|
HC NAIL PROCEDURE
|
Facility
|
IP
|
$277.25
|
|
| Hospital Charge Code |
45000047
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$174.67 |
| Max. Negotiated Rate |
$249.53 |
| Rate for Payer: Aetna Commercial |
$235.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.21
|
| Rate for Payer: Cash Price |
$221.80
|
| Rate for Payer: Cofinity Advantage |
$194.07
|
| Rate for Payer: Cofinity Commercial |
$238.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.80
|
| Rate for Payer: Healthscope Commercial |
$249.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.94
|
| Rate for Payer: PHP Commercial |
$235.66
|
| Rate for Payer: Priority Health SBD |
$174.67
|
|
|
HC NAIL PROCEDURE
|
Facility
|
OP
|
$277.25
|
|
| Hospital Charge Code |
45000047
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$110.90 |
| Max. Negotiated Rate |
$249.53 |
| Rate for Payer: Aetna Commercial |
$235.66
|
| Rate for Payer: Aetna Medicare |
$138.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.21
|
| Rate for Payer: BCBS Complete |
$110.90
|
| Rate for Payer: Cash Price |
$221.80
|
| Rate for Payer: Cash Price |
$221.80
|
| Rate for Payer: Cofinity Advantage |
$194.07
|
| Rate for Payer: Cofinity Commercial |
$238.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.80
|
| Rate for Payer: Healthscope Commercial |
$249.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$221.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.94
|
| Rate for Payer: PHP Commercial |
$235.66
|
| Rate for Payer: Priority Health SBD |
$174.67
|
| Rate for Payer: UHCCP Medicaid |
$144.00
|
|
|
HC NA PHOSPHATE PER MCI
|
Facility
|
OP
|
$334.65
|
|
|
Service Code
|
HCPCS A9563
|
| Hospital Charge Code |
34400004
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$145.52 |
| Max. Negotiated Rate |
$877.56 |
| Rate for Payer: Aetna Commercial |
$284.45
|
| Rate for Payer: Aetna Medicare |
$289.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$347.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$347.80
|
| Rate for Payer: BCBS Complete |
$152.81
|
| Rate for Payer: BCBS MAPPO |
$278.24
|
| Rate for Payer: BCBS Trust/PPO |
$254.64
|
| Rate for Payer: BCN Commercial |
$254.64
|
| Rate for Payer: BCN Medicare Advantage |
$278.24
|
| Rate for Payer: Cash Price |
$267.72
|
| Rate for Payer: Cash Price |
$267.72
|
| Rate for Payer: Cofinity Advantage |
$234.25
|
| Rate for Payer: Cofinity Commercial |
$287.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$278.24
|
| Rate for Payer: Healthscope Commercial |
$301.19
|
| Rate for Payer: Mclaren Medicaid |
$145.52
|
| Rate for Payer: Mclaren Medicare |
$278.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$292.15
|
| Rate for Payer: Meridian Medicaid |
$292.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$319.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$306.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$284.45
|
| Rate for Payer: Nomi Health Commercial |
$834.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.99
|
| Rate for Payer: PACE Medicare |
$264.33
|
| Rate for Payer: PACE SWMI |
$278.24
|
| Rate for Payer: PHP Commercial |
$284.45
|
| Rate for Payer: PHP Medicare Advantage |
$278.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$145.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$877.56
|
| Rate for Payer: Priority Health Medicare |
$278.24
|
| Rate for Payer: Priority Health SBD |
$210.83
|
| Rate for Payer: Priority Health Tiered Network |
$702.05
|
| Rate for Payer: Railroad Medicare Medicare |
$278.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$459.10
|
| Rate for Payer: UHC Core |
$459.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$278.24
|
| Rate for Payer: UHC Exchange |
$459.10
|
| Rate for Payer: UHC Medicaid |
$145.52
|
| Rate for Payer: UHCCP Medicaid |
$145.52
|
| Rate for Payer: VA VA |
$278.24
|
|
|
HC NA PHOSPHATE PER MCI
|
Facility
|
IP
|
$334.65
|
|
|
Service Code
|
HCPCS A9563
|
| Hospital Charge Code |
34400004
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$210.83 |
| Max. Negotiated Rate |
$301.19 |
| Rate for Payer: Aetna Commercial |
$284.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.52
