|
HC MYRINGOTOMY ASPIR&EUSTACHIAN TUBE NFLTJ
|
Facility
|
IP
|
$628.32
|
|
|
Service Code
|
CPT 69420
|
| Hospital Charge Code |
76100484
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$395.84 |
| Max. Negotiated Rate |
$565.49 |
| Rate for Payer: Aetna Commercial |
$534.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$408.41
|
| Rate for Payer: Cash Price |
$502.66
|
| Rate for Payer: Cofinity Commercial |
$439.82
|
| Rate for Payer: Cofinity Commercial |
$540.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$439.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$502.66
|
| Rate for Payer: Healthscope Commercial |
$565.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$534.07
|
| Rate for Payer: PHP Commercial |
$534.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$408.41
|
| Rate for Payer: Priority Health SBD |
$395.84
|
|
|
HC NAIL BED REPAIR
|
Facility
|
OP
|
$757.63
|
|
|
Service Code
|
CPT 11760
|
| Hospital Charge Code |
45000077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$319.99 |
| Max. Negotiated Rate |
$1,680.50 |
| Rate for Payer: Aetna Commercial |
$643.99
|
| Rate for Payer: Aetna Medicare |
$620.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$492.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$746.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$746.25
|
| Rate for Payer: BCBS Complete |
$335.99
|
| Rate for Payer: BCBS MAPPO |
$597.00
|
| Rate for Payer: BCN Medicare Advantage |
$597.00
|
| Rate for Payer: Cash Price |
$606.10
|
| Rate for Payer: Cash Price |
$606.10
|
| Rate for Payer: Cofinity Commercial |
$530.34
|
| Rate for Payer: Cofinity Commercial |
$651.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$530.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$606.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$597.00
|
| Rate for Payer: Healthscope Commercial |
$681.87
|
| Rate for Payer: Mclaren Medicaid |
$319.99
|
| Rate for Payer: Mclaren Medicare |
$597.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$626.85
|
| Rate for Payer: Meridian Medicaid |
$335.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$686.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$643.99
|
| Rate for Payer: PACE Medicare |
$567.15
|
| Rate for Payer: PACE SWMI |
$597.00
|
| Rate for Payer: PHP Commercial |
$643.99
|
| Rate for Payer: PHP Medicare Advantage |
$597.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$492.46
|
| Rate for Payer: Priority Health Medicare |
$597.00
|
| Rate for Payer: Priority Health SBD |
$477.31
|
| Rate for Payer: Railroad Medicare Medicare |
$597.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,680.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.00
|
| Rate for Payer: UHC Medicare Advantage |
$597.00
|
| Rate for Payer: UHCCP Medicaid |
$336.11
|
| Rate for Payer: VA VA |
$597.00
|
|
|
HC NAIL BED REPAIR
|
Facility
|
IP
|
$757.63
|
|
|
Service Code
|
CPT 11760
|
| Hospital Charge Code |
45000077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$477.31 |
| Max. Negotiated Rate |
$681.87 |
| Rate for Payer: Aetna Commercial |
$643.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$492.46
|
| Rate for Payer: Cash Price |
$606.10
|
| Rate for Payer: Cofinity Commercial |
$530.34
|
| Rate for Payer: Cofinity Commercial |
$651.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$530.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$606.10
|
| Rate for Payer: Healthscope Commercial |
$681.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$643.99
|
| Rate for Payer: PHP Commercial |
$643.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$492.46
|
| Rate for Payer: Priority Health SBD |
$477.31
|
|
|
HC NAIL PROCEDURE
|
Facility
|
OP
|
$271.81
|
|
| Hospital Charge Code |
45000047
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$108.72 |
| Max. Negotiated Rate |
$244.63 |
| Rate for Payer: Aetna Commercial |
$231.04
|
| Rate for Payer: Aetna Medicare |
$135.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.68
|
| Rate for Payer: BCBS Complete |
$108.72
|
| Rate for Payer: Cash Price |
$217.45
|
| Rate for Payer: Cofinity Commercial |
$190.27
|
| Rate for Payer: Cofinity Commercial |
$233.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.45
|
| Rate for Payer: Healthscope Commercial |
$244.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.04
|
| Rate for Payer: PHP Commercial |
$231.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.68
|
| Rate for Payer: Priority Health SBD |
$171.24
|
|
|
HC NAIL PROCEDURE
|
Facility
|
IP
|
$271.81
|
|
| Hospital Charge Code |
45000047
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$171.24 |
| Max. Negotiated Rate |
$244.63 |
| Rate for Payer: Aetna Commercial |
$231.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.68
|
| Rate for Payer: Cash Price |
$217.45
|
