|
HC TX INCOMPLETE AB ANY TRI SURG
|
Facility
|
OP
|
$7,789.74
|
|
|
Service Code
|
CPT 59812
|
| Hospital Charge Code |
76100342
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$8,478.18 |
| Rate for Payer: Aetna Commercial |
$6,621.28
|
| Rate for Payer: Aetna Medicare |
$2,893.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,063.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,477.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,477.26
|
| Rate for Payer: BCBS Complete |
$1,597.87
|
| Rate for Payer: BCBS MAPPO |
$2,781.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,417.50
|
| Rate for Payer: BCN Medicare Advantage |
$2,781.81
|
| Rate for Payer: Cash Price |
$6,231.79
|
| Rate for Payer: Cash Price |
$6,231.79
|
| Rate for Payer: Cofinity Commercial |
$6,699.18
|
| Rate for Payer: Cofinity Commercial |
$5,452.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,781.81
|
| Rate for Payer: Healthscope Commercial |
$7,010.77
|
| Rate for Payer: Mclaren Medicaid |
$1,521.65
|
| Rate for Payer: Mclaren Medicare |
$2,781.81
|
| Rate for Payer: Meridian Medicaid |
$1,597.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,920.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,199.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,621.28
|
| Rate for Payer: PACE Medicare |
$2,642.72
|
| Rate for Payer: PACE SWMI |
$2,781.81
|
| Rate for Payer: PHP Commercial |
$6,621.28
|
| Rate for Payer: PHP Medicare Advantage |
$2,781.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,521.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,452.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,478.18
|
| Rate for Payer: Priority Health Medicare |
$2,781.81
|
| Rate for Payer: Priority Health Narrow Network |
$6,782.54
|
| Rate for Payer: Priority Health SBD |
$4,907.54
|
| Rate for Payer: Railroad Medicare Medicare |
$2,781.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,781.81
|
| Rate for Payer: UHC Exchange |
$306.16
|
| Rate for Payer: UHC Medicare Advantage |
$2,865.26
|
| Rate for Payer: VA VA |
$2,781.81
|
|
|
HC TX MISSED AB 1ST TRI SURG
|
Facility
|
OP
|
$7,789.74
|
|
|
Service Code
|
CPT 59820
|
| Hospital Charge Code |
76100343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.40 |
| Max. Negotiated Rate |
$8,478.18 |
| Rate for Payer: Aetna Commercial |
$6,621.28
|
| Rate for Payer: Aetna Medicare |
$2,893.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,063.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,477.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,477.26
|
| Rate for Payer: BCBS Complete |
$1,597.87
|
| Rate for Payer: BCBS MAPPO |
$2,781.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,299.88
|
| Rate for Payer: BCN Medicare Advantage |
$2,781.81
|
| Rate for Payer: Cash Price |
$6,231.79
|
| Rate for Payer: Cash Price |
$6,231.79
|
| Rate for Payer: Cofinity Commercial |
$6,699.18
|
| Rate for Payer: Cofinity Commercial |
$5,452.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,781.81
|
| Rate for Payer: Healthscope Commercial |
$7,010.77
|
| Rate for Payer: Mclaren Medicaid |
$1,521.65
|
| Rate for Payer: Mclaren Medicare |
$2,781.81
|
| Rate for Payer: Meridian Medicaid |
$1,597.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,920.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,199.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,621.28
|
| Rate for Payer: PACE Medicare |
$2,642.72
|
| Rate for Payer: PACE SWMI |
$2,781.81
|
| Rate for Payer: PHP Commercial |
$6,621.28
|
| Rate for Payer: PHP Medicare Advantage |
$2,781.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,521.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,452.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,478.18
|
| Rate for Payer: Priority Health Medicare |
$2,781.81
|
| Rate for Payer: Priority Health Narrow Network |
$6,782.54
|
| Rate for Payer: Priority Health SBD |
$4,907.54
|
| Rate for Payer: Railroad Medicare Medicare |
$2,781.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$423.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,781.81
|
| Rate for Payer: UHC Exchange |
