|
HC SRT UP TO 5 FRACTIONS
|
Facility
|
IP
|
$5,412.16
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
33300018
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$3,409.66 |
| Max. Negotiated Rate |
$4,870.94 |
| Rate for Payer: Aetna Commercial |
$4,600.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,517.90
|
| Rate for Payer: Cash Price |
$4,329.73
|
| Rate for Payer: Cofinity Advantage |
$3,788.51
|
| Rate for Payer: Cofinity Commercial |
$4,654.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,329.73
|
| Rate for Payer: Healthscope Commercial |
$4,870.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,600.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,059.12
|
| Rate for Payer: PHP Commercial |
$4,600.34
|
| Rate for Payer: Priority Health SBD |
$3,409.66
|
|
|
HC SRT UP TO 5 FRACTIONS
|
Facility
|
OP
|
$5,412.16
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
33300018
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$931.79 |
| Max. Negotiated Rate |
$5,761.61 |
| Rate for Payer: Aetna Commercial |
$4,600.34
|
| Rate for Payer: Aetna Medicare |
$1,852.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,517.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,227.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,227.03
|
| Rate for Payer: BCBS Complete |
$978.47
|
| Rate for Payer: BCBS MAPPO |
$1,781.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,222.22
|
| Rate for Payer: BCN Commercial |
$2,222.22
|
| Rate for Payer: BCN Medicare Advantage |
$1,781.62
|
| Rate for Payer: Cash Price |
$4,329.73
|
| Rate for Payer: Cash Price |
$4,329.73
|
| Rate for Payer: Cofinity Advantage |
$3,788.51
|
| Rate for Payer: Cofinity Commercial |
$4,654.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,329.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,781.62
|
| Rate for Payer: Healthscope Commercial |
$4,870.94
|
| Rate for Payer: Mclaren Medicaid |
$931.79
|
| Rate for Payer: Mclaren Medicare |
$1,781.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,870.70
|
| Rate for Payer: Meridian Medicaid |
$1,870.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,048.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,959.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,600.34
|
| Rate for Payer: Nomi Health Commercial |
$5,344.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,059.12
|
| Rate for Payer: PACE Medicare |
$1,692.54
|
| Rate for Payer: PACE SWMI |
$1,781.62
|
| Rate for Payer: PHP Commercial |
$4,600.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,781.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$931.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,761.61
|
| Rate for Payer: Priority Health Medicare |
$1,781.62
|
| Rate for Payer: Priority Health SBD |
$3,409.66
|
| Rate for Payer: Priority Health Tiered Network |
$4,609.29
|
| Rate for Payer: Railroad Medicare Medicare |
$1,781.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,781.62
|
| Rate for Payer: UHC Medicaid |
$931.79
|
| Rate for Payer: UHCCP Medicaid |
$931.79
|
| Rate for Payer: VA VA |
$1,781.62
|
|
|
HC SS2PC SPECIAL STAIN (BILL ONLY)
|
Facility
|
OP
|
$114.44
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
31200007
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$428.73 |
| Rate for Payer: Aetna Commercial |
$97.27
|
| Rate for Payer: Aetna Medicare |
$137.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$119.83
|
| Rate for Payer: BCN Commercial |
$119.83
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$91.55
|
| Rate for Payer: Cash Price |
$91.55
|
| Rate for Payer: Cofinity Advantage |
$80.11
|
| Rate for Payer: Cofinity Commercial |
$98.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$103.00
|
| Rate for Payer: Mclaren Medicaid |
$69.33
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$139.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.27
|
| Rate for Payer: Nomi Health Commercial |
$397.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.83
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$97.27
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.73
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health SBD |
$72.10
|
| Rate for Payer: Priority Health Tiered Network |
$342.98
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.35
|
| Rate for Payer: UHC Core |
$193.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$193.35
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
