|
HC US DUPLX DOP ABD PELV SCROTUM
|
Facility
|
IP
|
$1,708.29
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
92100013
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,076.22 |
| Max. Negotiated Rate |
$1,537.46 |
| Rate for Payer: Aetna Commercial |
$1,452.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,110.39
|
| Rate for Payer: Cash Price |
$1,366.63
|
| Rate for Payer: Cofinity Commercial |
$1,469.13
|
| Rate for Payer: Cofinity Commercial |
$1,195.80
|
| Rate for Payer: Healthscope Commercial |
$1,537.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,452.05
|
| Rate for Payer: PHP Commercial |
$1,452.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,195.80
|
| Rate for Payer: Priority Health SBD |
$1,076.22
|
|
|
HC US DUPLX DOP ABD PELV SCROTUM
|
Facility
|
OP
|
$1,708.29
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
92100013
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$119.26 |
| Max. Negotiated Rate |
$1,537.46 |
| Rate for Payer: Aetna Commercial |
$1,452.05
|
| Rate for Payer: Aetna Medicare |
$226.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,110.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.54
|
| Rate for Payer: BCBS Complete |
$125.24
|
| Rate for Payer: BCBS MAPPO |
$218.03
|
| Rate for Payer: BCBS Trust/PPO |
$973.24
|
| Rate for Payer: BCN Medicare Advantage |
$218.03
|
| Rate for Payer: Cash Price |
$1,366.63
|
| Rate for Payer: Cash Price |
$1,366.63
|
| Rate for Payer: Cofinity Commercial |
$1,469.13
|
| Rate for Payer: Cofinity Commercial |
$1,195.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.03
|
| Rate for Payer: Healthscope Commercial |
$1,537.46
|
| Rate for Payer: Mclaren Medicaid |
$119.26
|
| Rate for Payer: Mclaren Medicare |
$218.03
|
| Rate for Payer: Meridian Medicaid |
$125.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,452.05
|
| Rate for Payer: PACE Medicare |
$207.13
|
| Rate for Payer: PACE SWMI |
$218.03
|
| Rate for Payer: PHP Commercial |
$1,452.05
|
| Rate for Payer: PHP Medicare Advantage |
$218.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,195.80
|
| Rate for Payer: Priority Health Medicare |
$218.03
|
| Rate for Payer: Priority Health SBD |
$1,076.22
|
| Rate for Payer: Railroad Medicare Medicare |
$218.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$285.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.03
|
| Rate for Payer: UHC Exchange |
$259.66
|
| Rate for Payer: UHC Medicare Advantage |
$224.57
|
| Rate for Payer: VA VA |
$218.03
|
|
|
HC US EACH ADDL FETUS BPP
|
Facility
|
OP
|
$476.47
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
40200026
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$428.82 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$309.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$79.44
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$381.18
|
| Rate for Payer: Cash Price |
$381.18
|
| Rate for Payer: Cofinity Commercial |
$409.76
|
| Rate for Payer: Cofinity Commercial |
$333.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$428.82
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$405.00
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$405.00
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.98
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$271.18
|
| Rate for Payer: Priority Health SBD |
$300.18
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$84.15
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC US EACH ADDL FETUS BPP
|
Facility
|
IP
|
$476.47
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
40200026
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$300.18 |
| Max. Negotiated Rate |
$428.82 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$309.71
|
| Rate for Payer: Cash Price |
$381.18
|
| Rate for Payer: Cofinity Commercial |
$333.53
|
| Rate for Payer: Cofinity Commercial |
$409.76
|
| Rate for Payer: Healthscope Commercial |
$428.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$405.00
|
| Rate for Payer: PHP Commercial |
$405.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.53
|
| Rate for Payer: Priority Health SBD |
$300.18
|
|
|
HC US EACH ADDL FETUS GT 14 WKS
|
Facility
|
OP
|
$423.30
|
|
|
Service Code
|
CPT 76810
|
| Hospital Charge Code |
40200018
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$68.95 |
| Max. Negotiated Rate |
$380.97 |
| Rate for Payer: Aetna Commercial |
$359.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.14
|
| Rate for Payer: BCBS Complete |
$169.32
|
| Rate for Payer: BCBS Trust/PPO |
$68.95
|
| Rate for Payer: Cash Price |
$338.64
|
| Rate for Payer: Cash Price |
$338.64
|
| Rate for Payer: Cofinity Commercial |
$296.31
|
| Rate for Payer: Cofinity Commercial |
$364.04
|
| Rate for Payer: Healthscope Commercial |
$380.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$359.80
|
| Rate for Payer: PHP Commercial |
$359.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$296.31
|
| Rate for Payer: Priority Health SBD |
$266.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.37
|
| Rate for Payer: UHC Exchange |
$85.79
|
|
|
HC US EACH ADDL FETUS GT 14 WKS
|
Facility
|
IP
|
$423.30
|
|
|
Service Code
|
CPT 76810
|
| Hospital Charge Code |
40200018
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$266.68 |
| Max. Negotiated Rate |