$385.40
|
| Rate for Payer: UHC Medicare Advantage |
$2,865.26
|
| Rate for Payer: VA VA |
$2,781.81
|
|
|
HC TX MISSED AB 1ST TRI SURG
|
Facility
|
IP
|
$7,789.74
|
|
|
Service Code
|
CPT 59820
|
| Hospital Charge Code |
76100343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,907.54 |
| Max. Negotiated Rate |
$7,010.77 |
| Rate for Payer: Aetna Commercial |
$6,621.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,063.33
|
| Rate for Payer: Cash Price |
$6,231.79
|
| Rate for Payer: Cofinity Commercial |
$5,452.82
|
| Rate for Payer: Cofinity Commercial |
$6,699.18
|
| Rate for Payer: Healthscope Commercial |
$7,010.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,621.28
|
| Rate for Payer: PHP Commercial |
$6,621.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,452.82
|
| Rate for Payer: Priority Health SBD |
$4,907.54
|
|
|
HC TX SUPERFICIAL WOUND DEHISCENCE, SIMPLE CLOSURE
|
Facility
|
OP
|
$760.44
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
76100243
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.33 |
| Max. Negotiated Rate |
$1,757.43 |
| Rate for Payer: Aetna Commercial |
$646.37
|
| Rate for Payer: Aetna Medicare |
$581.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$494.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$698.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$698.54
|
| Rate for Payer: BCBS Complete |
$320.99
|
| Rate for Payer: BCBS MAPPO |
$558.83
|
| Rate for Payer: BCBS Trust/PPO |
$363.15
|
| Rate for Payer: BCN Medicare Advantage |
$558.83
|
| Rate for Payer: Cash Price |
$608.35
|
| Rate for Payer: Cash Price |
$608.35
|
| Rate for Payer: Cofinity Commercial |
$532.31
|
| Rate for Payer: Cofinity Commercial |
$653.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.83
|
| Rate for Payer: Healthscope Commercial |
$684.40
|
| Rate for Payer: Mclaren Medicaid |
$305.68
|
| Rate for Payer: Mclaren Medicare |
$558.83
|
| Rate for Payer: Meridian Medicaid |
$320.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$646.37
|
| Rate for Payer: PACE Medicare |
$530.89
|
| Rate for Payer: PACE SWMI |
$558.83
|
| Rate for Payer: PHP Commercial |
$646.37
|
| Rate for Payer: PHP Medicare Advantage |
$558.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$532.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,757.43
|
| Rate for Payer: Priority Health Medicare |
$558.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,405.94
|
| Rate for Payer: Priority Health SBD |
$479.08
|
| Rate for Payer: Railroad Medicare Medicare |
$558.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.83
|
| Rate for Payer: UHC Exchange |
$185.33
|
| Rate for Payer: UHC Medicare Advantage |
$575.59
|
| Rate for Payer: VA VA |
$558.83
|
|
|
HC TX SUPERFICIAL WOUND DEHISCENCE, SIMPLE CLOSURE
|
Facility
|
IP
|
$760.44
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
76100243
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$479.08 |
| Max. Negotiated Rate |
$684.40 |
| Rate for Payer: Aetna Commercial |
$646.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$494.29
|
| Rate for Payer: Cash Price |
$608.35
|
| Rate for Payer: Cofinity Commercial |
$532.31
|
| Rate for Payer: Cofinity Commercial |
$653.98
|
| Rate for Payer: Healthscope Commercial |
$684.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$646.37
|
| Rate for Payer: PHP Commercial |
$646.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$532.31
|
| Rate for Payer: Priority Health SBD |
$479.08
|
|
|
HC TX TARSAL BONE FX, EXCEPT TALUS/CALCANEUS; W/O MANIP
|
Facility
|
IP
|
$329.46
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
76100287
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.56 |
| Max. Negotiated Rate |
$296.51 |
| Rate for Payer: Aetna Commercial |
$280.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.15
|
| Rate for Payer: Cash Price |
$263.57
|
| Rate for Payer: Cofinity Commercial |
$230.62
|
| Rate for Payer: Cofinity Commercial |
$283.34
|
| Rate for Payer: Healthscope Commercial |
$296.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$280.04
|
| Rate for Payer: PHP Commercial |