| Rate for Payer: Cofinity Commercial |
$190.27
|
| Rate for Payer: Cofinity Commercial |
$233.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.45
|
| Rate for Payer: Healthscope Commercial |
$244.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.04
|
| Rate for Payer: PHP Commercial |
$231.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.68
|
| Rate for Payer: Priority Health SBD |
$171.24
|
|
|
HC NA PHOSPHATE PER MCI
|
Facility
|
OP
|
$328.09
|
|
|
Service Code
|
HCPCS A9563
|
| Hospital Charge Code |
34400004
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$96.01 |
| Max. Negotiated Rate |
$504.20 |
| Rate for Payer: Aetna Commercial |
$278.88
|
| Rate for Payer: Aetna Medicare |
$186.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$223.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$223.90
|
| Rate for Payer: BCBS Complete |
$100.81
|
| Rate for Payer: BCBS MAPPO |
$179.12
|
| Rate for Payer: BCN Medicare Advantage |
$179.12
|
| Rate for Payer: Cash Price |
$262.47
|
| Rate for Payer: Cash Price |
$262.47
|
| Rate for Payer: Cofinity Commercial |
$282.16
|
| Rate for Payer: Cofinity Commercial |
$229.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$229.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.12
|
| Rate for Payer: Healthscope Commercial |
$295.28
|
| Rate for Payer: Mclaren Medicaid |
$96.01
|
| Rate for Payer: Mclaren Medicare |
$179.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.08
|
| Rate for Payer: Meridian Medicaid |
$100.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$205.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.88
|
| Rate for Payer: PACE Medicare |
$170.16
|
| Rate for Payer: PACE SWMI |
$179.12
|
| Rate for Payer: PHP Commercial |
$278.88
|
| Rate for Payer: PHP Medicare Advantage |
$179.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.26
|
| Rate for Payer: Priority Health Medicare |
$179.12
|
| Rate for Payer: Priority Health SBD |
$206.70
|
| Rate for Payer: Railroad Medicare Medicare |
$179.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$504.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.12
|
| Rate for Payer: UHC Medicare Advantage |
$179.12
|
| Rate for Payer: UHCCP Medicaid |
$100.84
|
| Rate for Payer: VA VA |
$179.12
|
|
|
HC NA PHOSPHATE PER MCI
|
Facility
|
IP
|
$328.09
|
|
|
Service Code
|
HCPCS A9563
|
| Hospital Charge Code |
34400004
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$206.70 |
| Max. Negotiated Rate |
$295.28 |
| Rate for Payer: Aetna Commercial |
$278.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.26
|
| Rate for Payer: Cash Price |
$262.47
|
| Rate for Payer: Cofinity Commercial |
$229.66
|
| Rate for Payer: Cofinity Commercial |
$282.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$229.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.47
|
| Rate for Payer: Healthscope Commercial |
$295.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.88
|
| Rate for Payer: PHP Commercial |
$278.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.26
|
| Rate for Payer: Priority Health SBD |
$206.70
|
|
|
HC NASAL BONES COMP MIN 3 VW
|
Facility
|
OP
|
$198.81
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
32000011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$241.72 |
| Rate for Payer: Aetna Commercial |
$168.99
|
| Rate for Payer: Aetna Medicare |
$89.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$159.05
|
| Rate for Payer: Cash Price |
$159.05
|
| Rate for Payer: Cofinity Commercial |
$170.98
|
| Rate for Payer: Cofinity Commercial |
$139.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$178.93
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.99
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$168.99
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.23
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health SBD |
$125.25
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.72
|
| Rate for Payer: UHC Core |
$147.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$147.12
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$48.34
|
| Rate for Payer: VA VA |
$85.87
|
|
|
HC NASAL BONES COMP MIN 3 VW
|
Facility
|
IP
|
$198.81
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
32000011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$125.25 |
| Max. Negotiated Rate |
$178.93 |
| Rate for Payer: Aetna Commercial |
$168.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.23
|
| Rate for Payer: Cash Price |
$159.05
|
| Rate for Payer: Cofinity Commercial |
$139.17
|
| Rate for Payer: Cofinity Commercial |
$170.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.05
|
| Rate for Payer: Healthscope Commercial |
$178.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.99
|
| Rate for Payer: PHP Commercial |
$168.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.23
|
| Rate for Payer: Priority Health SBD |
