|
HC SCALLOP IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200060
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
|
|
HC SCALP ELECTRODE
|
Facility
|
OP
|
$133.77
|
|
| Hospital Charge Code |
72000005
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$120.39 |
| Rate for Payer: Aetna Commercial |
$113.70
|
| Rate for Payer: Aetna Medicare |
$66.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.95
|
| Rate for Payer: BCBS Complete |
$53.51
|
| Rate for Payer: Cash Price |
$107.02
|
| Rate for Payer: Cofinity Commercial |
$115.04
|
| Rate for Payer: Cofinity Commercial |
$93.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$93.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.02
|
| Rate for Payer: Healthscope Commercial |
$120.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.70
|
| Rate for Payer: PHP Commercial |
$113.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.95
|
| Rate for Payer: Priority Health SBD |
$84.28
|
| Rate for Payer: UHC Core |
$98.99
|
| Rate for Payer: UHC Exchange |
$98.99
|
|
|
HC SCALP ELECTRODE
|
Facility
|
IP
|
$133.77
|
|
| Hospital Charge Code |
72000005
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$84.28 |
| Max. Negotiated Rate |
$120.39 |
| Rate for Payer: Aetna Commercial |
$113.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.95
|
| Rate for Payer: Cash Price |
$107.02
|
| Rate for Payer: Cofinity Commercial |
$115.04
|
| Rate for Payer: Cofinity Commercial |
$93.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$93.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.02
|
| Rate for Payer: Healthscope Commercial |
$120.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.70
|
| Rate for Payer: PHP Commercial |
$113.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.95
|
| Rate for Payer: Priority Health SBD |
$84.28
|
|
|
HC SCHISTOSOMA SPECIES ANTIBODY, IGG, SERUM
|
Facility
|
IP
|
$99.76
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
30200489
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.85 |
| Max. Negotiated Rate |
$89.78 |
| Rate for Payer: Aetna Commercial |
$84.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.84
|
| Rate for Payer: Cash Price |
$79.81
|
| Rate for Payer: Cofinity Commercial |
$69.83
|
| Rate for Payer: Cofinity Commercial |
$85.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.81
|
| Rate for Payer: Healthscope Commercial |
$89.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.80
|
| Rate for Payer: PHP Commercial |
$84.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.84
|
| Rate for Payer: Priority Health SBD |
$62.85
|
|
|
HC SCHISTOSOMA SPECIES ANTIBODY, IGG, SERUM
|
Facility
|
OP
|
$99.76
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
30200489
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$89.78 |
| Rate for Payer: Aetna Commercial |
$84.80
|
| Rate for Payer: Aetna Medicare |
$13.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.26
|
| Rate for Payer: BCBS Complete |
$7.32
|
| Rate for Payer: BCBS MAPPO |
$13.01
|
| Rate for Payer: BCN Medicare Advantage |
$13.01
|
| Rate for Payer: Cash Price |
$79.81
|
| Rate for Payer: Cash Price |
$79.81
|
| Rate for Payer: Cofinity Commercial |
$85.79
|
| Rate for Payer: Cofinity Commercial |
$69.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.01
|
| Rate for Payer: Healthscope Commercial |
$89.78
|
| Rate for Payer: Mclaren Medicaid |
$6.97
|
| Rate for Payer: Mclaren Medicare |
$13.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.66
|
| Rate for Payer: Meridian Medicaid |
$7.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.80
|
| Rate for Payer: PACE Medicare |
$12.36
|
| Rate for Payer: PACE SWMI |
$13.01
|
| Rate for Payer: PHP Commercial |
$84.80
|
| Rate for Payer: PHP Medicare Advantage |
$13.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.84
|
| Rate for Payer: Priority Health Medicare |
$13.01
|
| Rate for Payer: Priority Health SBD |
$62.85
|
| Rate for Payer: Railroad Medicare Medicare |
$13.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.01
|
| Rate for Payer: UHC Medicare Advantage |
$13.01
|
| Rate for Payer: UHCCP Medicaid |
$7.32
|
| Rate for Payer: VA VA |
$13.01
|
|