$380.97 |
| Rate for Payer: Aetna Commercial |
$359.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.14
|
| Rate for Payer: Cash Price |
$338.64
|
| Rate for Payer: Cofinity Commercial |
$296.31
|
| Rate for Payer: Cofinity Commercial |
$364.04
|
| Rate for Payer: Healthscope Commercial |
$380.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$359.80
|
| Rate for Payer: PHP Commercial |
$359.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$296.31
|
| Rate for Payer: Priority Health SBD |
$266.68
|
|
|
HC US EACH ADDL FETUS LESS THAN 14 WKS
|
Facility
|
OP
|
$348.47
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
40200016
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$35.30 |
| Max. Negotiated Rate |
$313.62 |
| Rate for Payer: Aetna Commercial |
$296.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.51
|
| Rate for Payer: BCBS Complete |
$139.39
|
| Rate for Payer: BCBS Trust/PPO |
$35.30
|
| Rate for Payer: Cash Price |
$278.78
|
| Rate for Payer: Cash Price |
$278.78
|
| Rate for Payer: Cofinity Commercial |
$243.93
|
| Rate for Payer: Cofinity Commercial |
$299.68
|
| Rate for Payer: Healthscope Commercial |
$313.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$296.20
|
| Rate for Payer: PHP Commercial |
$296.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.93
|
| Rate for Payer: Priority Health SBD |
$219.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.83
|
| Rate for Payer: UHC Exchange |
$58.94
|
|
|
HC US EACH ADDL FETUS LESS THAN 14 WKS
|
Facility
|
IP
|
$348.47
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
40200016
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$219.54 |
| Max. Negotiated Rate |
$313.62 |
| Rate for Payer: Aetna Commercial |
$296.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.51
|
| Rate for Payer: Cash Price |
$278.78
|
| Rate for Payer: Cofinity Commercial |
$243.93
|
| Rate for Payer: Cofinity Commercial |
$299.68
|
| Rate for Payer: Healthscope Commercial |
$313.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$296.20
|
| Rate for Payer: PHP Commercial |
$296.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.93
|
| Rate for Payer: Priority Health SBD |
$219.54
|
|
|
HC US ELASTOGRAPHY 1ST LESION
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 76982
|
| Hospital Charge Code |
40200075
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$128.52 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Aetna Commercial |
$173.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.60
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$142.80
|
| Rate for Payer: Cofinity Commercial |
$175.44
|
| Rate for Payer: Healthscope Commercial |
$183.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$173.40
|
| Rate for Payer: PHP Commercial |
$173.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.80
|
| Rate for Payer: Priority Health SBD |
$128.52
|
|
|
HC US ELASTOGRAPHY 1ST LESION
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
CPT 76982
|
| Hospital Charge Code |
40200075
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$338.98 |
| Rate for Payer: Aetna Commercial |
$173.40
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$108.12
|
| Rate for Payer: BCCCP Commercial |
$95.77
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$142.80
|
| Rate for Payer: Cofinity Commercial |
$175.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$183.60
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$173.40
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$173.40
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.98
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$271.18
|
| Rate for Payer: Priority Health SBD |
$128.52
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$91.68
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC US ELASTOGRAPHY EA ADDL LESION
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
40200076
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.89
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Cofinity Commercial |
$21.42
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.01
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.42
|
| Rate for Payer: Priority Health SBD |
$19.28
|
|
|
HC US ELASTOGRAPHY EA ADDL LESION
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
40200076
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$66.64 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.89
|
| Rate for Payer: BCBS Complete |
$12.24
|
| Rate for Payer: BCBS Trust/PPO |
$60.12
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Cofinity Commercial |
$21.42
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.01
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.42
|
| Rate for Payer: Priority Health SBD |
$19.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.64
|
| Rate for Payer: UHC Exchange |
$60.58
|
|
|
HC US ELASTOGRAPHY ORGAN
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
40200074
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$338.98 |
| Rate for Payer: Aetna Commercial |
$173.40
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$125.76
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$142.80
|
| Rate for Payer: Cofinity Commercial |
$175.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$183.60