$125.25
|
|
|
HC NASAL ENDOSCOPY DX
|
Facility
|
IP
|
$255.90
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
76100183
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$161.22 |
| Max. Negotiated Rate |
$230.31 |
| Rate for Payer: Aetna Commercial |
$217.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.34
|
| Rate for Payer: Cash Price |
$204.72
|
| Rate for Payer: Cofinity Commercial |
$179.13
|
| Rate for Payer: Cofinity Commercial |
$220.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.72
|
| Rate for Payer: Healthscope Commercial |
$230.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.51
|
| Rate for Payer: PHP Commercial |
$217.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.34
|
| Rate for Payer: Priority Health SBD |
$161.22
|
|
|
HC NASAL ENDOSCOPY DX
|
Facility
|
OP
|
$255.90
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
76100183
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.49 |
| Max. Negotiated Rate |
$532.97 |
| Rate for Payer: Aetna Commercial |
$217.51
|
| Rate for Payer: Aetna Medicare |
$196.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$236.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$236.68
|
| Rate for Payer: BCBS Complete |
$106.56
|
| Rate for Payer: BCBS MAPPO |
$189.34
|
| Rate for Payer: BCN Medicare Advantage |
$189.34
|
| Rate for Payer: Cash Price |
$204.72
|
| Rate for Payer: Cash Price |
$204.72
|
| Rate for Payer: Cofinity Commercial |
$220.07
|
| Rate for Payer: Cofinity Commercial |
$179.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.34
|
| Rate for Payer: Healthscope Commercial |
$230.31
|
| Rate for Payer: Mclaren Medicaid |
$101.49
|
| Rate for Payer: Mclaren Medicare |
$189.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.81
|
| Rate for Payer: Meridian Medicaid |
$106.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$217.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.51
|
| Rate for Payer: PACE Medicare |
$179.87
|
| Rate for Payer: PACE SWMI |
$189.34
|
| Rate for Payer: PHP Commercial |
$217.51
|
| Rate for Payer: PHP Medicare Advantage |
$189.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.34
|
| Rate for Payer: Priority Health Medicare |
$189.34
|
| Rate for Payer: Priority Health SBD |
$161.22
|
| Rate for Payer: Railroad Medicare Medicare |
$189.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$532.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.34
|
| Rate for Payer: UHC Medicare Advantage |
$189.34
|
| Rate for Payer: UHCCP Medicaid |
$106.60
|
| Rate for Payer: VA VA |
$189.34
|
|
|
HC NASAL/SINUS ENDSC SURG W/BX POLYPEC/DBRD SPX
|
Facility
|
IP
|
$4,437.00
|
|
|
Service Code
|
CPT 31237
|
| Hospital Charge Code |
76100454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,795.31 |
| Max. Negotiated Rate |
$3,993.30 |
| Rate for Payer: Aetna Commercial |
$3,771.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,884.05
|
| Rate for Payer: Cash Price |
$3,549.60
|
| Rate for Payer: Cofinity Commercial |
$3,105.90
|
| Rate for Payer: Cofinity Commercial |
$3,815.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,105.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,549.60
|
| Rate for Payer: Healthscope Commercial |
$3,993.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,771.45
|
| Rate for Payer: PHP Commercial |
$3,771.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,884.05
|
| Rate for Payer: Priority Health SBD |
$2,795.31
|
|
|
HC NASAL/SINUS ENDSC SURG W/BX POLYPEC/DBRD SPX
|
Facility
|
OP
|
$4,437.00
|
|
|
Service Code
|
CPT 31237
|
| Hospital Charge Code |
76100454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$901.47 |
| Max. Negotiated Rate |
$4,734.21 |
| Rate for Payer: Aetna Commercial |
$3,771.45
|
| Rate for Payer: Aetna Medicare |
$1,749.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,884.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,102.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,102.30
|
| Rate for Payer: BCBS Complete |
$946.54
|
| Rate for Payer: BCBS MAPPO |
$1,681.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,681.84
|
| Rate for Payer: Cash Price |
$3,549.60
|
| Rate for Payer: Cash Price |
$3,549.60
|
| Rate for Payer: Cofinity Commercial |
$3,815.82
|
| Rate for Payer: Cofinity Commercial |
$3,105.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,105.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,549.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,681.84
|
| Rate for Payer: Healthscope Commercial |
$3,993.30
|
| Rate for Payer: Mclaren Medicaid |
$901.47
|
| Rate for Payer: Mclaren Medicare |
$1,681.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,765.93
|
| Rate for Payer: Meridian Medicaid |
$946.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,934.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,771.45
