.52 |
| Max. Negotiated Rate |
$132.16 |
| Rate for Payer: Aetna Commercial |
$124.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.45
|
| Rate for Payer: Cash Price |
$117.48
|
| Rate for Payer: Cofinity Commercial |
$102.80
|
| Rate for Payer: Cofinity Commercial |
$126.29
|
| Rate for Payer: Healthscope Commercial |
$132.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.82
|
| Rate for Payer: PHP Commercial |
$124.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.80
|
| Rate for Payer: Priority Health SBD |
$92.52
|
|
|
HC SRA, LMWH
|
Facility
|
IP
|
$326.40
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200424
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$205.63 |
| Max. Negotiated Rate |
$293.76 |
| Rate for Payer: Aetna Commercial |
$277.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.16
|
| Rate for Payer: Cash Price |
$261.12
|
| Rate for Payer: Cofinity Commercial |
$228.48
|
| Rate for Payer: Cofinity Commercial |
$280.70
|
| Rate for Payer: Healthscope Commercial |
$293.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$277.44
|
| Rate for Payer: PHP Commercial |
$277.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.48
|
| Rate for Payer: Priority Health SBD |
$205.63
|
|
|
HC SRA, LMWH
|
Facility
|
OP
|
$326.40
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200424
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$293.76 |
| Rate for Payer: Aetna Commercial |
$277.44
|
| Rate for Payer: Aetna Medicare |
$19.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.96
|
| Rate for Payer: BCBS Complete |
$10.55
|
| Rate for Payer: BCBS MAPPO |
$18.37
|
| Rate for Payer: BCBS Trust/PPO |
$14.39
|
| Rate for Payer: BCN Medicare Advantage |
$18.37
|
| Rate for Payer: Cash Price |
$261.12
|
| Rate for Payer: Cash Price |
$261.12
|
| Rate for Payer: Cofinity Commercial |
$280.70
|
| Rate for Payer: Cofinity Commercial |
$228.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.37
|
| Rate for Payer: Healthscope Commercial |
$293.76
|
| Rate for Payer: Mclaren Medicaid |
$10.05
|
| Rate for Payer: Mclaren Medicare |
$18.37
|
| Rate for Payer: Meridian Medicaid |
$10.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$277.44
|
| Rate for Payer: PACE Medicare |
$17.45
|
| Rate for Payer: PACE SWMI |
$18.37
|
| Rate for Payer: PHP Commercial |
$277.44
|
| Rate for Payer: PHP Medicare Advantage |
$18.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.48
|
| Rate for Payer: Priority Health Medicare |
$18.37
|
| Rate for Payer: Priority Health SBD |
$205.63
|
| Rate for Payer: Railroad Medicare Medicare |
$18.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.04
|
| Rate for Payer: UHC Core |
$31.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.37
|
| Rate for Payer: UHC Exchange |
$18.37
|
| Rate for Payer: UHC Medicare Advantage |
$18.92
|
| Rate for Payer: VA VA |
$18.37
|
|
|
HC SRS CRANIAL LESION LIN ACC
|
Facility
|
IP
|
$7,990.00
|
|
|
Service Code
|
CPT 77372
|
| Hospital Charge Code |
33300032
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$5,033.70 |
| Max. Negotiated Rate |
$7,191.00 |
| Rate for Payer: Aetna Commercial |
$6,791.50
|
| Rate for Payer: Aetna Commercial |
$2,584.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,976.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,193.50
|
| Rate for Payer: Cash Price |
$2,432.50
|
| Rate for Payer: Cash Price |
$6,392.00
|
| Rate for Payer: Cofinity Commercial |
$5,593.00
|
| Rate for Payer: Cofinity Commercial |
$2,128.43
|
| Rate for Payer: Cofinity Commercial |
$2,614.93
|
| Rate for Payer: Cofinity Commercial |
$6,871.40
|
| Rate for Payer: Healthscope Commercial |
$2,736.56
|
| Rate for Payer: Healthscope Commercial |
$7,191.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,584.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,791.50
|
| Rate for Payer: PHP Commercial |
$6,791.50
|
| Rate for Payer: PHP Commercial |
$2,584.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,128.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,593.00