|
| Rate for Payer: Cash Price |
$267.72
|
| Rate for Payer: Cofinity Advantage |
$234.25
|
| Rate for Payer: Cofinity Commercial |
$287.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.72
|
| Rate for Payer: Healthscope Commercial |
$301.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$284.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.99
|
| Rate for Payer: PHP Commercial |
$284.45
|
| Rate for Payer: Priority Health SBD |
$210.83
|
|
|
HC NASAL BONES COMP MIN 3 VW
|
Facility
|
OP
|
$202.79
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
32000011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$280.42 |
| Rate for Payer: Aetna Commercial |
$172.37
|
| Rate for Payer: Aetna Medicare |
$90.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$66.63
|
| Rate for Payer: BCN Commercial |
$66.63
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$162.23
|
| Rate for Payer: Cash Price |
$162.23
|
| Rate for Payer: Cofinity Advantage |
$141.95
|
| Rate for Payer: Cofinity Commercial |
$174.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$182.51
|
| Rate for Payer: Mclaren Medicaid |
$45.35
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$91.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.37
|
| Rate for Payer: Nomi Health Commercial |
$260.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.09
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$172.37
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$280.42
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health SBD |
$127.76
|
| Rate for Payer: Priority Health Tiered Network |
$224.34
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.81
|
| Rate for Payer: UHC Core |
$105.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$79.70
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC NASAL BONES COMP MIN 3 VW
|
Facility
|
IP
|
$202.79
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
32000011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$127.76 |
| Max. Negotiated Rate |
$182.51 |
| Rate for Payer: Aetna Commercial |
$172.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.81
|
| Rate for Payer: Cash Price |
$162.23
|
| Rate for Payer: Cofinity Advantage |
$141.95
|
| Rate for Payer: Cofinity Commercial |
$174.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.23
|
| Rate for Payer: Healthscope Commercial |
$182.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.09
|
| Rate for Payer: PHP Commercial |
$172.37
|
| Rate for Payer: Priority Health SBD |
$127.76
|
|
|
HC NASAL ENDOSCOPY DX
|
Facility
|
IP
|
$261.02
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
76100183
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.44 |
| Max. Negotiated Rate |
$234.92 |
| Rate for Payer: Aetna Commercial |
$221.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.66
|
| Rate for Payer: Cash Price |
$208.82
|
| Rate for Payer: Cofinity Advantage |
$182.71
|
| Rate for Payer: Cofinity Commercial |
$224.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.82
|
| Rate for Payer: Healthscope Commercial |
$234.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.76
|
| Rate for Payer: PHP Commercial |
$221.87
|
| Rate for Payer: Priority Health SBD |
$164.44
|
|
|
HC NASAL ENDOSCOPY DX
|
Facility
|
OP
|
$261.02
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
76100183
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.33 |
| Max. Negotiated Rate |
$643.18 |
| Rate for Payer: Aetna Commercial |
$221.87
|
| Rate for Payer: Aetna Medicare |
$206.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$248.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$248.61
|
| Rate for Payer: BCBS Complete |
$109.23
|
| Rate for Payer: BCBS MAPPO |
$198.89
|
| Rate for Payer: BCBS Trust/PPO |
$73.33
|
| Rate for Payer: BCN Commercial |
$73.33
|
| Rate for Payer: BCN Medicare Advantage |
$198.89
|
| Rate for Payer: Cash Price |
$208.82
|
| Rate for Payer: Cash Price |
$208.82
|
| Rate for Payer: Cash Price |
$208.82
|
| Rate for Payer: Cofinity Advantage |
$182.71
|
| Rate for Payer: Cofinity Commercial |
$224.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.89
|
| Rate for Payer: Healthscope Commercial |