|
HC SCISSORS
|
Facility
|
IP
|
$17.67
|
|
| Hospital Charge Code |
27000143
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.13 |
| Max. Negotiated Rate |
$15.90 |
| Rate for Payer: Aetna Commercial |
$15.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.49
|
| Rate for Payer: Cash Price |
$14.14
|
| Rate for Payer: Cofinity Commercial |
$12.37
|
| Rate for Payer: Cofinity Commercial |
$15.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.14
|
| Rate for Payer: Healthscope Commercial |
$15.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.02
|
| Rate for Payer: PHP Commercial |
$15.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.49
|
| Rate for Payer: Priority Health SBD |
$11.13
|
|
|
HC SCISSORS
|
Facility
|
OP
|
$17.67
|
|
| Hospital Charge Code |
27000143
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$15.90 |
| Rate for Payer: Aetna Commercial |
$15.02
|
| Rate for Payer: Aetna Medicare |
$8.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.49
|
| Rate for Payer: BCBS Complete |
$7.07
|
| Rate for Payer: Cash Price |
$14.14
|
| Rate for Payer: Cofinity Commercial |
$12.37
|
| Rate for Payer: Cofinity Commercial |
$15.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.14
|
| Rate for Payer: Healthscope Commercial |
$15.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.02
|
| Rate for Payer: PHP Commercial |
$15.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.49
|
| Rate for Payer: Priority Health SBD |
$11.13
|
|
|
HC SCL70 SCLERODERMA AB
|
Facility
|
IP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200161
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.16 |
| Max. Negotiated Rate |
$31.65 |
| Rate for Payer: Aetna Commercial |
$29.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.86
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$24.62
|
| Rate for Payer: Cofinity Commercial |
$30.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Healthscope Commercial |
$31.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: PHP Commercial |
$29.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: Priority Health SBD |
$22.16
|
|
|
HC SCL70 SCLERODERMA AB
|
Facility
|
OP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200161
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$50.47 |
| Rate for Payer: Aetna Commercial |
$29.89
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$30.25
|
| Rate for Payer: Cofinity Commercial |
$24.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$31.65
|
| Rate for Payer: Mclaren Medicaid |
$9.61
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$10.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$29.89
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$22.16
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Medicare Advantage |
$17.93
|
| Rate for Payer: UHCCP Medicaid |
$10.09
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC SCLEROTHERAPY OF FLUID COLLECTION
|
Facility
|
IP
|
$2,550.48
|
|
|
Service Code
|
CPT 49185
|
| Hospital Charge Code |
36100501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,606.80 |
| Max. Negotiated Rate |
$2,295.43 |
| Rate for Payer: Aetna Commercial |
$2,167.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,657.81
|
| Rate for Payer: Cash Price |
$2,040.38
|
| Rate for Payer: Cofinity Commercial |
$1,785.34
|
| Rate for Payer: Cofinity Commercial |
$2,193.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,785.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,040.38
|
| Rate for Payer: Healthscope Commercial |
$2,295.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,167.91
|
| Rate for Payer: PHP Commercial |
$2,167.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,657.81
|
| Rate for Payer: Priority Health SBD |
$1,606.80
|
|
|
HC SCLEROTHERAPY OF FLUID COLLECTION
|
Facility
|
OP
|
$2,550.48
|
|
|
Service Code
|
CPT 49185
|
| Hospital Charge Code |
36100501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$846.98 |
| Max. Negotiated Rate |
$4,448.08 |
| Rate for Payer: Aetna Commercial |
$2,167.91
|
| Rate for Payer: Aetna Medicare |
$1,643.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,657.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$2,040.38