|
| Rate for Payer: Priority Health SBD |
$1,915.59
|
| Rate for Payer: Priority Health SBD |
$5,033.70
|
|
|
HC SRS CRANIAL LESION LIN ACC
|
Facility
|
OP
|
$3,040.62
|
|
|
Service Code
|
CPT 77372
|
| Hospital Charge Code |
33300032
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$936.16 |
| Max. Negotiated Rate |
$8,661.31 |
| Rate for Payer: Aetna Commercial |
$2,584.53
|
| Rate for Payer: Aetna Commercial |
$6,791.50
|
| Rate for Payer: Aetna Medicare |
$7,206.21
|
| Rate for Payer: Aetna Medicare |
$7,206.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,976.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,193.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,661.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,661.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,661.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,661.31
|
| Rate for Payer: BCBS Complete |
$3,980.05
|
| Rate for Payer: BCBS Complete |
$3,980.05
|
| Rate for Payer: BCBS MAPPO |
$6,929.05
|
| Rate for Payer: BCBS MAPPO |
$6,929.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,596.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,596.32
|
| Rate for Payer: BCN Medicare Advantage |
$6,929.05
|
| Rate for Payer: BCN Medicare Advantage |
$6,929.05
|
| Rate for Payer: Cash Price |
$6,392.00
|
| Rate for Payer: Cash Price |
$2,432.50
|
| Rate for Payer: Cash Price |
$2,432.50
|
| Rate for Payer: Cash Price |
$6,392.00
|
| Rate for Payer: Cofinity Commercial |
$6,871.40
|
| Rate for Payer: Cofinity Commercial |
$5,593.00
|
| Rate for Payer: Cofinity Commercial |
$2,128.43
|
| Rate for Payer: Cofinity Commercial |
$2,614.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,929.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,929.05
|
| Rate for Payer: Healthscope Commercial |
$2,736.56
|
| Rate for Payer: Healthscope Commercial |
$7,191.00
|
| Rate for Payer: Mclaren Medicaid |
$3,790.19
|
| Rate for Payer: Mclaren Medicaid |
$3,790.19
|
| Rate for Payer: Mclaren Medicare |
$6,929.05
|
| Rate for Payer: Mclaren Medicare |
$6,929.05
|
| Rate for Payer: Meridian Medicaid |
$3,980.05
|
| Rate for Payer: Meridian Medicaid |
$3,980.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,275.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,275.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,968.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,968.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,791.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,584.53
|
| Rate for Payer: PACE Medicare |
$6,582.60
|
| Rate for Payer: PACE Medicare |
$6,582.60
|
| Rate for Payer: PACE SWMI |
$6,929.05
|
| Rate for Payer: PACE SWMI |
$6,929.05
|
| Rate for Payer: PHP Commercial |
$6,791.50
|
| Rate for Payer: PHP Commercial |
$2,584.53
|
| Rate for Payer: PHP Medicare Advantage |
$6,929.05
|
| Rate for Payer: PHP Medicare Advantage |
$6,929.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,790.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,790.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,128.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,593.00
|
| Rate for Payer: Priority Health Medicare |
$6,929.05
|
| Rate for Payer: Priority Health Medicare |
$6,929.05
|
| Rate for Payer: Priority Health SBD |
$1,915.59
|
| Rate for Payer: Priority Health SBD |
$5,033.70
|
| Rate for Payer: Railroad Medicare Medicare |
$6,929.05
|
| Rate for Payer: Railroad Medicare Medicare |
$6,929.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,029.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,029.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,929.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,929.05
|
| Rate for Payer: UHC Exchange |
$936.16
|
| Rate for Payer: UHC Exchange |
$936.16
|
| Rate for Payer: UHC Medicare Advantage |
$7,136.92
|
| Rate for Payer: UHC Medicare Advantage |
$7,136.92
|
| Rate for Payer: VA VA |
$6,929.05
|
| Rate for Payer: VA VA |