HC SS2PC SPECIAL STAIN (BILL ONLY)
|
Facility
|
IP
|
$114.44
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
31200007
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$72.10 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: Aetna Commercial |
$97.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.39
|
| Rate for Payer: Cash Price |
$91.55
|
| Rate for Payer: Cofinity Advantage |
$80.11
|
| Rate for Payer: Cofinity Commercial |
$98.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.55
|
| Rate for Payer: Healthscope Commercial |
$103.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.83
|
| Rate for Payer: PHP Commercial |
$97.27
|
| Rate for Payer: Priority Health SBD |
$72.10
|
|
|
HC STABILIZERS HEART ESTECH
|
Facility
|
IP
|
$951.97
|
|
| Hospital Charge Code |
27000292
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$599.74 |
| Max. Negotiated Rate |
$856.77 |
| Rate for Payer: Aetna Commercial |
$809.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$618.78
|
| Rate for Payer: Cash Price |
$761.58
|
| Rate for Payer: Cofinity Advantage |
$666.38
|
| Rate for Payer: Cofinity Commercial |
$818.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$761.58
|
| Rate for Payer: Healthscope Commercial |
$856.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$809.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$713.98
|
| Rate for Payer: PHP Commercial |
$809.17
|
| Rate for Payer: Priority Health SBD |
$599.74
|
|
|
HC STABILIZERS HEART ESTECH
|
Facility
|
OP
|
$951.97
|
|
| Hospital Charge Code |
27000292
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$374.12 |
| Max. Negotiated Rate |
$856.77 |
| Rate for Payer: Aetna Commercial |
$809.17
|
| Rate for Payer: Aetna Medicare |
$475.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$618.78
|
| Rate for Payer: BCBS Complete |
$380.79
|
| Rate for Payer: Cash Price |
$761.58
|
| Rate for Payer: Cofinity Advantage |
$666.38
|
| Rate for Payer: Cofinity Commercial |
$818.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$761.58
|
| Rate for Payer: Healthscope Commercial |
$856.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$761.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$809.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$713.98
|
| Rate for Payer: PHP Commercial |
$809.17
|
| Rate for Payer: Priority Health SBD |
$599.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$618.78
|
| Rate for Payer: UHC Core |
$495.98
|
| Rate for Payer: UHC Exchange |
$374.12
|
|
|
HC STACLOT LA.
|
Facility
|
OP
|
$151.90
|
|
|
Service Code
|
CPT 85597
|
| Hospital Charge Code |
30500085
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$136.71 |
| Rate for Payer: Aetna Commercial |
$129.12
|
| Rate for Payer: Aetna Medicare |
$18.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.48
|
| Rate for Payer: BCBS Complete |
$9.87
|
| Rate for Payer: BCBS MAPPO |
$17.98
|
| Rate for Payer: BCBS Trust/PPO |
$19.18
|
| Rate for Payer: BCN Commercial |
$19.18
|
| Rate for Payer: BCN Medicare Advantage |
$17.98
|
| Rate for Payer: Cash Price |
$121.52
|
| Rate for Payer: Cash Price |
$121.52
|
| Rate for Payer: Cofinity Advantage |
$106.33
|
| Rate for Payer: Cofinity Commercial |
$130.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.98
|
| Rate for Payer: Healthscope Commercial |
$136.71
|
| Rate for Payer: Mclaren Medicaid |
$9.40
|
| Rate for Payer: Mclaren Medicare |
$17.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.88
|
| Rate for Payer: Meridian Medicaid |
$18.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.12
|
| Rate for Payer: Nomi Health Commercial |
$26.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.92
|
| Rate for Payer: PACE Medicare |
$17.08
|
| Rate for Payer: PACE SWMI |
$17.98
|
| Rate for Payer: PHP Commercial |
$129.12
|
| Rate for Payer: PHP Medicare Advantage |
$17.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.98
|
| Rate for Payer: Priority Health Medicare |
$17.98
|
| Rate for Payer: Priority Health SBD |
$95.70
|
| Rate for Payer: Priority Health Tiered Network |
$14.38
|
| Rate for Payer: Railroad Medicare Medicare |
$17.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.97
|
| Rate for Payer: UHC Core |
$26.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.98
|
| Rate for Payer: UHC Exchange |
$26.97
|
| Rate for Payer: UHC Medicaid |
$9.40
|
| Rate for Payer: UHCCP Medicaid |
$9.40
|
| Rate for Payer: VA VA |
$17.98
|
|
|
HC STACLOT LA.