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$173.40
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$173.40
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.98
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$271.18
|
| Rate for Payer: Priority Health SBD |
$128.52
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$102.49
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC US ELASTOGRAPHY ORGAN
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
40200074
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$128.52 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Aetna Commercial |
$173.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.60
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$142.80
|
| Rate for Payer: Cofinity Commercial |
$175.44
|
| Rate for Payer: Healthscope Commercial |
$183.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$173.40
|
| Rate for Payer: PHP Commercial |
$173.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.80
|
| Rate for Payer: Priority Health SBD |
$128.52
|
|
|
HC USE OF SPEECH DEVICE SERVICE
|
Facility
|
OP
|
$463.88
|
|
|
Service Code
|
CPT 92609
|
| Hospital Charge Code |
44000003
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$101.51 |
| Max. Negotiated Rate |
$417.49 |
| Rate for Payer: Aetna Commercial |
$394.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.52
|
| Rate for Payer: BCBS Complete |
$185.55
|
| Rate for Payer: Cash Price |
$371.10
|
| Rate for Payer: Cash Price |
$371.10
|
| Rate for Payer: Cofinity Commercial |
$324.72
|
| Rate for Payer: Cofinity Commercial |
$398.94
|
| Rate for Payer: Healthscope Commercial |
$417.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$394.30
|
| Rate for Payer: PHP Commercial |
$394.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.72
|
| Rate for Payer: Priority Health SBD |
$292.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.66
|
| Rate for Payer: UHC Exchange |
$101.51
|
|
|
HC USE OF SPEECH DEVICE SERVICE
|
Facility
|
IP
|
$463.88
|
|
|
Service Code
|
CPT 92609
|
| Hospital Charge Code |
44000003
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$292.24 |
| Max. Negotiated Rate |
$417.49 |
| Rate for Payer: Aetna Commercial |
$394.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.52
|
| Rate for Payer: Cash Price |
$371.10
|
| Rate for Payer: Cofinity Commercial |
$324.72
|
| Rate for Payer: Cofinity Commercial |
$398.94
|
| Rate for Payer: Healthscope Commercial |
$417.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$394.30
|
| Rate for Payer: PHP Commercial |
$394.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.72
|
| Rate for Payer: Priority Health SBD |
$292.24
|
|
|
HC US EXTREMITY NONVASC LTD
|
Facility
|
OP
|
$673.54
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
40200038
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$15.44 |
| Max. Negotiated Rate |
$606.19 |
| Rate for Payer: Aetna Commercial |
$572.51
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$437.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$15.44
|
| Rate for Payer: BCCCP Commercial |
$43.69
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$538.83
|
| Rate for Payer: Cash Price |
$538.83
|
| Rate for Payer: Cofinity Commercial |
$579.24
|
| Rate for Payer: Cofinity Commercial |
$471.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$606.19
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$572.51
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$572.51
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.98
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$271.18
|
| Rate for Payer: Priority Health SBD |
$424.33
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$62.21
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC US EXTREMITY NONVASC LTD
|
Facility
|
IP
|
$673.54
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
40200038
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$424.33 |
| Max. Negotiated Rate |
$606.19 |
| Rate for Payer: Aetna Commercial |
$572.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$437.80
|
| Rate for Payer: Cash Price |
$538.83
|
| Rate for Payer: Cofinity Commercial |
$579.24
|
| Rate for Payer: Cofinity Commercial |
$471.48
|
| Rate for Payer: Healthscope Commercial |
$606.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$572.51
|
| Rate for Payer: PHP Commercial |
$572.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.48
|
| Rate for Payer: Priority Health SBD |
$424.33
|
|
|
HC US EXTREMITY NONVASCULAR COMP
|
Facility
|
IP
|
$673.54
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
40200037
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$424.33 |
| Max. Negotiated Rate |
$606.19 |
| Rate for Payer: Aetna Commercial |
$572.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$437.80
|
| Rate for Payer: Cash Price |
$538.83
|
| Rate for Payer: Cofinity Commercial |
$471.48
|
| Rate for Payer: Cofinity Commercial |
$579.24
|
| Rate for Payer: Healthscope Commercial |
$606.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$572.51
|
| Rate for Payer: PHP Commercial |
$572.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.48
|
| Rate for Payer: Priority Health SBD |
$424.33
|
|
|
HC US EXTREMITY NONVASCULAR COMP
|
Facility
|
OP
|
$673.54
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