$280.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.62
|
| Rate for Payer: Priority Health SBD |
$207.56
|
|
|
HC TX TARSAL BONE FX, EXCEPT TALUS/CALCANEUS; W/O MANIP
|
Facility
|
OP
|
$329.46
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
76100287
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.68 |
| Max. Negotiated Rate |
$296.51 |
| Rate for Payer: Aetna Commercial |
$280.04
|
| Rate for Payer: Aetna Medicare |
$218.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.29
|
| Rate for Payer: BCBS Complete |
$120.53
|
| Rate for Payer: BCBS MAPPO |
$209.83
|
| Rate for Payer: BCBS Trust/PPO |
$79.68
|
| Rate for Payer: BCN Medicare Advantage |
$209.83
|
| Rate for Payer: Cash Price |
$263.57
|
| Rate for Payer: Cash Price |
$263.57
|
| Rate for Payer: Cofinity Commercial |
$283.34
|
| Rate for Payer: Cofinity Commercial |
$230.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.83
|
| Rate for Payer: Healthscope Commercial |
$296.51
|
| Rate for Payer: Mclaren Medicaid |
$114.78
|
| Rate for Payer: Mclaren Medicare |
$209.83
|
| Rate for Payer: Meridian Medicaid |
$120.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$220.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$280.04
|
| Rate for Payer: PACE Medicare |
$199.34
|
| Rate for Payer: PACE SWMI |
$209.83
|
| Rate for Payer: PHP Commercial |
$280.04
|
| Rate for Payer: PHP Medicare Advantage |
$209.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.62
|
| Rate for Payer: Priority Health Medicare |
$209.83
|
| Rate for Payer: Priority Health SBD |
$207.56
|
| Rate for Payer: Railroad Medicare Medicare |
$209.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.83
|
| Rate for Payer: UHC Exchange |
$194.50
|
| Rate for Payer: UHC Medicare Advantage |
$216.12
|
| Rate for Payer: VA VA |
$209.83
|
|
|
HC TYMPANOMETRY
|
Facility
|
OP
|
$28.56
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
47100008
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$101.83 |
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: Aetna Medicare |
$37.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.60
|
| Rate for Payer: BCBS Complete |
$20.49
|
| Rate for Payer: BCBS MAPPO |
$35.68
|
| Rate for Payer: BCBS Trust/PPO |
$42.98
|
| Rate for Payer: BCN Medicare Advantage |
$35.68
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$19.99
|
| Rate for Payer: Cofinity Commercial |
$24.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.68
|
| Rate for Payer: Healthscope Commercial |
$25.70
|
| Rate for Payer: Mclaren Medicaid |
$19.52
|
| Rate for Payer: Mclaren Medicare |
$35.68
|
| Rate for Payer: Meridian Medicaid |
$20.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.28
|
| Rate for Payer: PACE Medicare |
$33.90
|
| Rate for Payer: PACE SWMI |
$35.68
|
| Rate for Payer: PHP Commercial |
$24.28
|
| Rate for Payer: PHP Medicare Advantage |
$35.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.83
|
| Rate for Payer: Priority Health Medicare |
$35.68
|
| Rate for Payer: Priority Health Narrow Network |
$81.46
|
| Rate for Payer: Priority Health SBD |
$17.99
|
| Rate for Payer: Railroad Medicare Medicare |
$35.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.68
|
| Rate for Payer: UHC Exchange |
$10.48
|
| Rate for Payer: UHC Medicare Advantage |
$36.75
|
| Rate for Payer: VA VA |
$35.68
|
|
|
HC TYMPANOMETRY
|
Facility
|
IP
|
$28.56
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
47100008
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$17.99 |
| Max. Negotiated Rate |
$25.70 |
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.56
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$19.99
|
| Rate for Payer: Cofinity Commercial |
$24.56
|
| Rate for Payer: Healthscope Commercial |
$25.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.28
|
| Rate for Payer: PHP Commercial |
$24.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.99
|
| Rate for Payer: Priority Health SBD |
$17.99
|
|
|
HC TYMPANOMETRY & REFLEX THRESH
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 92550
|
| Hospital Charge Code |
76100503
|
|
Hospital Revenue Code
|
471
|