$6,929.05
|
|
|
HC SRT UP TO 5 FRACTIONS
|
Facility
|
IP
|
$14,900.00
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
33300018
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$9,387.00 |
| Max. Negotiated Rate |
$13,410.00 |
| Rate for Payer: Aetna Commercial |
$12,665.00
|
| Rate for Payer: Aetna Commercial |
$4,421.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,381.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,685.00
|
| Rate for Payer: Cash Price |
$11,920.00
|
| Rate for Payer: Cash Price |
$4,161.60
|
| Rate for Payer: Cofinity Commercial |
$12,814.00
|
| Rate for Payer: Cofinity Commercial |
$10,430.00
|
| Rate for Payer: Cofinity Commercial |
$3,641.40
|
| Rate for Payer: Cofinity Commercial |
$4,473.72
|
| Rate for Payer: Healthscope Commercial |
$4,681.80
|
| Rate for Payer: Healthscope Commercial |
$13,410.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,665.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,421.70
|
| Rate for Payer: PHP Commercial |
$12,665.00
|
| Rate for Payer: PHP Commercial |
$4,421.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,641.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,430.00
|
| Rate for Payer: Priority Health SBD |
$9,387.00
|
| Rate for Payer: Priority Health SBD |
$3,277.26
|
|
|
HC SRT UP TO 5 FRACTIONS
|
Facility
|
OP
|
$14,900.00
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
33300018
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$868.48 |
| Max. Negotiated Rate |
$13,410.00 |
| Rate for Payer: Aetna Commercial |
$12,665.00
|
| Rate for Payer: Aetna Commercial |
$4,421.70
|
| Rate for Payer: Aetna Medicare |
$1,651.22
|
| Rate for Payer: Aetna Medicare |
$1,651.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,381.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,685.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.64
|
| Rate for Payer: BCBS Complete |
$911.98
|
| Rate for Payer: BCBS Complete |
$911.98
|
| Rate for Payer: BCBS MAPPO |
$1,587.71
|
| Rate for Payer: BCBS MAPPO |
$1,587.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,658.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,658.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.71
|
| Rate for Payer: Cash Price |
$11,920.00
|
| Rate for Payer: Cash Price |
$11,920.00
|
| Rate for Payer: Cash Price |
$4,161.60
|
| Rate for Payer: Cash Price |
$4,161.60
|
| Rate for Payer: Cofinity Commercial |
$4,473.72
|
| Rate for Payer: Cofinity Commercial |
$12,814.00
|
| Rate for Payer: Cofinity Commercial |
$10,430.00
|
| Rate for Payer: Cofinity Commercial |
$3,641.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.71
|
| Rate for Payer: Healthscope Commercial |
$13,410.00
|
| Rate for Payer: Healthscope Commercial |
$4,681.80
|
| Rate for Payer: Mclaren Medicaid |
$868.48
|
| Rate for Payer: Mclaren Medicaid |
$868.48
|
| Rate for Payer: Mclaren Medicare |
$1,587.71
|
| Rate for Payer: Mclaren Medicare |
$1,587.71
|
| Rate for Payer: Meridian Medicaid |
$911.98
|
| Rate for Payer: Meridian Medicaid |
$911.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,667.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,667.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,665.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,421.70
|
| Rate for Payer: PACE Medicare |
$1,508.32
|
| Rate for Payer: PACE Medicare |
$1,508.32
|
| Rate for Payer: PACE SWMI |
$1,587.71
|
| Rate for Payer: PACE SWMI |
$1,587.71
|
| Rate for Payer: PHP Commercial |
$4,421.70
|
| Rate for Payer: PHP Commercial |
$12,665.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.71
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$868.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$868.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,430.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,641.40
|
| Rate for Payer: Priority Health Medicare |
$1,587.71
|
| Rate for Payer: Priority Health Medicare |
$1,587.71
|
| Rate for Payer: Priority Health SBD |
