|
HC SUPPLEMENTAL NEWBORN SCRN
|
Facility
|
IP
|
$88.43
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
30100686
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.71 |
| Max. Negotiated Rate |
$79.59 |
| Rate for Payer: Aetna Commercial |
$75.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.48
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cofinity Advantage |
$61.90
|
| Rate for Payer: Cofinity Commercial |
$76.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.74
|
| Rate for Payer: Healthscope Commercial |
$79.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.32
|
| Rate for Payer: PHP Commercial |
$75.17
|
| Rate for Payer: Priority Health SBD |
$55.71
|
|
|
HC SUPRAPUBIC CATHETER
|
Facility
|
OP
|
$121.35
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
27200072
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.69 |
| Max. Negotiated Rate |
$109.22 |
| Rate for Payer: Aetna Commercial |
$103.15
|
| Rate for Payer: Aetna Medicare |
$60.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.88
|
| Rate for Payer: BCBS Complete |
$48.54
|
| Rate for Payer: Cash Price |
$97.08
|
| Rate for Payer: Cofinity Advantage |
$84.94
|
| Rate for Payer: Cofinity Commercial |
$104.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.08
|
| Rate for Payer: Healthscope Commercial |
$109.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.01
|
| Rate for Payer: PHP Commercial |
$103.15
|
| Rate for Payer: Priority Health SBD |
$76.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.88
|
| Rate for Payer: UHC Core |
$63.22
|
| Rate for Payer: UHC Exchange |
$47.69
|
|
|
HC SUPRAPUBIC CATHETER
|
Facility
|
IP
|
$121.35
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
27200072
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.45 |
| Max. Negotiated Rate |
$109.22 |
| Rate for Payer: Aetna Commercial |
$103.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.88
|
| Rate for Payer: Cash Price |
$97.08
|
| Rate for Payer: Cofinity Advantage |
$84.94
|
| Rate for Payer: Cofinity Commercial |
$104.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.08
|
| Rate for Payer: Healthscope Commercial |
$109.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.01
|
| Rate for Payer: PHP Commercial |
$103.15
|
| Rate for Payer: Priority Health SBD |
$76.45
|
|
|
HC SURGERY FROZEN EA ADDL
|
Facility
|
OP
|
$76.19
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
31000057
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$30.48 |
| Max. Negotiated Rate |
$68.57 |
| Rate for Payer: Aetna Commercial |
$64.76
|
| Rate for Payer: Aetna Medicare |
$38.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.52
|
| Rate for Payer: BCBS Complete |
$30.48
|
| Rate for Payer: BCBS Trust/PPO |
$42.59
|
| Rate for Payer: BCCCP Commercial |
$51.41
|
| Rate for Payer: BCN Commercial |
$42.59
|
| Rate for Payer: Cash Price |
$60.95
|
| Rate for Payer: Cash Price |
$60.95
|
| Rate for Payer: Cofinity Advantage |
$53.33
|
| Rate for Payer: Cofinity Commercial |
$65.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.95
|
| Rate for Payer: Healthscope Commercial |
$68.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.14
|
| Rate for Payer: PHP Commercial |
$64.76
|
| Rate for Payer: Priority Health SBD |
$48.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.39
|
| Rate for Payer: UHC Core |
$36.39
|
| Rate for Payer: UHC Exchange |
$36.39
|
|
|
HC SURGERY FROZEN EA ADDL
|
Facility
|
IP
|
$76.19
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
31000057
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$68.57 |
| Rate for Payer: Aetna Commercial |
$64.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.52
|
| Rate for Payer: Cash Price |
$60.95
|
| Rate for Payer: Cofinity Advantage |
$53.33
|
| Rate for Payer: Cofinity Commercial |
$65.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.95
|
| Rate for Payer: Healthscope Commercial |
$68.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.14
|
| Rate for Payer: PHP Commercial |
$64.76
|
| Rate for Payer: Priority Health SBD |
$48.00
|
|
|
HC SURGICAL HAND
|
Facility
|
IP
|
$718.51
|
|
| Hospital Charge Code |
45000053
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$452.66 |
| Max. Negotiated Rate |
$646.66 |
| Rate for Payer: Aetna Commercial |
$610.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$467.03
|
| Rate for Payer: Cash Price |