| 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 TYMPANOMETRY & REFLEX THRESH
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 92550
|
| Hospital Charge Code |
76100503
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$21.28 |
| Max. Negotiated Rate |
$436.07 |
| Rate for Payer: Aetna Commercial |
$124.10
|
| Rate for Payer: Aetna Medicare |
$144.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.74
|
| Rate for Payer: BCBS Complete |
$79.84
|
| Rate for Payer: BCBS MAPPO |
$138.99
|
| Rate for Payer: BCBS Trust/PPO |
$46.06
|
| Rate for Payer: BCN Medicare Advantage |
$138.99
|
| 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 |
$138.99
|
| Rate for Payer: Healthscope Commercial |
$131.40
|
| Rate for Payer: Mclaren Medicaid |
$76.03
|
| Rate for Payer: Mclaren Medicare |
$138.99
|
| Rate for Payer: Meridian Medicaid |
$79.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.10
|
| Rate for Payer: PACE Medicare |
$132.04
|
| Rate for Payer: PACE SWMI |
$138.99
|
| Rate for Payer: PHP Commercial |
$124.10
|
| Rate for Payer: PHP Medicare Advantage |
$138.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$436.07
|
| Rate for Payer: Priority Health Medicare |
$138.99
|
| Rate for Payer: Priority Health Narrow Network |
$348.85
|
| Rate for Payer: Priority Health SBD |
$91.98
|
| Rate for Payer: Railroad Medicare Medicare |
$138.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.99
|
| Rate for Payer: UHC Exchange |
$21.28
|
| Rate for Payer: UHC Medicare Advantage |
$143.16
|
| Rate for Payer: VA VA |
$138.99
|
|
|
HC TYMPANOSTOMY LOCAL/TOPICAL ANES
|
Facility
|
IP
|
$1,316.00
|
|
|
Service Code
|
CPT 69433
|
| Hospital Charge Code |
76100486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$829.08 |
| Max. Negotiated Rate |
$1,184.40 |
| Rate for Payer: Aetna Commercial |
$1,118.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$855.40
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cofinity Commercial |
$1,131.76
|
| Rate for Payer: Cofinity Commercial |
$921.20
|
| Rate for Payer: Healthscope Commercial |
$1,184.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,118.60
|
| Rate for Payer: PHP Commercial |
$1,118.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$921.20
|
| Rate for Payer: Priority Health SBD |
$829.08
|
|
|
HC TYMPANOSTOMY LOCAL/TOPICAL ANES
|
Facility
|
OP
|
$1,316.00
|
|
|
Service Code
|
CPT 69433
|
| Hospital Charge Code |
76100486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$131.63 |
| Max. Negotiated Rate |
$1,184.40 |
| Rate for Payer: Aetna Commercial |
$1,118.60
|
| Rate for Payer: Aetna Medicare |
$509.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$855.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$611.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$611.96
|
| Rate for Payer: BCBS Complete |
$281.21
|
| Rate for Payer: BCBS MAPPO |
$489.57
|
| Rate for Payer: BCBS Trust/PPO |
$183.32
|
| Rate for Payer: BCN Medicare Advantage |
$489.57
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cofinity Commercial |
$1,131.76
|
| Rate for Payer: Cofinity Commercial |
$921.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$489.57
|
| Rate for Payer: Healthscope Commercial |
$1,184.40
|
| Rate for Payer: Mclaren Medicaid |
$267.79
|
| Rate for Payer: Mclaren Medicare |
$489.57
|
| Rate for Payer: Meridian Medicaid |
$281.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$514.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$563.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,118.60
|
| Rate for Payer: PACE Medicare |
$465.09
|
| Rate for Payer: PACE SWMI |
$489.57
|
| Rate for Payer: PHP Commercial |
$1,118.60
|
| Rate for Payer: PHP Medicare Advantage |
$489.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$921.20
|
| Rate for Payer: Priority Health Medicare |
$489.57
|
| Rate for Payer: Priority Health SBD |
$829.08
|
| Rate for Payer: Railroad Medicare Medicare |
$489.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$489.57
|
| Rate for Payer: UHC Exchange |
$131.63
|
| Rate for Payer: UHC Medicare Advantage |
$504.26
|
| Rate for Payer: VA VA |
$489.57
|
|
|