|
| Rate for Payer: PACE Medicare |
$1,597.75
|
| Rate for Payer: PACE SWMI |
$1,681.84
|
| Rate for Payer: PHP Commercial |
$3,771.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,681.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$901.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,884.05
|
| Rate for Payer: Priority Health Medicare |
$1,681.84
|
| Rate for Payer: Priority Health SBD |
$2,795.31
|
| Rate for Payer: Railroad Medicare Medicare |
$1,681.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,734.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,681.84
|
| Rate for Payer: UHC Medicare Advantage |
$1,681.84
|
| Rate for Payer: UHCCP Medicaid |
$946.88
|
| Rate for Payer: VA VA |
$1,681.84
|
|
|
HC NASOPHARYNGOSCOPY
|
Facility
|
IP
|
$255.90
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
76100177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$161.22 |
| Max. Negotiated Rate |
$230.31 |
| Rate for Payer: Aetna Commercial |
$217.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.34
|
| Rate for Payer: Cash Price |
$204.72
|
| Rate for Payer: Cofinity Commercial |
$179.13
|
| Rate for Payer: Cofinity Commercial |
$220.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.72
|
| Rate for Payer: Healthscope Commercial |
$230.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.51
|
| Rate for Payer: PHP Commercial |
$217.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.34
|
| Rate for Payer: Priority Health SBD |
$161.22
|
|
|
HC NASOPHARYNGOSCOPY
|
Facility
|
OP
|
$255.90
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
76100177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.49 |
| Max. Negotiated Rate |
$532.97 |
| Rate for Payer: Aetna Commercial |
$217.51
|
| Rate for Payer: Aetna Medicare |
$196.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$236.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$236.68
|
| Rate for Payer: BCBS Complete |
$106.56
|
| Rate for Payer: BCBS MAPPO |
$189.34
|
| Rate for Payer: BCN Medicare Advantage |
$189.34
|
| Rate for Payer: Cash Price |
$204.72
|
| Rate for Payer: Cash Price |
$204.72
|
| Rate for Payer: Cofinity Commercial |
$220.07
|
| Rate for Payer: Cofinity Commercial |
$179.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.34
|
| Rate for Payer: Healthscope Commercial |
$230.31
|
| Rate for Payer: Mclaren Medicaid |
$101.49
|
| Rate for Payer: Mclaren Medicare |
$189.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.81
|
| Rate for Payer: Meridian Medicaid |
$106.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$217.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.51
|
| Rate for Payer: PACE Medicare |
$179.87
|
| Rate for Payer: PACE SWMI |
$189.34
|
| Rate for Payer: PHP Commercial |
$217.51
|
| Rate for Payer: PHP Medicare Advantage |
$189.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.34
|
| Rate for Payer: Priority Health Medicare |
$189.34
|
| Rate for Payer: Priority Health SBD |
$161.22
|
| Rate for Payer: Railroad Medicare Medicare |
$189.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$532.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.34
|
| Rate for Payer: UHC Medicare Advantage |
$189.34
|
| Rate for Payer: UHCCP Medicaid |
$106.60
|
| Rate for Payer: VA VA |
$189.34
|
|
|
HC NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE BI
|
Facility
|
IP
|
$16,400.00
|
|
|
Service Code
|
CPT 69706
|
| Hospital Charge Code |
76100518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$10,332.00 |
| Max. Negotiated Rate |
$14,760.00 |
| Rate for Payer: Aetna Commercial |
$13,940.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,660.00
|
| Rate for Payer: Cash Price |
$13,120.00
|
| Rate for Payer: Cofinity Commercial |
$11,480.00
|
| Rate for Payer: Cofinity Commercial |
$14,104.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,480.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,120.00
|
| Rate for Payer: Healthscope Commercial |
$14,760.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,940.00
|
| Rate for Payer: PHP Commercial |
$13,940.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,660.00
|
| Rate for Payer: Priority Health SBD |
$10,332.00
|
|
|
HC NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE BI
|
Facility
|
OP
|
$16,400.00
|
|
|
Service Code
|
CPT 69706
|
| Hospital Charge Code |
76100518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,092.41 |
| Max. Negotiated Rate |
$16,240.34 |
| Rate for Payer: Aetna Commercial |
$13,940.00
|
| Rate for Payer: Aetna Medicare |
$6,000.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,660.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Cash Price |
$13,120.00
|
| Rate for Payer: Cash Price |
$13,120.00
|
| Rate for Payer: Cofinity Commercial |
$14,104.00
|
| Rate for Payer: Cofinity Commercial |