|
| Rate for Payer: Cash Price |
$2,040.38
|
| Rate for Payer: Cofinity Commercial |
$2,193.41
|
| Rate for Payer: Cofinity Commercial |
$1,785.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,785.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,040.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$2,295.43
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,167.91
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$2,167.91
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,657.81
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health SBD |
$1,606.80
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,448.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$889.65
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
HC SCREENING PAP SMEAR, OBTAIN PREP TO LAB
|
Facility
|
OP
|
$78.59
|
|
|
Service Code
|
CPT Q0091
|
| Hospital Charge Code |
31100043
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$70.73 |
| Rate for Payer: Aetna Commercial |
$66.80
|
| Rate for Payer: Aetna Medicare |
$24.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.85
|
| Rate for Payer: BCBS Complete |
$13.44
|
| Rate for Payer: BCBS MAPPO |
$23.88
|
| Rate for Payer: BCN Medicare Advantage |
$23.88
|
| Rate for Payer: Cash Price |
$62.87
|
| Rate for Payer: Cash Price |
$62.87
|
| Rate for Payer: Cofinity Commercial |
$67.59
|
| Rate for Payer: Cofinity Commercial |
$55.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.88
|
| Rate for Payer: Healthscope Commercial |
$70.73
|
| Rate for Payer: Mclaren Medicaid |
$12.80
|
| Rate for Payer: Mclaren Medicare |
$23.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.07
|
| Rate for Payer: Meridian Medicaid |
$13.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.80
|
| Rate for Payer: PACE Medicare |
$22.69
|
| Rate for Payer: PACE SWMI |
$23.88
|
| Rate for Payer: PHP Commercial |
$66.80
|
| Rate for Payer: PHP Medicare Advantage |
$23.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.08
|
| Rate for Payer: Priority Health Medicare |
$23.88
|
| Rate for Payer: Priority Health SBD |
$49.51
|
| Rate for Payer: Railroad Medicare Medicare |
$23.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.88
|
| Rate for Payer: UHC Medicare Advantage |
$23.88
|
| Rate for Payer: UHCCP Medicaid |
$13.44
|
| Rate for Payer: VA VA |
$23.88
|
|
|
HC SCREENING PAP SMEAR, OBTAIN PREP TO LAB
|
Facility
|
IP
|
$78.59
|
|
|
Service Code
|
CPT Q0091
|
| Hospital Charge Code |
31100043
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$49.51 |
| Max. Negotiated Rate |
$70.73 |
| Rate for Payer: Aetna Commercial |
$66.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.08
|
| Rate for Payer: Cash Price |
$62.87
|
| Rate for Payer: Cofinity Commercial |
$55.01
|
| Rate for Payer: Cofinity Commercial |
$67.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.87
|
| Rate for Payer: Healthscope Commercial |
$70.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.80
|
| Rate for Payer: PHP Commercial |
$66.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.08
|
| Rate for Payer: Priority Health SBD |
$49.51
|
|
|
HC SCREENING TOMOSYNTHESIS
|
Facility
|
IP
|
$103.21
|
|
|
Service Code
|
CPT 77063
|
| Hospital Charge Code |
32000301
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$65.02 |
| Max. Negotiated Rate |
$92.89 |
| Rate for Payer: Aetna Commercial |
$87.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.09
|
| Rate for Payer: Cash Price |
$82.57
|
| Rate for Payer: Cofinity Commercial |
$72.25
|
| Rate for Payer: Cofinity Commercial |
$88.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.57
|
| Rate for Payer: Healthscope Commercial |
$92.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.73
|
| Rate for Payer: PHP Commercial |
$87.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.09
|
| Rate for Payer: Priority Health SBD |
$65.02
|
|
|
HC SCREENING TOMOSYNTHESIS
|
Facility
|
OP
|
$103.21
|
|
|
Service Code
|
CPT 77063
|
| Hospital Charge Code |
32000301
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$92.89 |
| Rate for Payer: Aetna Commercial |
$87.73
|
| Rate for Payer: Aetna Medicare |