HC TYPE & SCREEN ABO
|
Facility
|
OP
|
$21.83
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
30200347
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$351.10 |
| Rate for Payer: Aetna Commercial |
$18.56
|
| Rate for Payer: Aetna Medicare |
$118.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$142.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$142.08
|
| Rate for Payer: BCBS Complete |
$65.29
|
| Rate for Payer: BCBS MAPPO |
$113.66
|
| Rate for Payer: BCBS Trust/PPO |
$2.34
|
| Rate for Payer: BCN Medicare Advantage |
$113.66
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cofinity Commercial |
$15.28
|
| Rate for Payer: Cofinity Commercial |
$18.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.66
|
| Rate for Payer: Healthscope Commercial |
$19.65
|
| Rate for Payer: Mclaren Medicaid |
$62.17
|
| Rate for Payer: Mclaren Medicare |
$113.66
|
| Rate for Payer: Meridian Medicaid |
$65.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.56
|
| Rate for Payer: PACE Medicare |
$107.98
|
| Rate for Payer: PACE SWMI |
$113.66
|
| Rate for Payer: PHP Commercial |
$18.56
|
| Rate for Payer: PHP Medicare Advantage |
$113.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$351.10
|
| Rate for Payer: Priority Health Medicare |
$113.66
|
| Rate for Payer: Priority Health Narrow Network |
$280.88
|
| Rate for Payer: Priority Health SBD |
$13.75
|
| Rate for Payer: Railroad Medicare Medicare |
$113.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.59
|
| Rate for Payer: UHC Core |
$5.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.66
|
| Rate for Payer: UHC Exchange |
$2.99
|
| Rate for Payer: UHC Medicare Advantage |
$117.07
|
| Rate for Payer: VA VA |
$113.66
|
|
|
HC TYPE & SCREEN ABO
|
Facility
|
IP
|
$21.83
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
30200347
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$19.65 |
| Rate for Payer: Aetna Commercial |
$18.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.19
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cofinity Commercial |
$15.28
|
| Rate for Payer: Cofinity Commercial |
$18.77
|
| Rate for Payer: Healthscope Commercial |
$19.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.56
|
| Rate for Payer: PHP Commercial |
$18.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.28
|
| Rate for Payer: Priority Health SBD |
$13.75
|
|
|
HC TYPE & SCREEN ANTIBODY
|
Facility
|
OP
|
$37.11
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
30200340
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$154.72 |
| Rate for Payer: Aetna Commercial |
$31.54
|
| Rate for Payer: Aetna Medicare |
$50.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.28
|
| Rate for Payer: BCBS Complete |
$27.70
|
| Rate for Payer: BCBS MAPPO |
$48.22
|
| Rate for Payer: BCBS Trust/PPO |
$7.65
|
| Rate for Payer: BCN Medicare Advantage |
$48.22
|
| Rate for Payer: Cash Price |
$29.69
|
| Rate for Payer: Cash Price |
$29.69
|
| Rate for Payer: Cofinity Commercial |
$25.98
|
| Rate for Payer: Cofinity Commercial |
$31.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.22
|
| Rate for Payer: Healthscope Commercial |
$33.40
|
| Rate for Payer: Mclaren Medicaid |
$26.38
|
| Rate for Payer: Mclaren Medicare |
$48.22
|
| Rate for Payer: Meridian Medicaid |
$27.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$50.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.54
|
| Rate for Payer: PACE Medicare |
$45.81
|
| Rate for Payer: PACE SWMI |
$48.22
|
| Rate for Payer: PHP Commercial |
$31.54
|
| Rate for Payer: PHP Medicare Advantage |
$48.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$154.72
|
| Rate for Payer: Priority Health Medicare |
$48.22
|
| Rate for Payer: Priority Health Narrow Network |
$123.78
|
| Rate for Payer: Priority Health SBD |
$23.38
|
| Rate for Payer: Railroad Medicare Medicare |
$48.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.72
|
| Rate for Payer: UHC Core |
$17.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.22
|
| Rate for Payer: UHC Exchange |
$9.77
|
| Rate for Payer: UHC Medicare Advantage |
$49.67
|
| Rate for Payer: VA VA |
$48.22