|
Facility
|
IP
|
$151.90
|
|
|
Service Code
|
CPT 85597
|
| Hospital Charge Code |
30500085
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$95.70 |
| Max. Negotiated Rate |
$136.71 |
| Rate for Payer: Aetna Commercial |
$129.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.73
|
| Rate for Payer: Cash Price |
$121.52
|
| Rate for Payer: Cofinity Advantage |
$106.33
|
| Rate for Payer: Cofinity Commercial |
$130.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.52
|
| Rate for Payer: Healthscope Commercial |
$136.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.92
|
| Rate for Payer: PHP Commercial |
$129.12
|
| Rate for Payer: Priority Health SBD |
$95.70
|
|
|
HC STANDBY OPEN HEART/TAVR
|
Facility
|
IP
|
$2,465.99
|
|
| Hospital Charge Code |
27000151
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,553.57 |
| Max. Negotiated Rate |
$2,219.39 |
| Rate for Payer: Aetna Commercial |
$2,096.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,602.89
|
| Rate for Payer: Cash Price |
$1,972.79
|
| Rate for Payer: Cofinity Advantage |
$1,726.19
|
| Rate for Payer: Cofinity Commercial |
$2,120.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,972.79
|
| Rate for Payer: Healthscope Commercial |
$2,219.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,096.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,849.49
|
| Rate for Payer: PHP Commercial |
$2,096.09
|
| Rate for Payer: Priority Health SBD |
$1,553.57
|
|
|
HC STANDBY OPEN HEART/TAVR
|
Facility
|
OP
|
$2,465.99
|
|
| Hospital Charge Code |
27000151
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$969.13 |
| Max. Negotiated Rate |
$2,219.39 |
| Rate for Payer: Aetna Commercial |
$2,096.09
|
| Rate for Payer: Aetna Medicare |
$1,232.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,602.89
|
| Rate for Payer: BCBS Complete |
$986.40
|
| Rate for Payer: Cash Price |
$1,972.79
|
| Rate for Payer: Cofinity Advantage |
$1,726.19
|
| Rate for Payer: Cofinity Commercial |
$2,120.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,972.79
|
| Rate for Payer: Healthscope Commercial |
$2,219.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,972.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,096.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,849.49
|
| Rate for Payer: PHP Commercial |
$2,096.09
|
| Rate for Payer: Priority Health SBD |
$1,553.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,602.89
|
| Rate for Payer: UHC Core |
$1,284.78
|
| Rate for Payer: UHC Exchange |
$969.13
|
|
|
HC STAPHYLOCOCCUS AUREUS PCR
|
Facility
|
IP
|
$57.22
|
|
|
Service Code
|
CPT 87640
|
| Hospital Charge Code |
30600263
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.05 |
| Max. Negotiated Rate |
$51.50 |
| Rate for Payer: Aetna Commercial |
$48.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.19
|
| Rate for Payer: Cash Price |
$45.78
|
| Rate for Payer: Cofinity Advantage |
$40.05
|
| Rate for Payer: Cofinity Commercial |
$49.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.78
|
| Rate for Payer: Healthscope Commercial |
$51.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.91
|
| Rate for Payer: PHP Commercial |
$48.64
|
| Rate for Payer: Priority Health SBD |
$36.05
|
|
|
HC STAPHYLOCOCCUS AUREUS PCR
|
Facility
|
OP
|
$57.22
|
|
|
Service Code
|
CPT 87640
|
| Hospital Charge Code |
30600263
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$52.64 |
| Rate for Payer: Aetna Commercial |
$48.64
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$19.27
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$37.42
|
| Rate for Payer: BCN Commercial |
$37.42
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$45.78
|
| Rate for Payer: Cash Price |
$45.78
|
| Rate for Payer: Cofinity Advantage |
$40.05
|
| Rate for Payer: Cofinity Commercial |
$49.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$51.50
|
| Rate for Payer: Mclaren Medicaid |
$18.35
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.64
|
| Rate for Payer: Nomi Health Commercial |
$52.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.91
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$48.64
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$35.09
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$36.05
|
| Rate for Payer: Priority Health Tiered Network |
$28.07
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.64
|
| Rate for Payer: UHC Core |