$574.81
|
| Rate for Payer: Cofinity Advantage |
$502.96
|
| Rate for Payer: Cofinity Commercial |
$617.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$574.81
|
| Rate for Payer: Healthscope Commercial |
$646.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$610.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$538.88
|
| Rate for Payer: PHP Commercial |
$610.73
|
| Rate for Payer: Priority Health SBD |
$452.66
|
|
|
HC SURGICAL HAND
|
Facility
|
OP
|
$718.51
|
|
| Hospital Charge Code |
45000053
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$646.66 |
| Rate for Payer: Aetna Commercial |
$610.73
|
| Rate for Payer: Aetna Medicare |
$359.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$467.03
|
| Rate for Payer: BCBS Complete |
$287.40
|
| Rate for Payer: Cash Price |
$574.81
|
| Rate for Payer: Cash Price |
$574.81
|
| Rate for Payer: Cofinity Advantage |
$502.96
|
| Rate for Payer: Cofinity Commercial |
$617.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$574.81
|
| Rate for Payer: Healthscope Commercial |
$646.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$574.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$610.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$538.88
|
| Rate for Payer: PHP Commercial |
$610.73
|
| Rate for Payer: Priority Health SBD |
$452.66
|
| Rate for Payer: UHCCP Medicaid |
$144.00
|
|
|
HC SURG SUPPLY MISC
|
Facility
|
IP
|
$88.16
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
62300132
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$55.54 |
| Max. Negotiated Rate |
$79.34 |
| Rate for Payer: Aetna Commercial |
$74.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.30
|
| Rate for Payer: Cash Price |
$70.53
|
| Rate for Payer: Cofinity Advantage |
$61.71
|
| Rate for Payer: Cofinity Commercial |
$75.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.53
|
| Rate for Payer: Healthscope Commercial |
$79.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.12
|
| Rate for Payer: PHP Commercial |
$74.94
|
| Rate for Payer: Priority Health SBD |
$55.54
|
|
|
HC SURG SUPPLY MISC
|
Facility
|
OP
|
$88.16
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
62300132
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$377.01 |
| Rate for Payer: Aetna Commercial |
$74.94
|
| Rate for Payer: Aetna Medicare |
$44.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.30
|
| Rate for Payer: BCBS Complete |
$35.26
|
| Rate for Payer: BCBS Trust/PPO |
$377.01
|
| Rate for Payer: BCN Commercial |
$377.01
|
| Rate for Payer: Cash Price |
$70.53
|
| Rate for Payer: Cash Price |
$70.53
|
| Rate for Payer: Cofinity Advantage |
$61.71
|
| Rate for Payer: Cofinity Commercial |
$75.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.53
|
| Rate for Payer: Healthscope Commercial |
$79.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.12
|
| Rate for Payer: PHP Commercial |
$74.94
|
| Rate for Payer: Priority Health SBD |
$55.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.30
|
| Rate for Payer: UHC Core |
$45.93
|
| Rate for Payer: UHC Exchange |
$34.65
|
|
|
HC SUSCEPTIBILITY DISK
|
Facility
|
IP
|
$59.82
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
30600098
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$37.69 |
| Max. Negotiated Rate |
$53.84 |
| Rate for Payer: Aetna Commercial |
$50.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.88
|
| Rate for Payer: Cash Price |
$47.86
|
| Rate for Payer: Cofinity Advantage |
$41.87
|
| Rate for Payer: Cofinity Commercial |
$51.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.86
|
| Rate for Payer: Healthscope Commercial |
$53.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.87
|
| Rate for Payer: PHP Commercial |
$50.85
|
| Rate for Payer: Priority Health SBD |
$37.69
|
|
|
HC SUSCEPTIBILITY DISK
|
Facility
|
OP
|
$59.82
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
30600098
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$53.84 |
| Rate for Payer: Aetna Commercial |
$50.85
|
| Rate for Payer: Aetna Medicare |
$7.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.35
|
| Rate for Payer: BCBS Complete |
$4.11
|
| Rate for Payer: BCBS MAPPO |
$7.48
|
| Rate for Payer: BCBS Trust/PPO |
$7.98
|
| Rate for Payer: BCN Commercial |
$7.98
|
| Rate for Payer: BCN Medicare Advantage |
$7.48
|
| Rate for Payer: Cash Price |
$47.86
|
| Rate for Payer: Cash Price |