|
|
|
HC TYPE & SCREEN ANTIBODY
|
Facility
|
IP
|
$37.11
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
30200340
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.38 |
| Max. Negotiated Rate |
$33.40 |
| Rate for Payer: Aetna Commercial |
$31.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.12
|
| Rate for Payer: Cash Price |
$29.69
|
| Rate for Payer: Cofinity Commercial |
$25.98
|
| Rate for Payer: Cofinity Commercial |
$31.91
|
| Rate for Payer: Healthscope Commercial |
$33.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.54
|
| Rate for Payer: PHP Commercial |
$31.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.98
|
| Rate for Payer: Priority Health SBD |
$23.38
|
|
|
HC TYRX ANTIBACTERIAL POUCH
|
Facility
|
IP
|
$2,750.00
|
|
| Hospital Charge Code |
27800115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,732.50 |
| Max. Negotiated Rate |
$2,475.00 |
| Rate for Payer: Aetna Commercial |
$2,337.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,787.50
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Cofinity Commercial |
$1,925.00
|
| Rate for Payer: Cofinity Commercial |
$2,365.00
|
| Rate for Payer: Healthscope Commercial |
$2,475.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,337.50
|
| Rate for Payer: PHP Commercial |
$2,337.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,925.00
|
| Rate for Payer: Priority Health SBD |
$1,732.50
|
|
|
HC TYRX ANTIBACTERIAL POUCH
|
Facility
|
OP
|
$2,750.00
|
|
| Hospital Charge Code |
27800115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,100.00 |
| Max. Negotiated Rate |
$2,475.00 |
| Rate for Payer: Aetna Commercial |
$2,337.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,787.50
|
| Rate for Payer: BCBS Complete |
$1,100.00
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Cofinity Commercial |
$1,925.00
|
| Rate for Payer: Cofinity Commercial |
$2,365.00
|
| Rate for Payer: Healthscope Commercial |
$2,475.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,337.50
|
| Rate for Payer: PHP Commercial |
$2,337.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,925.00
|
| Rate for Payer: Priority Health SBD |
$1,732.50
|
|
|
HC UA - KETONE
|
Facility
|
IP
|
$12.24
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
30700009
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.96
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Cofinity Commercial |
$8.57
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.40
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.57
|
| Rate for Payer: Priority Health SBD |
$7.71
|
|
|
HC UA - KETONE
|
Facility
|
OP
|
$12.24
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
30700009
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: Aetna Medicare |
$3.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.35
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS MAPPO |
$3.48
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCN Medicare Advantage |
$3.48
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$8.57
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.48
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: Mclaren Medicaid |
$1.90
|
| Rate for Payer: Mclaren Medicare |
$3.48
|
| Rate for Payer: Meridian Medicaid |
$2.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.40
|
| Rate for Payer: PACE Medicare |
$3.31
|
| Rate for Payer: PACE SWMI |
$3.48
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: PHP Medicare Advantage |
$3.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.57
|
| Rate for Payer: Priority Health Medicare |
$3.48
|
| Rate for Payer: Priority Health SBD |
$7.71
|
| Rate for Payer: Railroad Medicare Medicare |
$3.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.18
|
| Rate for Payer: UHC Core |
$4.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.48
|
| Rate for Payer: UHC Exchange |
$3.48
|
| Rate for Payer: UHC Medicare Advantage |
$3.58
|
| Rate for Payer: VA VA |
$3.48
|
|
|
HC ULTRASOUND EACH 15 MIN
|
Facility
|
OP
|
$82.62
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
42000018