$51.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.09
|
| Rate for Payer: BCBS Complete |
$41.28
|
| Rate for Payer: Cash Price |
$82.57
|
| Rate for Payer: Cofinity Commercial |
$72.25
|
| Rate for Payer: Cofinity Commercial |
$88.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.57
|
| Rate for Payer: Healthscope Commercial |
$92.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.73
|
| Rate for Payer: PHP Commercial |
$87.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.09
|
| Rate for Payer: Priority Health SBD |
$65.02
|
| Rate for Payer: UHC Core |
$76.38
|
| Rate for Payer: UHC Exchange |
$76.38
|
|
|
HC SDL MSLT/MWT
|
Facility
|
IP
|
$2,572.19
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
92000005
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$1,620.48 |
| Max. Negotiated Rate |
$2,314.97 |
| Rate for Payer: Aetna Commercial |
$2,186.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,671.92
|
| Rate for Payer: Cash Price |
$2,057.75
|
| Rate for Payer: Cofinity Commercial |
$1,800.53
|
| Rate for Payer: Cofinity Commercial |
$2,212.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,800.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,057.75
|
| Rate for Payer: Healthscope Commercial |
$2,314.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,186.36
|
| Rate for Payer: PHP Commercial |
$2,186.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,671.92
|
| Rate for Payer: Priority Health SBD |
$1,620.48
|
|
|
HC SDL MSLT/MWT
|
Facility
|
OP
|
$2,572.19
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
92000005
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$277.37 |
| Max. Negotiated Rate |
$2,314.97 |
| Rate for Payer: Aetna Commercial |
$2,186.36
|
| Rate for Payer: Aetna Medicare |
$538.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,671.92
|
| 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 |
$2,057.75
|
| Rate for Payer: Cash Price |
$2,057.75
|
| Rate for Payer: Cofinity Commercial |
$2,212.08
|
| Rate for Payer: Cofinity Commercial |
$1,800.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,800.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,057.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$517.48
|
| Rate for Payer: Healthscope Commercial |
$2,314.97
|
| 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 |
$2,186.36
|
| Rate for Payer: PACE Medicare |
$491.61
|
| Rate for Payer: PACE SWMI |
$517.48
|
| Rate for Payer: PHP Commercial |
$2,186.36
|
| 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 |
$1,671.92
|
| Rate for Payer: Priority Health Medicare |
$517.48
|
| Rate for Payer: Priority Health SBD |
$1,620.48
|
| Rate for Payer: Railroad Medicare Medicare |
$517.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,456.65
|
| Rate for Payer: UHC Core |
$1,903.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.48
|
| Rate for Payer: UHC Exchange |
$1,903.42
|
| Rate for Payer: UHC Medicare Advantage |
$517.48
|
| Rate for Payer: UHCCP Medicaid |
$291.34
|
| Rate for Payer: VA VA |
$517.48
|
|
|
HC SDL POLYSOMNOGRAPHY
|
Facility
|
OP
|
$3,560.39
|
|
|
Service Code
|
CPT 95810
|
| Hospital Charge Code |
74000001
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$531.84 |
| Max. Negotiated Rate |
$3,204.35 |
| Rate for Payer: Aetna Commercial |
$3,026.33
|
| Rate for Payer: Aetna Medicare |
$1,031.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,314.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,240.30
|
| Rate for Payer: BCBS Complete |
$558.43
|
| Rate for Payer: BCBS MAPPO |
$992.24
|
| Rate for Payer: BCN Medicare Advantage |
$992.24
|
| Rate for Payer: Cash Price |
$2,848.31
|
| Rate for Payer: Cash Price |
$2,848.31
|
| Rate for Payer: Cofinity Commercial |
$2,492.27
|
| Rate for Payer: Cofinity Commercial |
$3,061.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,492.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,848.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$992.24
|
| Rate for Payer: Healthscope Commercial |
$3,204.35
|
| Rate for Payer: Mclaren Medicaid |
$531.84
|
| Rate for Payer: Mclaren Medicare |
$992.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,041.85
|
| Rate for Payer: Meridian Medicaid |