$47.86
|
| Rate for Payer: Cofinity Advantage |
$41.87
|
| Rate for Payer: Cofinity Commercial |
$51.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.48
|
| Rate for Payer: Healthscope Commercial |
$53.84
|
| Rate for Payer: Mclaren Medicaid |
$3.91
|
| Rate for Payer: Mclaren Medicare |
$7.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.85
|
| Rate for Payer: Meridian Medicaid |
$7.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.85
|
| Rate for Payer: Nomi Health Commercial |
$11.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.87
|
| Rate for Payer: PACE Medicare |
$7.11
|
| Rate for Payer: PACE SWMI |
$7.48
|
| Rate for Payer: PHP Commercial |
$50.85
|
| Rate for Payer: PHP Medicare Advantage |
$7.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$7.48
|
| Rate for Payer: Priority Health Medicare |
$7.48
|
| Rate for Payer: Priority Health SBD |
$37.69
|
| Rate for Payer: Priority Health Tiered Network |
$5.98
|
| Rate for Payer: Railroad Medicare Medicare |
$7.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.22
|
| Rate for Payer: UHC Core |
$11.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.48
|
| Rate for Payer: UHC Exchange |
$11.22
|
| Rate for Payer: UHC Medicaid |
$3.91
|
| Rate for Payer: UHCCP Medicaid |
$3.91
|
| Rate for Payer: VA VA |
$7.48
|
|
|
HC SUSCEPTIBILITY E TEST
|
Facility
|
IP
|
$33.43
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
30600097
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.06 |
| Max. Negotiated Rate |
$30.09 |
| Rate for Payer: Aetna Commercial |
$28.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.73
|
| Rate for Payer: Cash Price |
$26.74
|
| Rate for Payer: Cofinity Advantage |
$23.40
|
| Rate for Payer: Cofinity Commercial |
$28.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.74
|
| Rate for Payer: Healthscope Commercial |
$30.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.07
|
| Rate for Payer: PHP Commercial |
$28.42
|
| Rate for Payer: Priority Health SBD |
$21.06
|
|
|
HC SUSCEPTIBILITY E TEST
|
Facility
|
OP
|
$33.43
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
30600097
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$30.09 |
| Rate for Payer: Aetna Commercial |
$28.42
|
| Rate for Payer: Aetna Medicare |
$4.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.94
|
| Rate for Payer: BCBS Complete |
$2.61
|
| Rate for Payer: BCBS MAPPO |
$4.75
|
| Rate for Payer: BCBS Trust/PPO |
$5.06
|
| Rate for Payer: BCN Commercial |
$5.06
|
| Rate for Payer: BCN Medicare Advantage |
$4.75
|
| Rate for Payer: Cash Price |
$26.74
|
| Rate for Payer: Cash Price |
$26.74
|
| Rate for Payer: Cofinity Advantage |
$23.40
|
| Rate for Payer: Cofinity Commercial |
$28.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.75
|
| Rate for Payer: Healthscope Commercial |
$30.09
|
| Rate for Payer: Mclaren Medicaid |
$2.48
|
| Rate for Payer: Mclaren Medicare |
$4.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.99
|
| Rate for Payer: Meridian Medicaid |
$4.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.42
|
| Rate for Payer: Nomi Health Commercial |
$7.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.07
|
| Rate for Payer: PACE Medicare |
$4.51
|
| Rate for Payer: PACE SWMI |
$4.75
|
| Rate for Payer: PHP Commercial |
$28.42
|
| Rate for Payer: PHP Medicare Advantage |
$4.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.75
|
| Rate for Payer: Priority Health Medicare |
$4.75
|
| Rate for Payer: Priority Health SBD |
$21.06
|
| Rate for Payer: Priority Health Tiered Network |
$3.80
|
| Rate for Payer: Railroad Medicare Medicare |
$4.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.13
|
| Rate for Payer: UHC Core |
$7.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.75
|
| Rate for Payer: UHC Exchange |
$7.13
|
| Rate for Payer: UHC Medicaid |
$2.48
|
| Rate for Payer: UHCCP Medicaid |
$2.48
|
| Rate for Payer: VA VA |
$4.75
|
|
|
HC SUSCEPTIBILITY, MIC
|
Facility
|
OP
|
$82.19
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
30600100
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$73.97 |
| Rate for Payer: Aetna Commercial |
$69.86
|
| Rate for Payer: Aetna Medicare |
$9.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.81
|
| Rate for Payer: BCBS Complete |
$4.75
|
| Rate for Payer: BCBS MAPPO |
$8.65
|
| Rate for Payer: BCBS Trust/PPO |
$9.23
|
| Rate for Payer: BCN Commercial |