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$74.36 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.70
|
| Rate for Payer: BCBS Complete |
$33.05
|
| Rate for Payer: BCBS Trust/PPO |
$9.60
|
| Rate for Payer: Cash Price |
$66.10
|
| Rate for Payer: Cash Price |
$66.10
|
| Rate for Payer: Cofinity Commercial |
$71.05
|
| Rate for Payer: Cofinity Commercial |
$57.83
|
| Rate for Payer: Healthscope Commercial |
$74.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.23
|
| Rate for Payer: PHP Commercial |
$70.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.83
|
| Rate for Payer: Priority Health SBD |
$52.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.12
|
| Rate for Payer: UHC Exchange |
$13.75
|
|
|
HC ULTRASOUND EACH 15 MIN
|
Facility
|
IP
|
$82.62
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
42000018
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$52.05 |
| Max. Negotiated Rate |
$74.36 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.70
|
| Rate for Payer: Cash Price |
$66.10
|
| Rate for Payer: Cofinity Commercial |
$57.83
|
| Rate for Payer: Cofinity Commercial |
$71.05
|
| Rate for Payer: Healthscope Commercial |
$74.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.23
|
| Rate for Payer: PHP Commercial |
$70.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.83
|
| Rate for Payer: Priority Health SBD |
$52.05
|
|
|
HC ULTRASOUND RF UTERINE FIBROID ABLATION TRANSCERVICAL
|
Facility
|
OP
|
$9,446.22
|
|
|
Service Code
|
CPT 58580
|
| Hospital Charge Code |
36100485
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$391.62 |
| Max. Negotiated Rate |
$8,501.60 |
| Rate for Payer: Aetna Commercial |
$8,029.29
|
| Rate for Payer: Aetna Medicare |
$6,992.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,140.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,404.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,404.69
|
| Rate for Payer: BCBS Complete |
$3,862.12
|
| Rate for Payer: BCBS MAPPO |
$6,723.75
|
| Rate for Payer: BCN Medicare Advantage |
$6,723.75
|
| Rate for Payer: Cash Price |
$7,556.98
|
| Rate for Payer: Cash Price |
$7,556.98
|
| Rate for Payer: Cofinity Commercial |
$8,123.75
|
| Rate for Payer: Cofinity Commercial |
$6,612.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,723.75
|
| Rate for Payer: Healthscope Commercial |
$8,501.60
|
| Rate for Payer: Mclaren Medicaid |
$3,677.89
|
| Rate for Payer: Mclaren Medicare |
$6,723.75
|
| Rate for Payer: Meridian Medicaid |
$3,862.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,059.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,732.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,029.29
|
| Rate for Payer: PACE Medicare |
$6,387.56
|
| Rate for Payer: PACE SWMI |
$6,723.75
|
| Rate for Payer: PHP Commercial |
$8,029.29
|
| Rate for Payer: PHP Medicare Advantage |
$6,723.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,677.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,612.35
|
| Rate for Payer: Priority Health Medicare |
$6,723.75
|
| Rate for Payer: Priority Health SBD |
$5,951.12
|
| Rate for Payer: Railroad Medicare Medicare |
$6,723.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$430.78
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,723.75
|
| Rate for Payer: UHC Exchange |
$391.62
|
| Rate for Payer: UHC Medicare Advantage |
$6,925.46
|
| Rate for Payer: VA VA |
$6,723.75
|
|
|
HC ULTRASOUND RF UTERINE FIBROID ABLATION TRANSCERVICAL
|
Facility
|
IP
|
$9,446.22
|
|
|
Service Code
|
CPT 58580
|
| Hospital Charge Code |
36100485
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,951.12 |
| Max. Negotiated Rate |
$8,501.60 |
| Rate for Payer: Aetna Commercial |
$8,029.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,140.04
|
| Rate for Payer: Cash Price |
$7,556.98
|
| Rate for Payer: Cofinity Commercial |
$6,612.35
|
| Rate for Payer: Cofinity Commercial |
$8,123.75
|
| Rate for Payer: Healthscope Commercial |
$8,501.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,029.29
|
| Rate for Payer: PHP Commercial |
$8,029.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,612.35
|
| Rate for Payer: Priority Health SBD |
$5,951.12
|
|