$52.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.09
|
| Rate for Payer: UHC Exchange |
$52.64
|
| Rate for Payer: UHC Medicaid |
$18.35
|
| Rate for Payer: UHCCP Medicaid |
$18.35
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC STAPHYLOCOCCUS AUREUS PCR METHICILLIN RESISTANT
|
Facility
|
OP
|
$62.82
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
30600264
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$56.54 |
| Rate for Payer: Aetna Commercial |
$53.40
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$19.27
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$37.42
|
| Rate for Payer: BCN Commercial |
$37.42
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$50.26
|
| Rate for Payer: Cash Price |
$50.26
|
| Rate for Payer: Cofinity Advantage |
$43.97
|
| Rate for Payer: Cofinity Commercial |
$54.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$56.54
|
| Rate for Payer: Mclaren Medicaid |
$18.35
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.40
|
| Rate for Payer: Nomi Health Commercial |
$52.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.12
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$53.40
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$35.09
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$39.58
|
| Rate for Payer: Priority Health Tiered Network |
$28.07
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.64
|
| Rate for Payer: UHC Core |
$52.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.09
|
| Rate for Payer: UHC Exchange |
$52.64
|
| Rate for Payer: UHC Medicaid |
$18.35
|
| Rate for Payer: UHCCP Medicaid |
$18.35
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC STAPHYLOCOCCUS AUREUS PCR METHICILLIN RESISTANT
|
Facility
|
IP
|
$62.82
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
30600264
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.58 |
| Max. Negotiated Rate |
$56.54 |
| Rate for Payer: Aetna Commercial |
$53.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.83
|
| Rate for Payer: Cash Price |
$50.26
|
| Rate for Payer: Cofinity Advantage |
$43.97
|
| Rate for Payer: Cofinity Commercial |
$54.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.26
|
| Rate for Payer: Healthscope Commercial |
$56.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.12
|
| Rate for Payer: PHP Commercial |
$53.40
|
| Rate for Payer: Priority Health SBD |
$39.58
|
|
|
HC STATLOCK
|
Facility
|
OP
|
$146.56
|
|
| Hospital Charge Code |
27000152
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$131.90 |
| Rate for Payer: Aetna Commercial |
$124.58
|
| Rate for Payer: Aetna Medicare |
$73.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.26
|
| Rate for Payer: BCBS Complete |
$58.62
|
| Rate for Payer: Cash Price |
$117.25
|
| Rate for Payer: Cofinity Advantage |
$102.59
|
| Rate for Payer: Cofinity Commercial |
$126.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.25
|
| Rate for Payer: Healthscope Commercial |
$131.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.92
|
| Rate for Payer: PHP Commercial |
$124.58
|
| Rate for Payer: Priority Health SBD |
$92.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.26
|
| Rate for Payer: UHC Core |
$76.36
|
| Rate for Payer: UHC Exchange |
$57.60
|
|
|
HC STATLOCK
|
Facility
|
IP
|
$146.56
|
|
| Hospital Charge Code |
27000152
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$92.33 |
| Max. Negotiated Rate |
$131.90 |
| Rate for Payer: Aetna Commercial |
$124.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.26
|
| Rate for Payer: Cash Price |
$117.25
|
| Rate for Payer: Cofinity Advantage |
$102.59
|
| Rate for Payer: Cofinity Commercial |
$126.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.25
|
| Rate for Payer: Healthscope Commercial |
$131.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.92
|
| Rate for Payer: PHP Commercial |
$124.58
|
| Rate for Payer: Priority Health SBD |
$92.33
|
|
|
HC STENGER TEST PURE TONE
|
Facility
|
IP
|
$35.37
|
|
|
Service Code
|
CPT 92565
|
| Hospital Charge Code |
76100500
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$22.28 |
| Max. Negotiated Rate |
$31.83 |
| Rate for Payer: Aetna Commercial |
$30.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.99
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cofinity Advantage |
$24.76
|
| Rate for Payer: Cofinity Commercial |
$30.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.30
|