$234.92
|
| Rate for Payer: Mclaren Medicaid |
$104.02
|
| Rate for Payer: Mclaren Medicare |
$198.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$208.83
|
| Rate for Payer: Meridian Medicaid |
$208.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$218.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.87
|
| Rate for Payer: Nomi Health Commercial |
$596.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.76
|
| Rate for Payer: PACE Medicare |
$188.95
|
| Rate for Payer: PACE SWMI |
$198.89
|
| Rate for Payer: PHP Commercial |
$221.87
|
| Rate for Payer: PHP Medicare Advantage |
$198.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$643.18
|
| Rate for Payer: Priority Health Medicare |
$198.89
|
| Rate for Payer: Priority Health SBD |
$164.44
|
| Rate for Payer: Priority Health Tiered Network |
$514.54
|
| Rate for Payer: Railroad Medicare Medicare |
$198.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.66
|
| Rate for Payer: UHC Core |
$135.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$198.89
|
| Rate for Payer: UHC Exchange |
$102.58
|
| Rate for Payer: UHC Medicaid |
$104.02
|
| Rate for Payer: UHCCP Medicaid |
$104.02
|
| Rate for Payer: VA VA |
$198.89
|
|
|
HC NASAL/SINUS ENDSC SURG W/BX POLYPEC/DBRD SPX
|
Facility
|
OP
|
$4,525.74
|
|
|
Service Code
|
CPT 31237
|
| Hospital Charge Code |
76100454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$927.54 |
| Max. Negotiated Rate |
$5,735.32 |
| Rate for Payer: Aetna Commercial |
$3,846.88
|
| Rate for Payer: Aetna Medicare |
$1,844.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,941.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,216.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,216.88
|
| Rate for Payer: BCBS Complete |
$974.01
|
| Rate for Payer: BCBS MAPPO |
$1,773.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,001.58
|
| Rate for Payer: BCN Commercial |
$1,001.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,773.50
|
| Rate for Payer: Cash Price |
$3,620.59
|
| Rate for Payer: Cash Price |
$3,620.59
|
| Rate for Payer: Cash Price |
$3,620.59
|
| Rate for Payer: Cofinity Advantage |
$3,168.02
|
| Rate for Payer: Cofinity Commercial |
$3,892.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,620.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,773.50
|
| Rate for Payer: Healthscope Commercial |
$4,073.17
|
| Rate for Payer: Mclaren Medicaid |
$927.54
|
| Rate for Payer: Mclaren Medicare |
$1,773.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,862.17
|
| Rate for Payer: Meridian Medicaid |
$1,862.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,039.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,950.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,846.88
|
| Rate for Payer: Nomi Health Commercial |
$5,320.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,394.30
|
| Rate for Payer: PACE Medicare |
$1,684.83
|
| Rate for Payer: PACE SWMI |
$1,773.50
|
| Rate for Payer: PHP Commercial |
$3,846.88
|
| Rate for Payer: PHP Medicare Advantage |
$1,773.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$927.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,735.32
|
| Rate for Payer: Priority Health Medicare |
$1,773.50
|
| Rate for Payer: Priority Health SBD |
$2,851.22
|
| Rate for Payer: Priority Health Tiered Network |
$4,588.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1,773.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,941.73
|
| Rate for Payer: UHC Core |
$2,357.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,773.50
|
| Rate for Payer: UHC Exchange |
$1,778.62
|
| Rate for Payer: UHC Medicaid |
$927.54
|
| Rate for Payer: UHCCP Medicaid |
$927.54
|
| Rate for Payer: VA VA |
$1,773.50
|
|
|
HC NASAL/SINUS ENDSC SURG W/BX POLYPEC/DBRD SPX
|
Facility
|
IP
|
$4,525.74
|
|
|
Service Code
|
CPT 31237
|
| Hospital Charge Code |
76100454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,851.22 |
| Max. Negotiated Rate |
$4,073.17 |
| Rate for Payer: Aetna Commercial |
$3,846.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,941.73
|
| Rate for Payer: Cash Price |
$3,620.59
|
| Rate for Payer: Cofinity Advantage |