$11,480.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,480.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,120.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Healthscope Commercial |
$14,760.00
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,940.00
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Commercial |
$13,940.00
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,660.00
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Priority Health SBD |
$10,332.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,240.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,248.18
|
| Rate for Payer: VA VA |
$5,769.42
|
|
|
HC NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE UNI
|
Facility
|
OP
|
$16,400.00
|
|
|
Service Code
|
CPT 69705
|
| Hospital Charge Code |
76100519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,092.41 |
| Max. Negotiated Rate |
$16,240.34 |
| Rate for Payer: Aetna Commercial |
$13,940.00
|
| Rate for Payer: Aetna Medicare |
$6,000.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,660.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Cash Price |
$13,120.00
|
| Rate for Payer: Cash Price |
$13,120.00
|
| Rate for Payer: Cofinity Commercial |
$14,104.00
|
| Rate for Payer: Cofinity Commercial |
$11,480.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,480.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,120.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Healthscope Commercial |
$14,760.00
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,940.00
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Commercial |
$13,940.00
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,660.00
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Priority Health SBD |
$10,332.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,240.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,248.18
|
| Rate for Payer: VA VA |
$5,769.42
|
|
|
HC NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE UNI
|
Facility
|
IP
|
$16,400.00
|
|
|
Service Code
|
CPT 69705
|
| Hospital Charge Code |
76100519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$10,332.00 |
| Max. Negotiated Rate |
$14,760.00 |
| Rate for Payer: Aetna Commercial |
$13,940.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,660.00
|
| Rate for Payer: Cash Price |
$13,120.00
|
| Rate for Payer: Cofinity Commercial |
$11,480.00
|
| Rate for Payer: Cofinity Commercial |
$14,104.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,480.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,120.00
|
| Rate for Payer: Healthscope Commercial |
$14,760.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,940.00
|
| Rate for Payer: PHP Commercial |
$13,940.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,660.00
|
| Rate for Payer: Priority Health SBD |
$10,332.00
|
|
|
HC NASOTRACHEAL SUCTION
|
Facility
|
OP
|
$278.92
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
41000001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$106.32 |
| Max. Negotiated Rate |
$558.36 |
| Rate for Payer: Aetna Commercial |
$237.08
|
| Rate for Payer: Aetna Medicare |
$206.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$247.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$247.95
|
| Rate for Payer: BCBS Complete |
$111.64
|
| Rate for Payer: BCBS MAPPO |
$198.36
|
| Rate for Payer: BCN Medicare Advantage |
$198.36
|
| Rate for Payer: Cash Price |
$223.14
|
| Rate for Payer: Cash Price |
$223.14
|
| Rate for Payer: Cofinity Commercial |
$239.87
|
| Rate for Payer: Cofinity Commercial |
$195.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$195.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.36
|
| Rate for Payer: Healthscope Commercial |
$251.03
|
| Rate for Payer: Mclaren Medicaid |
$106.32
|
| Rate for Payer: Mclaren Medicare |
$198.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$208.28
|
| Rate for Payer: Meridian Medicaid |
$111.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.08
|
| Rate for Payer: PACE Medicare |
$188.44
|
| Rate for Payer: PACE SWMI |
$198.36
|
| Rate for Payer: PHP Commercial |
$237.08
|
| Rate for Payer: PHP Medicare Advantage |
$198.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.30
|
| Rate for Payer: Priority Health Medicare |
$198.36
|
| Rate for Payer: Priority Health SBD |
$175.72
|
| Rate for Payer: Railroad Medicare Medicare |
$198.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$558.36
|
| Rate for Payer: UHC Core |
$206.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$198.36
|
| Rate for Payer: UHC Exchange |
$206.40
|
| Rate for Payer: UHC Medicare Advantage |
$198.36
|
| Rate for Payer: UHCCP Medicaid |
$111.68
|
| Rate for Payer: VA VA |
$198.36
|
|
|
HC NASOTRACHEAL SUCTION
|
Facility
|
IP
|
$278.92
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
41000001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$175.72 |