| Rate for Payer: Healthscope Commercial |
$31.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.53
|
| Rate for Payer: PHP Commercial |
$30.06
|
| Rate for Payer: Priority Health SBD |
$22.28
|
|
|
HC STENGER TEST PURE TONE
|
Facility
|
OP
|
$35.37
|
|
|
Service Code
|
CPT 92565
|
| Hospital Charge Code |
76100500
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$13.90 |
| Max. Negotiated Rate |
$190.09 |
| Rate for Payer: Aetna Commercial |
$30.06
|
| Rate for Payer: Aetna Medicare |
$61.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$96.23
|
| Rate for Payer: BCN Commercial |
$96.23
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cofinity Advantage |
$24.76
|
| Rate for Payer: Cofinity Commercial |
$30.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$31.83
|
| Rate for Payer: Mclaren Medicaid |
$30.74
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$61.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.06
|
| Rate for Payer: Nomi Health Commercial |
$176.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.53
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Commercial |
$30.06
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$190.09
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health SBD |
$22.28
|
| Rate for Payer: Priority Health Tiered Network |
$152.07
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.99
|
| Rate for Payer: UHC Core |
$18.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Exchange |
$13.90
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: VA VA |
$58.78
|
|
|
HC STENGER TEST SPEECH
|
Facility
|
OP
|
$1,478.41
|
|
|
Service Code
|
CPT 92577
|
| Hospital Charge Code |
76100488
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.68 |
| Max. Negotiated Rate |
$1,330.57 |
| Rate for Payer: Aetna Commercial |
$1,256.65
|
| Rate for Payer: Aetna Medicare |
$386.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$960.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$100.68
|
| Rate for Payer: BCN Commercial |
$100.68
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Cash Price |
$1,182.73
|
| Rate for Payer: Cash Price |
$1,182.73
|
| Rate for Payer: Cofinity Advantage |
$1,034.89
|
| Rate for Payer: Cofinity Commercial |
$1,271.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,182.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Healthscope Commercial |
$1,330.57
|
| Rate for Payer: Mclaren Medicaid |
$194.46
|
| Rate for Payer: Mclaren Medicare |
$371.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.41
|
| Rate for Payer: Meridian Medicaid |
$390.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,256.65
|
| Rate for Payer: Nomi Health Commercial |
$1,115.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,108.81
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Commercial |
$1,256.65
|
| Rate for Payer: PHP Medicare Advantage |
$371.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,202.41
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health SBD |
$931.40
|
| Rate for Payer: Priority Health Tiered Network |
$961.93
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$960.97
|
| Rate for Payer: UHC Core |
$770.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$581.02
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: VA VA |
$371.82
|
|
|
HC STENGER TEST SPEECH
|
Facility
|
IP
|
$1,478.41
|
|
|
Service Code
|
CPT 92577
|
| Hospital Charge Code |
76100488
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$931.40 |
| Max. Negotiated Rate |
$1,330.57 |
| Rate for Payer: Aetna Commercial |
$1,256.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$960.97
|
| Rate for Payer: Cash Price |
$1,182.73
|
| Rate for Payer: Cofinity Advantage |
$1,034.89
|
| Rate for Payer: Cofinity Commercial |
$1,271.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,182.73
|
| Rate for Payer: Healthscope Commercial |
$1,330.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,256.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,108.81
|
| Rate for Payer: PHP Commercial |
$1,256.65
|
| Rate for Payer: Priority Health SBD |
$931.40
|
|
|
HC STENT
|
Facility
|
OP
|
$972.22
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27800030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$382.08 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna Commercial |
$826.39
|
| Rate for Payer: Aetna Medicare |
$486.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$631.94