$3,168.02
|
| Rate for Payer: Cofinity Commercial |
$3,892.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,620.59
|
| Rate for Payer: Healthscope Commercial |
$4,073.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,846.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,394.30
|
| Rate for Payer: PHP Commercial |
$3,846.88
|
| Rate for Payer: Priority Health SBD |
$2,851.22
|
|
|
HC NASAL/SINUS ENDSC SURG W/CONTROL NASAL HEMRR
|
Facility
|
OP
|
$4,078.98
|
|
|
Service Code
|
CPT 31238
|
| Hospital Charge Code |
76100533
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$927.54 |
| Max. Negotiated Rate |
$5,735.32 |
| Rate for Payer: Aetna Commercial |
$3,467.13
|
| Rate for Payer: Aetna Medicare |
$1,844.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,651.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,216.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,216.88
|
| Rate for Payer: BCBS Complete |
$974.01
|
| Rate for Payer: BCBS MAPPO |
$1,773.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,492.77
|
| Rate for Payer: BCN Commercial |
$1,492.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,773.50
|
| Rate for Payer: Cash Price |
$3,263.18
|
| Rate for Payer: Cash Price |
$3,263.18
|
| Rate for Payer: Cash Price |
$3,263.18
|
| Rate for Payer: Cofinity Advantage |
$2,855.29
|
| Rate for Payer: Cofinity Commercial |
$3,507.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,263.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,773.50
|
| Rate for Payer: Healthscope Commercial |
$3,671.08
|
| Rate for Payer: Mclaren Medicaid |
$927.54
|
| Rate for Payer: Mclaren Medicare |
$1,773.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,862.17
|
| Rate for Payer: Meridian Medicaid |
$1,862.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,039.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,950.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,467.13
|
| Rate for Payer: Nomi Health Commercial |
$5,320.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,059.24
|
| Rate for Payer: PACE Medicare |
$1,684.83
|
| Rate for Payer: PACE SWMI |
$1,773.50
|
| Rate for Payer: PHP Commercial |
$3,467.13
|
| Rate for Payer: PHP Medicare Advantage |
$1,773.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$927.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,735.32
|
| Rate for Payer: Priority Health Medicare |
$1,773.50
|
| Rate for Payer: Priority Health SBD |
$2,569.76
|
| Rate for Payer: Priority Health Tiered Network |
$4,588.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1,773.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,651.34
|
| Rate for Payer: UHC Core |
$2,125.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,773.50
|
| Rate for Payer: UHC Exchange |
$1,603.04
|
| Rate for Payer: UHC Medicaid |
$927.54
|
| Rate for Payer: UHCCP Medicaid |
$927.54
|
| Rate for Payer: VA VA |
$1,773.50
|
|
|
HC NASAL/SINUS ENDSC SURG W/CONTROL NASAL HEMRR
|
Facility
|
IP
|
$4,078.98
|
|
|
Service Code
|
CPT 31238
|
| Hospital Charge Code |
76100533
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,569.76 |
| Max. Negotiated Rate |
$3,671.08 |
| Rate for Payer: Aetna Commercial |
$3,467.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,651.34
|
| Rate for Payer: Cash Price |
$3,263.18
|
| Rate for Payer: Cofinity Advantage |
$2,855.29
|
| Rate for Payer: Cofinity Commercial |
$3,507.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,263.18
|
| Rate for Payer: Healthscope Commercial |
$3,671.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,467.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,059.24
|
| Rate for Payer: PHP Commercial |
$3,467.13
|
| Rate for Payer: Priority Health SBD |
$2,569.76
|
|
|
HC NASOPHARYNGOSCOPY
|
Facility
|
IP
|
$261.02
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
76100177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.44 |
| Max. Negotiated Rate |
$234.92 |
| Rate for Payer: Aetna Commercial |
$221.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.66
|
| Rate for Payer: Cash Price |
$208.82
|
| Rate for Payer: Cofinity Advantage |
$182.71
|
| Rate for Payer: Cofinity Commercial |