$9.23
|
| Rate for Payer: BCN Medicare Advantage |
$8.65
|
| Rate for Payer: Cash Price |
$65.75
|
| Rate for Payer: Cash Price |
$65.75
|
| Rate for Payer: Cofinity Advantage |
$57.53
|
| Rate for Payer: Cofinity Commercial |
$70.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.65
|
| Rate for Payer: Healthscope Commercial |
$73.97
|
| Rate for Payer: Mclaren Medicaid |
$4.52
|
| Rate for Payer: Mclaren Medicare |
$8.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.08
|
| Rate for Payer: Meridian Medicaid |
$9.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.86
|
| Rate for Payer: Nomi Health Commercial |
$12.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.64
|
| Rate for Payer: PACE Medicare |
$8.22
|
| Rate for Payer: PACE SWMI |
$8.65
|
| Rate for Payer: PHP Commercial |
$69.86
|
| Rate for Payer: PHP Medicare Advantage |
$8.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8.65
|
| Rate for Payer: Priority Health Medicare |
$8.65
|
| Rate for Payer: Priority Health SBD |
$51.78
|
| Rate for Payer: Priority Health Tiered Network |
$6.92
|
| Rate for Payer: Railroad Medicare Medicare |
$8.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.98
|
| Rate for Payer: UHC Core |
$12.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.65
|
| Rate for Payer: UHC Exchange |
$12.98
|
| Rate for Payer: UHC Medicaid |
$4.52
|
| Rate for Payer: UHCCP Medicaid |
$4.52
|
| Rate for Payer: VA VA |
$8.65
|
|
|
HC SUSCEPTIBILITY, MIC
|
Facility
|
IP
|
$82.19
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
30600100
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$51.78 |
| Max. Negotiated Rate |
$73.97 |
| Rate for Payer: Aetna Commercial |
$69.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.42
|
| Rate for Payer: Cash Price |
$65.75
|
| Rate for Payer: Cofinity Advantage |
$57.53
|
| Rate for Payer: Cofinity Commercial |
$70.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.75
|
| Rate for Payer: Healthscope Commercial |
$73.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.64
|
| Rate for Payer: PHP Commercial |
$69.86
|
| Rate for Payer: Priority Health SBD |
$51.78
|
|
|
HC SWALLOW EVALUATION
|
Facility
|
OP
|
$340.02
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
44400004
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$306.02 |
| Rate for Payer: Aetna Commercial |
$289.02
|
| Rate for Payer: Aetna Medicare |
$170.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.01
|
| Rate for Payer: BCBS Complete |
$136.01
|
| Rate for Payer: BCBS Trust/PPO |
$117.24
|
| Rate for Payer: BCN Commercial |
$117.24
|
| Rate for Payer: Cash Price |
$272.02
|
| Rate for Payer: Cash Price |
$272.02
|
| Rate for Payer: Cash Price |
$272.02
|
| Rate for Payer: Cofinity Advantage |
$238.01
|
| Rate for Payer: Cofinity Commercial |
$292.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.02
|
| Rate for Payer: Healthscope Commercial |
$306.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.02
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$255.01
|
| Rate for Payer: PHP Commercial |
$289.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$105.00
|
| Rate for Payer: Priority Health SBD |
$214.21
|
| Rate for Payer: Priority Health Tiered Network |
$84.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.01
|
| Rate for Payer: UHC Core |
$177.15
|
| Rate for Payer: UHC Exchange |
$133.63
|
|
|
HC SWALLOW EVALUATION
|
Facility
|
IP
|
$340.02
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
44400004
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$214.21 |
| Max. Negotiated Rate |
$306.02 |
| Rate for Payer: Aetna Commercial |
$289.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.01
|
| Rate for Payer: Cash Price |
$272.02
|
| Rate for Payer: Cofinity Advantage |
$238.01
|
| Rate for Payer: Cofinity Commercial |
$292.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.02
|
| Rate for Payer: Healthscope Commercial |
$306.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$255.01
|
| Rate for Payer: PHP Commercial |
$289.02
|
| Rate for Payer: Priority Health SBD |
$214.21
|
|
|
HC SWALLOWING THERAPY
|
Facility
|
OP
|
$247.16
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
43000020
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$84.80 |
| Max. Negotiated Rate |
$222.44 |
| Rate for Payer: Aetna Commercial |
$210.09
|
| Rate for Payer: Aetna Medicare |