|
| Rate for Payer: BCBS Complete |
$388.89
|
| Rate for Payer: Cash Price |
$777.78
|
| Rate for Payer: Cofinity Advantage |
$680.55
|
| Rate for Payer: Cofinity Commercial |
$836.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$777.78
|
| Rate for Payer: Healthscope Commercial |
$875.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$777.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$826.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$729.16
|
| Rate for Payer: PHP Commercial |
$826.39
|
| Rate for Payer: Priority Health SBD |
$612.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$631.94
|
| Rate for Payer: UHC Core |
$506.53
|
| Rate for Payer: UHC Exchange |
$382.08
|
|
|
HC STENT
|
Facility
|
IP
|
$972.22
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27800030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.50 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna Commercial |
$826.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$631.94
|
| Rate for Payer: Cash Price |
$777.78
|
| Rate for Payer: Cofinity Advantage |
$680.55
|
| Rate for Payer: Cofinity Commercial |
$836.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$777.78
|
| Rate for Payer: Healthscope Commercial |
$875.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$826.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$729.16
|
| Rate for Payer: PHP Commercial |
$826.39
|
| Rate for Payer: Priority Health SBD |
$612.50
|
|
|
HC STENT ADD.BRANCH
|
Facility
|
OP
|
$17,350.78
|
|
|
Service Code
|
CPT 92929
|
| Hospital Charge Code |
48100074
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$389.82 |
| Max. Negotiated Rate |
$15,615.70 |
| Rate for Payer: Aetna Commercial |
$14,748.16
|
| Rate for Payer: Aetna Medicare |
$8,675.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,278.01
|
| Rate for Payer: BCBS Complete |
$6,940.31
|
| Rate for Payer: BCBS Trust/PPO |
$389.82
|
| Rate for Payer: BCN Commercial |
$389.82
|
| Rate for Payer: Cash Price |
$13,880.62
|
| Rate for Payer: Cash Price |
$13,880.62
|
| Rate for Payer: Cofinity Advantage |
$12,145.55
|
| Rate for Payer: Cofinity Commercial |
$14,921.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,880.62
|
| Rate for Payer: Healthscope Commercial |
$15,615.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,880.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,748.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,013.08
|
| Rate for Payer: PHP Commercial |
$14,748.16
|
| Rate for Payer: Priority Health SBD |
$10,930.99
|
|
|
HC STENT ADD.BRANCH
|
Facility
|
IP
|
$17,350.78
|
|
|
Service Code
|
CPT 92929
|
| Hospital Charge Code |
48100074
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$10,930.99 |
| Max. Negotiated Rate |
$15,615.70 |
| Rate for Payer: Aetna Commercial |
$14,748.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,278.01
|
| Rate for Payer: Cash Price |
$13,880.62
|
| Rate for Payer: Cofinity Advantage |
$12,145.55
|
| Rate for Payer: Cofinity Commercial |
$14,921.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,880.62
|
| Rate for Payer: Healthscope Commercial |
$15,615.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,748.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,013.08
|
| Rate for Payer: PHP Commercial |
$14,748.16
|
| Rate for Payer: Priority Health SBD |
$10,930.99
|
|
|
HC STENT COATED W DELIVERY SYSTEM
|
Facility
|
OP
|
$12,112.82
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,760.34 |
| Max. Negotiated Rate |
$10,901.54 |
| Rate for Payer: Aetna Commercial |
$10,295.90
|
| Rate for Payer: Aetna Medicare |
$6,056.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,873.33
|
| Rate for Payer: BCBS Complete |
$4,845.13
|
| Rate for Payer: Cash Price |
$9,690.26
|
| Rate for Payer: Cofinity Advantage |
$8,478.97
|
| Rate for Payer: Cofinity Commercial |
$10,417.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,690.26
|
| Rate for Payer: Healthscope Commercial |
$10,901.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,690.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,295.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,084.61
|
| Rate for Payer: PHP Commercial |
$10,295.90
|
| Rate for Payer: Priority Health SBD |
$7,631.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,873.33
|
| Rate for Payer: UHC Core |
$6,310.78
|
| Rate for Payer: UHC Exchange |
$4,760.34
|
|