$224.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.82
|
| Rate for Payer: Healthscope Commercial |
$234.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.76
|
| Rate for Payer: PHP Commercial |
$221.87
|
| Rate for Payer: Priority Health SBD |
$164.44
|
|
|
HC NASOPHARYNGOSCOPY
|
Facility
|
OP
|
$261.02
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
76100177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.31 |
| Max. Negotiated Rate |
$643.18 |
| Rate for Payer: Aetna Commercial |
$221.87
|
| Rate for Payer: Aetna Medicare |
$206.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$248.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$248.61
|
| Rate for Payer: BCBS Complete |
$109.23
|
| Rate for Payer: BCBS MAPPO |
$198.89
|
| Rate for Payer: BCBS Trust/PPO |
$97.31
|
| Rate for Payer: BCN Commercial |
$97.31
|
| Rate for Payer: BCN Medicare Advantage |
$198.89
|
| Rate for Payer: Cash Price |
$208.82
|
| Rate for Payer: Cash Price |
$208.82
|
| Rate for Payer: Cash Price |
$208.82
|
| Rate for Payer: Cofinity Advantage |
$182.71
|
| Rate for Payer: Cofinity Commercial |
$224.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.89
|
| Rate for Payer: Healthscope Commercial |
$234.92
|
| Rate for Payer: Mclaren Medicaid |
$104.02
|
| Rate for Payer: Mclaren Medicare |
$198.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$208.83
|
| Rate for Payer: Meridian Medicaid |
$208.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$218.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.87
|
| Rate for Payer: Nomi Health Commercial |
$596.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.76
|
| Rate for Payer: PACE Medicare |
$188.95
|
| Rate for Payer: PACE SWMI |
$198.89
|
| Rate for Payer: PHP Commercial |
$221.87
|
| Rate for Payer: PHP Medicare Advantage |
$198.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$643.18
|
| Rate for Payer: Priority Health Medicare |
$198.89
|
| Rate for Payer: Priority Health SBD |
$164.44
|
| Rate for Payer: Priority Health Tiered Network |
$514.54
|
| Rate for Payer: Railroad Medicare Medicare |
$198.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.66
|
| Rate for Payer: UHC Core |
$135.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$198.89
|
| Rate for Payer: UHC Exchange |
$102.58
|
| Rate for Payer: UHC Medicaid |
$104.02
|
| Rate for Payer: UHCCP Medicaid |
$104.02
|
| Rate for Payer: VA VA |
$198.89
|
|
|
HC NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE BI
|
Facility
|
OP
|
$16,728.00
|
|
|
Service Code
|
CPT 69706
|
| Hospital Charge Code |
76100518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,084.94 |
| Max. Negotiated Rate |
$19,075.37 |
| Rate for Payer: Aetna Commercial |
$14,218.80
|
| Rate for Payer: Aetna Medicare |
$6,134.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,873.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,373.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,373.18
|
| Rate for Payer: BCBS Complete |
$3,239.48
|
| Rate for Payer: BCBS MAPPO |
$5,898.54
|
| Rate for Payer: BCBS Trust/PPO |
$3,277.08
|
| Rate for Payer: BCN Commercial |
$3,277.08
|
| Rate for Payer: BCN Medicare Advantage |
$5,898.54
|
| Rate for Payer: Cash Price |
$13,382.40
|
| Rate for Payer: Cash Price |
$13,382.40
|
| Rate for Payer: Cash Price |
$13,382.40
|
| Rate for Payer: Cofinity Advantage |
$11,709.60
|
| Rate for Payer: Cofinity Commercial |
$14,386.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,382.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,898.54
|
| Rate for Payer: Healthscope Commercial |
$15,055.20
|
| Rate for Payer: Mclaren Medicaid |
$3,084.94
|
| Rate for Payer: Mclaren Medicare |
$5,898.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,193.47
|
| Rate for Payer: Meridian Medicaid |
$6,193.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,783.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,488.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,218.80
|
| Rate for Payer: Nomi Health Commercial |
$17,695.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,546.00
|
| Rate for Payer: PACE Medicare |
$5,603.61
|