$123.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.65
|
| Rate for Payer: BCBS Complete |
$98.86
|
| Rate for Payer: BCBS Trust/PPO |
$116.33
|
| Rate for Payer: BCN Commercial |
$116.33
|
| Rate for Payer: Cash Price |
$197.73
|
| Rate for Payer: Cash Price |
$197.73
|
| Rate for Payer: Cash Price |
$197.73
|
| Rate for Payer: Cofinity Advantage |
$173.01
|
| Rate for Payer: Cofinity Commercial |
$212.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.73
|
| Rate for Payer: Healthscope Commercial |
$222.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$197.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.09
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.37
|
| Rate for Payer: PHP Commercial |
$210.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$106.00
|
| Rate for Payer: Priority Health SBD |
$155.71
|
| Rate for Payer: Priority Health Tiered Network |
$84.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.65
|
| Rate for Payer: UHC Core |
$128.77
|
| Rate for Payer: UHC Exchange |
$97.13
|
|
|
HC SWALLOWING THERAPY
|
Facility
|
IP
|
$247.16
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
43000020
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$155.71 |
| Max. Negotiated Rate |
$222.44 |
| Rate for Payer: Aetna Commercial |
$210.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.65
|
| Rate for Payer: Cash Price |
$197.73
|
| Rate for Payer: Cofinity Advantage |
$173.01
|
| Rate for Payer: Cofinity Commercial |
$212.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.73
|
| Rate for Payer: Healthscope Commercial |
$222.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.37
|
| Rate for Payer: PHP Commercial |
$210.09
|
| Rate for Payer: Priority Health SBD |
$155.71
|
|
|
HC SWAN GANZ CATHETER
|
Facility
|
IP
|
$240.18
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200073
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$151.31 |
| Max. Negotiated Rate |
$216.16 |
| Rate for Payer: Aetna Commercial |
$204.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.12
|
| Rate for Payer: Cash Price |
$192.14
|
| Rate for Payer: Cofinity Advantage |
$168.13
|
| Rate for Payer: Cofinity Commercial |
$206.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.14
|
| Rate for Payer: Healthscope Commercial |
$216.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.13
|
| Rate for Payer: PHP Commercial |
$204.15
|
| Rate for Payer: Priority Health SBD |
$151.31
|
|
|
HC SWAN GANZ CATHETER
|
Facility
|
OP
|
$240.18
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200073
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.39 |
| Max. Negotiated Rate |
$216.16 |
| Rate for Payer: Aetna Commercial |
$204.15
|
| Rate for Payer: Aetna Medicare |
$120.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.12
|
| Rate for Payer: BCBS Complete |
$96.07
|
| Rate for Payer: Cash Price |
$192.14
|
| Rate for Payer: Cofinity Advantage |
$168.13
|
| Rate for Payer: Cofinity Commercial |
$206.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.14
|
| Rate for Payer: Healthscope Commercial |
$216.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.13
|
| Rate for Payer: PHP Commercial |
$204.15
|
| Rate for Payer: Priority Health SBD |
$151.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.12
|
| Rate for Payer: UHC Core |
$125.13
|
| Rate for Payer: UHC Exchange |
$94.39
|
|
|
HC SWAN GANZ PLACEMENT
|
Facility
|
OP
|
$1,677.77
|
|
|
Service Code
|
CPT 93503
|
| Hospital Charge Code |
48100024
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$60.71 |
| Max. Negotiated Rate |
$5,072.36 |
| Rate for Payer: Aetna Commercial |
$1,426.10
|
| Rate for Payer: Aetna Medicare |
$1,631.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,090.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.61
|
| Rate for Payer: BCBS Complete |
$861.41
|
| Rate for Payer: BCBS MAPPO |
$1,568.49
|
| Rate for Payer: BCBS Trust/PPO |
$60.71
|
| Rate for Payer: BCN Commercial |
$60.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.49
|
| Rate for Payer: Cash Price |
$1,342.22
|
| Rate for Payer: Cash Price |
$1,342.22
|
| Rate for Payer: Cofinity Advantage |
$1,174.44
|
| Rate for Payer: Cofinity Commercial |
$1,442.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,342.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.49
|
| Rate for Payer: Healthscope Commercial |
$1,509.99