$9,387.00
|
| Rate for Payer: Priority Health SBD |
$3,277.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,075.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,075.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.71
|
| Rate for Payer: UHC Exchange |
$977.41
|
| Rate for Payer: UHC Exchange |
$977.41
|
| Rate for Payer: UHC Medicare Advantage |
$1,635.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,635.34
|
| Rate for Payer: VA VA |
$1,587.71
|
| Rate for Payer: VA VA |
$1,587.71
|
|
|
HC SS2PC SPECIAL STAIN (BILL ONLY)
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
31200007
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$105.40 |
| Rate for Payer: Aetna Commercial |
$93.50
|
| Rate for Payer: Aetna Medicare |
$56.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.50
|
| 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 |
$86.46
|
| Rate for Payer: BCN Medicare Advantage |
$54.43
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$94.60
|
| Rate for Payer: Cofinity Commercial |
$77.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.43
|
| Rate for Payer: Healthscope Commercial |
$99.00
|
| 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 |
$93.50
|
| Rate for Payer: PACE Medicare |
$51.71
|
| Rate for Payer: PACE SWMI |
$54.43
|
| Rate for Payer: PHP Commercial |
$93.50
|
| 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 |
$77.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.40
|
| Rate for Payer: Priority Health Medicare |
$54.43
|
| Rate for Payer: Priority Health Narrow Network |
$84.32
|
| Rate for Payer: Priority Health SBD |
$69.30
|
| Rate for Payer: Railroad Medicare Medicare |
$54.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.68
|
| Rate for Payer: UHC Core |
$20.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.43
|
| Rate for Payer: UHC Exchange |
$81.53
|
| Rate for Payer: UHC Medicare Advantage |
$56.06
|
| Rate for Payer: VA VA |
$54.43
|
|
|
HC SS2PC SPECIAL STAIN (BILL ONLY)
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
31200007
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna Commercial |
$93.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.50
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$77.00
|
| Rate for Payer: Cofinity Commercial |
$94.60
|
| Rate for Payer: Healthscope Commercial |
$99.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.50
|
| Rate for Payer: PHP Commercial |
$93.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.00
|
| Rate for Payer: Priority Health SBD |
$69.30
|
|
|
HC STABILIZERS HEART ESTECH
|
Facility
|
OP
|
$915.00
|
|
| Hospital Charge Code |
27000292
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$366.00 |
| Max. Negotiated Rate |
$823.50 |
| Rate for Payer: Aetna Commercial |
$777.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$594.75
|
| Rate for Payer: BCBS Complete |
$366.00
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cofinity Commercial |
$640.50
|
| Rate for Payer: Cofinity Commercial |
$786.90
|
| Rate for Payer: Healthscope Commercial |
$823.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$777.75
|
| Rate for Payer: PHP Commercial |
$777.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$640.50
|
| Rate for Payer: Priority Health SBD |
$576.45
|
|
|
HC STABILIZERS HEART ESTECH
|
Facility
|
IP
|
$915.00
|
|
| Hospital Charge Code |
27000292
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$576.45 |
| Max. Negotiated Rate |
$823.50 |
| Rate for Payer: Aetna Commercial |
$777.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$594.75
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cofinity Commercial |
$640.50
|
| Rate for Payer: Cofinity Commercial |
$786.90
|
| Rate for Payer: Healthscope Commercial |
$823.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$777.75
|
| Rate for Payer: PHP Commercial |
$777.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$640.50
|
| Rate for Payer: Priority Health SBD |
$576.45
|
|
|
HC STACLOT LA.