| Rate for Payer: PACE SWMI |
$5,898.54
|
| Rate for Payer: PHP Commercial |
$14,218.80
|
| Rate for Payer: PHP Medicare Advantage |
$5,898.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,084.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,075.37
|
| Rate for Payer: Priority Health Medicare |
$5,898.54
|
| Rate for Payer: Priority Health SBD |
$10,538.64
|
| Rate for Payer: Priority Health Tiered Network |
$15,260.30
|
| Rate for Payer: Railroad Medicare Medicare |
$5,898.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,873.20
|
| Rate for Payer: UHC Core |
$8,715.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,898.54
|
| Rate for Payer: UHC Exchange |
$6,574.10
|
| Rate for Payer: UHC Medicaid |
$3,084.94
|
| Rate for Payer: UHCCP Medicaid |
$3,084.94
|
| Rate for Payer: VA VA |
$5,898.54
|
|
|
HC NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE BI
|
Facility
|
IP
|
$16,728.00
|
|
|
Service Code
|
CPT 69706
|
| Hospital Charge Code |
76100518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$10,538.64 |
| Max. Negotiated Rate |
$15,055.20 |
| Rate for Payer: Aetna Commercial |
$14,218.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,873.20
|
| Rate for Payer: Cash Price |
$13,382.40
|
| Rate for Payer: Cofinity Advantage |
$11,709.60
|
| Rate for Payer: Cofinity Commercial |
$14,386.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,382.40
|
| Rate for Payer: Healthscope Commercial |
$15,055.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,218.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,546.00
|
| Rate for Payer: PHP Commercial |
$14,218.80
|
| Rate for Payer: Priority Health SBD |
$10,538.64
|
|
|
HC NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE UNI
|
Facility
|
OP
|
$16,728.00
|
|
|
Service Code
|
CPT 69705
|
| Hospital Charge Code |
76100519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,039.63 |
| Max. Negotiated Rate |
$19,075.37 |
| Rate for Payer: Aetna Commercial |
$14,218.80
|
| Rate for Payer: Aetna Medicare |
$6,134.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,873.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,373.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,373.18
|
| Rate for Payer: BCBS Complete |
$3,239.48
|
| Rate for Payer: BCBS MAPPO |
$5,898.54
|
| Rate for Payer: BCBS Trust/PPO |
$3,039.63
|
| Rate for Payer: BCN Commercial |
$3,039.63
|
| Rate for Payer: BCN Medicare Advantage |
$5,898.54
|
| Rate for Payer: Cash Price |
$13,382.40
|
| Rate for Payer: Cash Price |
$13,382.40
|
| Rate for Payer: Cash Price |
$13,382.40
|
| Rate for Payer: Cofinity Advantage |
$11,709.60
|
| Rate for Payer: Cofinity Commercial |
$14,386.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,382.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,898.54
|
| Rate for Payer: Healthscope Commercial |
$15,055.20
|
| Rate for Payer: Mclaren Medicaid |
$3,084.94
|
| Rate for Payer: Mclaren Medicare |
$5,898.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,193.47
|
| Rate for Payer: Meridian Medicaid |
$6,193.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,783.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,488.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,218.80
|
| Rate for Payer: Nomi Health Commercial |
$17,695.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,546.00
|
| Rate for Payer: PACE Medicare |
$5,603.61
|
| Rate for Payer: PACE SWMI |
$5,898.54
|
| Rate for Payer: PHP Commercial |
$14,218.80
|
| Rate for Payer: PHP Medicare Advantage |
$5,898.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,084.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,075.37
|
| Rate for Payer: Priority Health Medicare |
$5,898.54
|
| Rate for Payer: Priority Health SBD |
$10,538.64
|
| Rate for Payer: Priority Health Tiered Network |
$15,260.30
|
| Rate for Payer: Railroad Medicare Medicare |
$5,898.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,873.20
|
| Rate for Payer: UHC Core |
$8,715.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,898.54
|
| Rate for Payer: UHC Exchange |
$6,574.10
|
| Rate for Payer: UHC Medicaid |
$3,084.94
|
| Rate for Payer: UHCCP Medicaid |
$3,084.94
|