|
| Rate for Payer: Mclaren Medicaid |
$820.32
|
| Rate for Payer: Mclaren Medicare |
$1,568.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.91
|
| Rate for Payer: Meridian Medicaid |
$1,646.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,725.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,426.10
|
| Rate for Payer: Nomi Health Commercial |
$4,705.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,258.33
|
| Rate for Payer: PACE Medicare |
$1,490.07
|
| Rate for Payer: PACE SWMI |
$1,568.49
|
| Rate for Payer: PHP Commercial |
$1,426.10
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$820.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,072.36
|
| Rate for Payer: Priority Health Medicare |
$1,568.49
|
| Rate for Payer: Priority Health SBD |
$1,057.00
|
| Rate for Payer: Priority Health Tiered Network |
$4,057.89
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,568.49
|
| Rate for Payer: UHC Medicaid |
$820.32
|
| Rate for Payer: UHCCP Medicaid |
$820.32
|
| Rate for Payer: VA VA |
$1,568.49
|
|
|
HC SWAN GANZ PLACEMENT
|
Facility
|
IP
|
$1,677.77
|
|
|
Service Code
|
CPT 93503
|
| Hospital Charge Code |
48100024
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,057.00 |
| Max. Negotiated Rate |
$1,509.99 |
| Rate for Payer: Aetna Commercial |
$1,426.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,090.55
|
| Rate for Payer: Cash Price |
$1,342.22
|
| Rate for Payer: Cofinity Advantage |
$1,174.44
|
| Rate for Payer: Cofinity Commercial |
$1,442.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,342.22
|
| Rate for Payer: Healthscope Commercial |
$1,509.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,426.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,258.33
|
| Rate for Payer: PHP Commercial |
$1,426.10
|
| Rate for Payer: Priority Health SBD |
$1,057.00
|
|
|
HC SWEAT CHLORIDE
|
Facility
|
IP
|
$80.84
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
30100154
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.93 |
| Max. Negotiated Rate |
$72.76 |
| Rate for Payer: Aetna Commercial |
$68.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.55
|
| Rate for Payer: Cash Price |
$64.67
|
| Rate for Payer: Cofinity Advantage |
$56.59
|
| Rate for Payer: Cofinity Commercial |
$69.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.67
|
| Rate for Payer: Healthscope Commercial |
$72.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.63
|
| Rate for Payer: PHP Commercial |
$68.71
|
| Rate for Payer: Priority Health SBD |
$50.93
|
|
|
HC SWEAT CHLORIDE
|
Facility
|
OP
|
$80.84
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
30100154
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$72.76 |
| Rate for Payer: Aetna Commercial |
$68.71
|
| Rate for Payer: Aetna Medicare |
$5.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.25
|
| Rate for Payer: BCBS Complete |
$2.75
|
| Rate for Payer: BCBS MAPPO |
$5.00
|
| Rate for Payer: BCBS Trust/PPO |
$5.33
|
| Rate for Payer: BCN Commercial |
$5.33
|
| Rate for Payer: BCN Medicare Advantage |
$5.00
|
| Rate for Payer: Cash Price |
$64.67
|
| Rate for Payer: Cash Price |
$64.67
|
| Rate for Payer: Cofinity Advantage |
$56.59
|
| Rate for Payer: Cofinity Commercial |
$69.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.00
|
| Rate for Payer: Healthscope Commercial |
$72.76
|
| Rate for Payer: Mclaren Medicaid |
$2.62
|
| Rate for Payer: Mclaren Medicare |
$5.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.25
|
| Rate for Payer: Meridian Medicaid |
$5.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.71
|
| Rate for Payer: Nomi Health Commercial |
$7.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.63
|
| Rate for Payer: PACE Medicare |
$4.75
|
| Rate for Payer: PACE SWMI |
$5.00
|
| Rate for Payer: PHP Commercial |
$68.71
|
| Rate for Payer: PHP Medicare Advantage |
$5.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.00
|
| Rate for Payer: Priority Health Medicare |
$5.00
|
| Rate for Payer: Priority Health SBD |
$50.93
|
| Rate for Payer: Priority Health Tiered Network |
$4.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.50
|
| Rate for Payer: UHC Core |
$7.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.00
|
| Rate for Payer: UHC Exchange |
$7.50
|
| Rate for Payer: UHC Medicaid |
$2.62
|
| Rate for Payer: UHCCP Medicaid |
$2.62
|
| Rate for Payer: VA VA |
$5.00
|
|