40200037
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$606.19 |
| Rate for Payer: Aetna Commercial |
$572.51
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$437.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$18.20
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$538.83
|
| Rate for Payer: Cash Price |
$538.83
|
| Rate for Payer: Cofinity Commercial |
$579.24
|
| Rate for Payer: Cofinity Commercial |
$471.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$606.19
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$572.51
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$572.51
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.98
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$271.18
|
| Rate for Payer: Priority Health SBD |
$424.33
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$52.72
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC US EYE B MODE
|
Facility
|
IP
|
$1,188.71
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
40200004
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$748.89 |
| Max. Negotiated Rate |
$1,069.84 |
| Rate for Payer: Aetna Commercial |
$1,010.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$772.66
|
| Rate for Payer: Cash Price |
$950.97
|
| Rate for Payer: Cofinity Commercial |
$1,022.29
|
| Rate for Payer: Cofinity Commercial |
$832.10
|
| Rate for Payer: Healthscope Commercial |
$1,069.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,010.40
|
| Rate for Payer: PHP Commercial |
$1,010.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$832.10
|
| Rate for Payer: Priority Health SBD |
$748.89
|
|
|
HC US EYE B MODE
|
Facility
|
OP
|
$1,188.71
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
40200004
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$29.23 |
| Max. Negotiated Rate |
$1,069.84 |
| Rate for Payer: Aetna Commercial |
$1,010.40
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$772.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$29.23
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$950.97
|
| Rate for Payer: Cash Price |
$950.97
|
| Rate for Payer: Cofinity Commercial |
$832.10
|
| Rate for Payer: Cofinity Commercial |
$1,022.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$1,069.84
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,010.40
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$1,010.40
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$832.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.98
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$271.18
|
| Rate for Payer: Priority Health SBD |
$748.89
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$47.15
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC US EYE B MODE BILAT
|
Facility
|
OP
|
$2,377.54
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
40200005
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$29.23 |
| Max. Negotiated Rate |
$2,139.79 |
| Rate for Payer: Aetna Commercial |
$2,020.91
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,545.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$29.23
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$1,902.03
|
| Rate for Payer: Cash Price |
$1,902.03
|
| Rate for Payer: Cofinity Commercial |
$1,664.28
|
| Rate for Payer: Cofinity Commercial |
$2,044.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$2,139.79
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,020.91
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$2,020.91
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,664.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.98
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$271.18
|
| Rate for Payer: Priority Health SBD |
$1,497.85
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$47.15
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC US EYE B MODE BILAT
|
Facility
|
IP
|
$2,377.54
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
40200005
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,497.85 |
| Max. Negotiated Rate |
$2,139.79 |
| Rate for Payer: Aetna Commercial |
$2,020.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,545.40
|
| Rate for Payer: Cash Price |
$1,902.03
|
| Rate for Payer: Cofinity Commercial |
$1,664.28
|
| Rate for Payer: Cofinity Commercial |
$2,044.68
|
| Rate for Payer: Healthscope Commercial |
$2,139.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,020.91
|
| Rate for Payer: PHP Commercial |
$2,020.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,664.28
|
| Rate for Payer: Priority Health SBD |
$1,497.85
|
|
|
HC US FETAL FLUID DRAIN INCL GUID
|
Facility
|
IP
|
$845.57
|
|
|
Service Code
|
CPT 59074
|
| Hospital Charge Code |
36100088
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$532.71 |
| Max. Negotiated Rate |
$761.01 |
| Rate for Payer: Aetna Commercial |
$718.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$549.62
|
| Rate for Payer: Cash Price |
$676.46
|
| Rate for Payer: Cofinity Commercial |
$591.90
|
| Rate for Payer: Cofinity Commercial |
$727.19
|
| Rate for Payer: Healthscope Commercial |
$761.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$718.73
|
| Rate for Payer: PHP Commercial |
$718.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$591.90
|
| Rate for Payer: Priority Health SBD |
$532.71
|
|