| Rate for Payer: VA VA |
$5,898.54
|
|
|
HC NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE UNI
|
Facility
|
IP
|
$16,728.00
|
|
|
Service Code
|
CPT 69705
|
| Hospital Charge Code |
76100519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$10,538.64 |
| Max. Negotiated Rate |
$15,055.20 |
| Rate for Payer: Aetna Commercial |
$14,218.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,873.20
|
| Rate for Payer: Cash Price |
$13,382.40
|
| Rate for Payer: Cofinity Advantage |
$11,709.60
|
| Rate for Payer: Cofinity Commercial |
$14,386.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,382.40
|
| Rate for Payer: Healthscope Commercial |
$15,055.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,218.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,546.00
|
| Rate for Payer: PHP Commercial |
$14,218.80
|
| Rate for Payer: Priority Health SBD |
$10,538.64
|
|
|
HC NASOTRACHEAL SUCTION
|
Facility
|
OP
|
$284.50
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
41000001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$111.28 |
| Max. Negotiated Rate |
$705.61 |
| Rate for Payer: Aetna Commercial |
$241.82
|
| Rate for Payer: Aetna Medicare |
$226.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.74
|
| Rate for Payer: BCBS Complete |
$119.83
|
| Rate for Payer: BCBS MAPPO |
$218.19
|
| Rate for Payer: BCBS Trust/PPO |
$111.28
|
| Rate for Payer: BCN Commercial |
$111.28
|
| Rate for Payer: BCN Medicare Advantage |
$218.19
|
| Rate for Payer: Cash Price |
$227.60
|
| Rate for Payer: Cash Price |
$227.60
|
| Rate for Payer: Cash Price |
$227.60
|
| Rate for Payer: Cofinity Advantage |
$199.15
|
| Rate for Payer: Cofinity Commercial |
$244.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.19
|
| Rate for Payer: Healthscope Commercial |
$256.05
|
| Rate for Payer: Mclaren Medicaid |
$114.11
|
| Rate for Payer: Mclaren Medicare |
$218.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$229.10
|
| Rate for Payer: Meridian Medicaid |
$229.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$240.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.82
|
| Rate for Payer: Nomi Health Commercial |
$654.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.38
|
| Rate for Payer: PACE Medicare |
$207.28
|
| Rate for Payer: PACE SWMI |
$218.19
|
| Rate for Payer: PHP Commercial |
$241.82
|
| Rate for Payer: PHP Medicare Advantage |
$218.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$705.61
|
| Rate for Payer: Priority Health Medicare |
$218.19
|
| Rate for Payer: Priority Health SBD |
$179.24
|
| Rate for Payer: Priority Health Tiered Network |
$564.49
|
| Rate for Payer: Railroad Medicare Medicare |
$218.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.93
|
| Rate for Payer: UHC Core |
$148.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$218.19
|
| Rate for Payer: UHC Exchange |
$111.81
|
| Rate for Payer: UHC Medicaid |
$114.11
|
| Rate for Payer: UHCCP Medicaid |
$114.11
|
| Rate for Payer: VA VA |
$218.19
|
|
|
HC NASOTRACHEAL SUCTION
|
Facility
|
IP
|
$284.50
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
41000001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$179.24 |
| Max. Negotiated Rate |
$256.05 |
| Rate for Payer: Aetna Commercial |
$241.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.93
|
| Rate for Payer: Cash Price |
$227.60
|
| Rate for Payer: Cofinity Advantage |
$199.15
|
| Rate for Payer: Cofinity Commercial |
$244.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.60
|
| Rate for Payer: Healthscope Commercial |
$256.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.38
|
| Rate for Payer: PHP Commercial |
$241.82
|
| Rate for Payer: Priority Health SBD |
$179.24
|
|
|
HC NCCU OBSERVATION PER HOUR
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200021
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna Medicare |
$80.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.00
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: BCBS Trust/PPO |
$112.58
|
| Rate for Payer: BCN Commercial |
$112.58
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Advantage |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health SBD |