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 85597
|
| Hospital Charge Code |
30500085
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.84 |
| Max. Negotiated Rate |
$131.40 |
| Rate for Payer: Aetna Commercial |
$124.10
|
| Rate for Payer: Aetna Medicare |
$18.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.48
|
| Rate for Payer: BCBS Complete |
$10.33
|
| Rate for Payer: BCBS MAPPO |
$17.98
|
| Rate for Payer: BCBS Trust/PPO |
$14.08
|
| Rate for Payer: BCN Medicare Advantage |
$17.98
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$102.20
|
| Rate for Payer: Cofinity Commercial |
$125.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.98
|
| Rate for Payer: Healthscope Commercial |
$131.40
|
| Rate for Payer: Mclaren Medicaid |
$9.84
|
| Rate for Payer: Mclaren Medicare |
$17.98
|
| Rate for Payer: Meridian Medicaid |
$10.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.10
|
| Rate for Payer: PACE Medicare |
$17.08
|
| Rate for Payer: PACE SWMI |
$17.98
|
| Rate for Payer: PHP Commercial |
$124.10
|
| Rate for Payer: PHP Medicare Advantage |
$17.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.20
|
| Rate for Payer: Priority Health Medicare |
$17.98
|
| Rate for Payer: Priority Health SBD |
$91.98
|
| Rate for Payer: Railroad Medicare Medicare |
$17.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.58
|
| Rate for Payer: UHC Core |
$30.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.98
|
| Rate for Payer: UHC Exchange |
$17.98
|
| Rate for Payer: UHC Medicare Advantage |
$18.52
|
| Rate for Payer: VA VA |
$17.98
|
|
|
HC STACLOT LA.
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 85597
|
| Hospital Charge Code |
30500085
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$91.98 |
| Max. Negotiated Rate |
$131.40 |
| Rate for Payer: Aetna Commercial |
$124.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.90
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$102.20
|
| Rate for Payer: Cofinity Commercial |
$125.56
|
| Rate for Payer: Healthscope Commercial |
$131.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.10
|
| Rate for Payer: PHP Commercial |
$124.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.20
|
| Rate for Payer: Priority Health SBD |
$91.98
|
|
|
HC STANDBY OPEN HEART
|
Facility
|
OP
|
$2,370.24
|
|
| Hospital Charge Code |
27000151
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$948.10 |
| Max. Negotiated Rate |
$2,133.22 |
| Rate for Payer: Aetna Commercial |
$2,014.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,540.66
|
| Rate for Payer: BCBS Complete |
$948.10
|
| Rate for Payer: Cash Price |
$1,896.19
|
| Rate for Payer: Cofinity Commercial |
$1,659.17
|
| Rate for Payer: Cofinity Commercial |
$2,038.41
|
| Rate for Payer: Healthscope Commercial |
$2,133.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,014.70
|
| Rate for Payer: PHP Commercial |
$2,014.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,659.17
|
| Rate for Payer: Priority Health SBD |
$1,493.25
|
|
|
HC STANDBY OPEN HEART
|
Facility
|
IP
|
$2,370.24
|
|
| Hospital Charge Code |
27000151
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,493.25 |
| Max. Negotiated Rate |
$2,133.22 |
| Rate for Payer: Aetna Commercial |
$2,014.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,540.66
|
| Rate for Payer: Cash Price |
$1,896.19
|
| Rate for Payer: Cofinity Commercial |
$1,659.17
|
| Rate for Payer: Cofinity Commercial |
$2,038.41
|
| Rate for Payer: Healthscope Commercial |
$2,133.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,014.70
|
| Rate for Payer: PHP Commercial |
$2,014.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,659.17
|
| Rate for Payer: Priority Health SBD |
$1,493.25
|
|
|
HC STAPHYLOCOCCUS AUREUS PCR
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 87640
|
| Hospital Charge Code |
30600263
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$59.65 |
| Rate for Payer: Aetna Commercial |
$46.75
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$27.48
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cofinity Commercial |
$38.50
|
| Rate for Payer: Cofinity Commercial |
$47.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$49.50
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.75
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$46.75
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.50
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$34.65
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$59.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC STAPHYLOCOCCUS AUREUS PCR
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 87640
|
| Hospital Charge Code |
30600263
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Aetna Commercial |
$46.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.75
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cofinity Commercial |
$38.50
|
| Rate for Payer: Cofinity Commercial |
$47.30
|
| Rate for Payer: Healthscope Commercial |
$49.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.75
|
| Rate for Payer: PHP Commercial |
$46.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.50