| Max. Negotiated Rate |
$251.03 |
| Rate for Payer: Aetna Commercial |
$237.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.30
|
| Rate for Payer: Cash Price |
$223.14
|
| Rate for Payer: Cofinity Commercial |
$195.24
|
| Rate for Payer: Cofinity Commercial |
$239.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$195.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.14
|
| Rate for Payer: Healthscope Commercial |
$251.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.08
|
| Rate for Payer: PHP Commercial |
$237.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.30
|
| Rate for Payer: Priority Health SBD |
$175.72
|
|
|
HC NCCU OBSERVATION PER HOUR
|
Facility
|
OP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200021
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$58.03 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: Aetna Medicare |
$72.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.30
|
| Rate for Payer: BCBS Complete |
$58.03
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$101.56
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$130.57
|
| Rate for Payer: Meridian Medicaid |
$1,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: PHP Commercial |
$123.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health SBD |
$91.40
|
| Rate for Payer: UHC Core |
$107.36
|
| Rate for Payer: UHC Exchange |
$107.36
|
|
|
HC NCCU OBSERVATION PER HOUR
|
Facility
|
IP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200021
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$130.57 |
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.30
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$101.56
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$130.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: PHP Commercial |
$123.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health SBD |
$91.40
|
|
|
HC NCS 11-12 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$2,277.10
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
92200032
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,434.57 |
| Max. Negotiated Rate |
$2,049.39 |
| Rate for Payer: Aetna Commercial |
$1,935.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,480.12
|
| Rate for Payer: Cash Price |
$1,821.68
|
| Rate for Payer: Cofinity Commercial |
$1,593.97
|
| Rate for Payer: Cofinity Commercial |
$1,958.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,593.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,821.68
|
| Rate for Payer: Healthscope Commercial |
$2,049.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,935.54
|
| Rate for Payer: PHP Commercial |
$1,935.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,480.12
|
| Rate for Payer: Priority Health SBD |
$1,434.57
|
|
|
HC NCS 11-12 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$2,277.10
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
92200032
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$277.37 |
| Max. Negotiated Rate |
$2,049.39 |
| Rate for Payer: Aetna Commercial |
$1,935.54
|
| Rate for Payer: Aetna Medicare |
$538.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,480.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$646.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$646.85
|
| Rate for Payer: BCBS Complete |
$291.24
|
| Rate for Payer: BCBS MAPPO |
$517.48
|
| Rate for Payer: BCN Medicare Advantage |
$517.48
|
| Rate for Payer: Cash Price |
$1,821.68
|
| Rate for Payer: Cash Price |
$1,821.68
|
| Rate for Payer: Cofinity Commercial |
$1,958.31
|
| Rate for Payer: Cofinity Commercial |
$1,593.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,593.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,821.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$517.48
|
| Rate for Payer: Healthscope Commercial |
$2,049.39
|
| Rate for Payer: Mclaren Medicaid |
$277.37
|
| Rate for Payer: Mclaren Medicare |
$517.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.35
|
| Rate for Payer: Meridian Medicaid |
$291.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,935.54
|
| Rate for Payer: PACE Medicare |
$491.61
|
| Rate for Payer: PACE SWMI |
$517.48
|
| Rate for Payer: PHP Commercial |
$1,935.54
|
| Rate for Payer: PHP Medicare Advantage |
$517.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,480.12
|
| Rate for Payer: Priority Health Medicare |
$517.48
|
| Rate for Payer: Priority Health SBD |
$1,434.57
|
| Rate for Payer: Railroad Medicare Medicare |
$517.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,456.65
|
| Rate for Payer: UHC Core |
$1,685.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.48
|
| Rate for Payer: UHC Exchange |
$1,685.05
|
| Rate for Payer: UHC Medicare Advantage |
$517.48
|
| Rate for Payer: UHCCP Medicaid |
$291.34
|
| Rate for Payer: VA VA |
$517.48
|
|