$100.80
|
| Rate for Payer: UHC Medicaid |
$1,608.00
|
| Rate for Payer: UHCCP Medicaid |
$810.00
|
|
|
HC NCCU OBSERVATION PER HOUR
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200021
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Advantage |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health SBD |
$100.80
|
|
|
HC NCS 11-12 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$2,322.64
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
92200032
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$194.46 |
| Max. Negotiated Rate |
$2,090.38 |
| Rate for Payer: Aetna Commercial |
$1,974.24
|
| Rate for Payer: Aetna Medicare |
$386.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,509.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$390.85
|
| Rate for Payer: BCN Commercial |
$390.85
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Cash Price |
$1,858.11
|
| Rate for Payer: Cash Price |
$1,858.11
|
| Rate for Payer: Cofinity Advantage |
$1,625.85
|
| Rate for Payer: Cofinity Commercial |
$1,997.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,858.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Healthscope Commercial |
$2,090.38
|
| Rate for Payer: Mclaren Medicaid |
$194.46
|
| Rate for Payer: Mclaren Medicare |
$371.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.41
|
| Rate for Payer: Meridian Medicaid |
$390.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,974.24
|
| Rate for Payer: Nomi Health Commercial |
$1,115.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,741.98
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Commercial |
$1,974.24
|
| Rate for Payer: PHP Medicare Advantage |
$371.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,202.41
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health SBD |
$1,463.26
|
| Rate for Payer: Priority Health Tiered Network |
$961.93
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,509.72
|
| Rate for Payer: UHC Core |
$1,210.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$912.80
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: VA VA |
$371.82
|
|
|
HC NCS 11-12 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$2,322.64
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
92200032
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,463.26 |
| Max. Negotiated Rate |
$2,090.38 |
| Rate for Payer: Aetna Commercial |
$1,974.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,509.72
|
| Rate for Payer: Cash Price |
$1,858.11
|
| Rate for Payer: Cofinity Advantage |
$1,625.85
|
| Rate for Payer: Cofinity Commercial |
$1,997.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,858.11
|
| Rate for Payer: Healthscope Commercial |
$2,090.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,974.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,741.98
|
| Rate for Payer: PHP Commercial |
$1,974.24
|
| Rate for Payer: Priority Health SBD |
$1,463.26
|
|
|
HC NCS 1-2 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$504.23
|
|
|
Service Code
|
CPT 95907
|
| Hospital Charge Code |
92200027
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$695.77 |
| Rate for Payer: Aetna Commercial |
$428.60
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$327.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$162.86
|
| Rate for Payer: BCN Commercial |
$162.86
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$403.38
|
| Rate for Payer: Cash Price |
$403.38
|
| Rate for Payer: Cofinity Advantage |
$352.96
|
| Rate for Payer: Cofinity Commercial |
$433.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$403.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$453.81
|
| Rate for Payer: Mclaren Medicaid |
$112.52
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$428.60
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$378.17
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$428.60
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$317.66
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.75
|
| Rate for Payer: UHC Core |
$262.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$198.16
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