$558.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,141.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,026.33
|
| Rate for Payer: PACE Medicare |
$942.63
|
| Rate for Payer: PACE SWMI |
$992.24
|
| Rate for Payer: PHP Commercial |
$3,026.33
|
| Rate for Payer: PHP Medicare Advantage |
$992.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$531.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,314.25
|
| Rate for Payer: Priority Health Medicare |
$992.24
|
| Rate for Payer: Priority Health SBD |
$2,243.05
|
| Rate for Payer: Railroad Medicare Medicare |
$992.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,793.06
|
| Rate for Payer: UHC Core |
$2,634.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$992.24
|
| Rate for Payer: UHC Exchange |
$2,634.69
|
| Rate for Payer: UHC Medicare Advantage |
$992.24
|
| Rate for Payer: UHCCP Medicaid |
$558.63
|
| Rate for Payer: VA VA |
$992.24
|
|
|
HC SDL POLYSOMNOGRAPHY
|
Facility
|
IP
|
$3,560.39
|
|
|
Service Code
|
CPT 95810
|
| Hospital Charge Code |
74000001
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$2,243.05 |
| Max. Negotiated Rate |
$3,204.35 |
| Rate for Payer: Aetna Commercial |
$3,026.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,314.25
|
| Rate for Payer: Cash Price |
$2,848.31
|
| Rate for Payer: Cofinity Commercial |
$2,492.27
|
| Rate for Payer: Cofinity Commercial |
$3,061.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,492.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,848.31
|
| Rate for Payer: Healthscope Commercial |
$3,204.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,026.33
|
| Rate for Payer: PHP Commercial |
$3,026.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,314.25
|
| Rate for Payer: Priority Health SBD |
$2,243.05
|
|
|
HC SDL PSG WITH CPAP/BIPAP
|
Facility
|
OP
|
$3,936.22
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
74000002
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$531.84 |
| Max. Negotiated Rate |
$3,542.60 |
| Rate for Payer: Aetna Commercial |
$3,345.79
|
| Rate for Payer: Aetna Medicare |
$1,031.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,558.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,240.30
|
| Rate for Payer: BCBS Complete |
$558.43
|
| Rate for Payer: BCBS MAPPO |
$992.24
|
| Rate for Payer: BCN Medicare Advantage |
$992.24
|
| Rate for Payer: Cash Price |
$3,148.98
|
| Rate for Payer: Cash Price |
$3,148.98
|
| Rate for Payer: Cofinity Commercial |
$3,385.15
|
| Rate for Payer: Cofinity Commercial |
$2,755.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,755.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,148.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$992.24
|
| Rate for Payer: Healthscope Commercial |
$3,542.60
|
| Rate for Payer: Mclaren Medicaid |
$531.84
|
| Rate for Payer: Mclaren Medicare |
$992.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,041.85
|
| Rate for Payer: Meridian Medicaid |
$558.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,141.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,345.79
|
| Rate for Payer: PACE Medicare |
$942.63
|
| Rate for Payer: PACE SWMI |
$992.24
|
| Rate for Payer: PHP Commercial |
$3,345.79
|
| Rate for Payer: PHP Medicare Advantage |
$992.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$531.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,558.54
|
| Rate for Payer: Priority Health Medicare |
$992.24
|
| Rate for Payer: Priority Health SBD |
$2,479.82
|
| Rate for Payer: Railroad Medicare Medicare |
$992.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,793.06
|
| Rate for Payer: UHC Core |
$2,912.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$992.24
|
| Rate for Payer: UHC Exchange |
$2,912.80
|
| Rate for Payer: UHC Medicare Advantage |
$992.24
|
| Rate for Payer: UHCCP Medicaid |
$558.63
|
| Rate for Payer: VA VA |
$992.24
|
|
|
HC SDL PSG WITH CPAP/BIPAP
|
Facility
|
IP
|
$3,936.22
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
74000002
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$2,479.82 |
| Max. Negotiated Rate |
$3,542.60 |
| Rate for Payer: Aetna Commercial |