|
| Rate for Payer: Priority Health SBD |
$34.65
|
|
|
HC STAPHYLOCOCCUS AUREUS PCR METHICILLIN RESISTANT
|
Facility
|
OP
|
$60.48
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
30600264
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$59.65 |
| Rate for Payer: Aetna Commercial |
$51.41
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$27.48
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$48.38
|
| Rate for Payer: Cash Price |
$48.38
|
| Rate for Payer: Cofinity Commercial |
$42.34
|
| Rate for Payer: Cofinity Commercial |
$52.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$54.43
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.41
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$51.41
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.34
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$38.10
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$59.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC STAPHYLOCOCCUS AUREUS PCR METHICILLIN RESISTANT
|
Facility
|
IP
|
$60.48
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
30600264
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$38.10 |
| Max. Negotiated Rate |
$54.43 |
| Rate for Payer: Aetna Commercial |
$51.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.31
|
| Rate for Payer: Cash Price |
$48.38
|
| Rate for Payer: Cofinity Commercial |
$42.34
|
| Rate for Payer: Cofinity Commercial |
$52.01
|
| Rate for Payer: Healthscope Commercial |
$54.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.41
|
| Rate for Payer: PHP Commercial |
$51.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.34
|
| Rate for Payer: Priority Health SBD |
$38.10
|
|
|
HC STATLOCK
|
Facility
|
IP
|
$140.87
|
|
| Hospital Charge Code |
27000152
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$88.75 |
| Max. Negotiated Rate |
$126.78 |
| Rate for Payer: Aetna Commercial |
$119.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.57
|
| Rate for Payer: Cash Price |
$112.70
|
| Rate for Payer: Cofinity Commercial |
$121.15
|
| Rate for Payer: Cofinity Commercial |
$98.61
|
| Rate for Payer: Healthscope Commercial |
$126.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.74
|
| Rate for Payer: PHP Commercial |
$119.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.61
|
| Rate for Payer: Priority Health SBD |
$88.75
|
|
|
HC STATLOCK
|
Facility
|
OP
|
$140.87
|
|
| Hospital Charge Code |
27000152
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$56.35 |
| Max. Negotiated Rate |
$126.78 |
| Rate for Payer: Aetna Commercial |
$119.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.57
|
| Rate for Payer: BCBS Complete |
$56.35
|
| Rate for Payer: Cash Price |
$112.70
|
| Rate for Payer: Cofinity Commercial |
$121.15
|
| Rate for Payer: Cofinity Commercial |
$98.61
|
| Rate for Payer: Healthscope Commercial |
$126.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.74
|
| Rate for Payer: PHP Commercial |
$119.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.61
|
| Rate for Payer: Priority Health SBD |
$88.75
|
|
|
HC STENGER TEST PURE TONE
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 92565
|
| Hospital Charge Code |
76100500
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$20.63 |
| Max. Negotiated Rate |
$101.83 |
| Rate for Payer: Aetna Commercial |
$28.90
|
| Rate for Payer: Aetna Medicare |
$56.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.10
|
| 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 |
$90.57
|
| Rate for Payer: BCN Medicare Advantage |
$54.43
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cofinity Commercial |
$23.80
|
| Rate for Payer: Cofinity Commercial |
$29.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.43
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| 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 |
$28.90
|
| Rate for Payer: PACE Medicare |
$51.71
|
| Rate for Payer: PACE SWMI |
$54.43
|
| Rate for Payer: PHP Commercial |
$28.90
|
| 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 |
$23.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.83
|
| Rate for Payer: Priority Health Medicare |
$54.43
|
| Rate for Payer: Priority Health Narrow Network |
$81.46
|
| Rate for Payer: Priority Health SBD |
$21.42
|
| Rate for Payer: Railroad Medicare Medicare |
$54.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.43
|
| Rate for Payer: UHC Exchange |
$20.63
|
| Rate for Payer: UHC Medicare Advantage |
$56.06
|
| Rate for Payer: VA VA |
$54.43
|
|
|
HC STENGER TEST PURE TONE
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 92565
|
| Hospital Charge Code |
76100500
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna Commercial |
$28.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.10
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cofinity Commercial |
$23.80
|
| Rate for Payer: Cofinity Commercial |
$29.24
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.90
|
| Rate for Payer: PHP Commercial |
$28.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.80
|
| Rate for Payer: Priority Health SBD |
$21.42
|
|