$3,345.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,558.54
|
| Rate for Payer: Cash Price |
$3,148.98
|
| Rate for Payer: Cofinity Commercial |
$2,755.35
|
| Rate for Payer: Cofinity Commercial |
$3,385.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,755.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,148.98
|
| Rate for Payer: Healthscope Commercial |
$3,542.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,345.79
|
| Rate for Payer: PHP Commercial |
$3,345.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,558.54
|
| Rate for Payer: Priority Health SBD |
$2,479.82
|
|
|
HC SEDATION IV / IM OR INHALANT
|
Facility
|
OP
|
$734.88
|
|
| Hospital Charge Code |
37000005
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$293.95 |
| Max. Negotiated Rate |
$661.39 |
| Rate for Payer: Aetna Commercial |
$624.65
|
| Rate for Payer: Aetna Medicare |
$367.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$477.67
|
| Rate for Payer: BCBS Complete |
$293.95
|
| Rate for Payer: Cash Price |
$587.90
|
| Rate for Payer: Cofinity Commercial |
$514.42
|
| Rate for Payer: Cofinity Commercial |
$632.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$514.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$587.90
|
| Rate for Payer: Healthscope Commercial |
$661.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$624.65
|
| Rate for Payer: PHP Commercial |
$624.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.67
|
| Rate for Payer: Priority Health SBD |
$462.97
|
|
|
HC SEDATION IV / IM OR INHALANT
|
Facility
|
IP
|
$734.88
|
|
| Hospital Charge Code |
37000005
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$462.97 |
| Max. Negotiated Rate |
$661.39 |
| Rate for Payer: Aetna Commercial |
$624.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$477.67
|
| Rate for Payer: Cash Price |
$587.90
|
| Rate for Payer: Cofinity Commercial |
$514.42
|
| Rate for Payer: Cofinity Commercial |
$632.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$514.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$587.90
|
| Rate for Payer: Healthscope Commercial |
$661.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$624.65
|
| Rate for Payer: PHP Commercial |
$624.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.67
|
| Rate for Payer: Priority Health SBD |
$462.97
|
|
|
HC SED RATE WESTERGREN
|
Facility
|
IP
|
$15.61
|
|
|
Service Code
|
CPT 85652
|
| Hospital Charge Code |
30500060
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Aetna Commercial |
$13.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.15
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$10.93
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$14.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: PHP Commercial |
$13.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health SBD |
$9.83
|
|
|
HC SED RATE WESTERGREN
|
Facility
|
OP
|
$15.61
|
|
|
Service Code
|
CPT 85652
|
| Hospital Charge Code |
30500060
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Aetna Commercial |
$13.27
|
| Rate for Payer: Aetna Medicare |
$2.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.38
|
| Rate for Payer: BCBS Complete |
$1.52
|
| Rate for Payer: BCBS MAPPO |
$2.70
|
| Rate for Payer: BCN Medicare Advantage |
$2.70
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Cofinity Commercial |
$10.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.70
|
| Rate for Payer: Healthscope Commercial |
$14.05
|
| Rate for Payer: Mclaren Medicaid |
$1.45
|
| Rate for Payer: Mclaren Medicare |
$2.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.83
|
| Rate for Payer: Meridian Medicaid |
$1.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: PACE Medicare |
$2.56
|
| Rate for Payer: PACE SWMI |
$2.70
|
| Rate for Payer: PHP Commercial |
$13.27
|
| Rate for Payer: PHP Medicare Advantage |
$2.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health Medicare |
$2.70
|
| Rate for Payer: Priority Health SBD |
$9.83
|
| Rate for Payer: Railroad Medicare Medicare |
$2.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.70
|
| Rate for Payer: UHC Medicare Advantage |
$2.70
|
| Rate for Payer: UHCCP Medicaid |
$1.52
|
| Rate for Payer: VA VA |
$2.70
|
|
