|
HC SQ OR IM INJECTION
|
Facility
|
IP
|
$149.79
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
51000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$94.37 |
| Max. Negotiated Rate |
$134.81 |
| Rate for Payer: Aetna Commercial |
$127.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.36
|
| Rate for Payer: Cash Price |
$119.83
|
| Rate for Payer: Cofinity Commercial |
$104.85
|
| Rate for Payer: Cofinity Commercial |
$128.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.83
|
| Rate for Payer: Healthscope Commercial |
$134.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.32
|
| Rate for Payer: PHP Commercial |
$127.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.36
|
| Rate for Payer: Priority Health SBD |
$94.37
|
|
|
HC SRA, LMWH
|
Facility
|
OP
|
$332.93
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200424
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$299.64 |
| Rate for Payer: Aetna Commercial |
$282.99
|
| Rate for Payer: Aetna Medicare |
$19.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.96
|
| Rate for Payer: BCBS Complete |
$10.34
|
| Rate for Payer: BCBS MAPPO |
$18.37
|
| Rate for Payer: BCN Medicare Advantage |
$18.37
|
| Rate for Payer: Cash Price |
$266.34
|
| Rate for Payer: Cash Price |
$266.34
|
| Rate for Payer: Cofinity Commercial |
$286.32
|
| Rate for Payer: Cofinity Commercial |
$233.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.37
|
| Rate for Payer: Healthscope Commercial |
$299.64
|
| Rate for Payer: Mclaren Medicaid |
$9.85
|
| Rate for Payer: Mclaren Medicare |
$18.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.29
|
| Rate for Payer: Meridian Medicaid |
$10.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.99
|
| Rate for Payer: PACE Medicare |
$17.45
|
| Rate for Payer: PACE SWMI |
$18.37
|
| Rate for Payer: PHP Commercial |
$282.99
|
| Rate for Payer: PHP Medicare Advantage |
$18.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.40
|
| Rate for Payer: Priority Health Medicare |
$18.37
|
| Rate for Payer: Priority Health SBD |
$209.75
|
| Rate for Payer: Railroad Medicare Medicare |
$18.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.37
|
| Rate for Payer: UHC Medicare Advantage |
$18.37
|
| Rate for Payer: UHCCP Medicaid |
$10.34
|
| Rate for Payer: VA VA |
$18.37
|
|
|
HC SRA, LMWH
|
Facility
|
IP
|
$332.93
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200424
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$209.75 |
| Max. Negotiated Rate |
$299.64 |
| Rate for Payer: Aetna Commercial |
$282.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.40
|
| Rate for Payer: Cash Price |
$266.34
|
| Rate for Payer: Cofinity Commercial |
$233.05
|
| Rate for Payer: Cofinity Commercial |
$286.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.34
|
| Rate for Payer: Healthscope Commercial |
$299.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.99
|
| Rate for Payer: PHP Commercial |
$282.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.40
|
| Rate for Payer: Priority Health SBD |
$209.75
|
|
|
HC SRS CRANIAL LESION LIN ACC
|
Facility
|
IP
|
$3,101.43
|
|
|
Service Code
|
CPT 77372
|
| Hospital Charge Code |
33300032
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,953.90 |
| Max. Negotiated Rate |
$2,791.29 |
| Rate for Payer: Aetna Commercial |
$2,636.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,015.93
|
| Rate for Payer: Cash Price |
$2,481.14
|
| Rate for Payer: Cofinity Commercial |
$2,171.00
|
| Rate for Payer: Cofinity Commercial |
$2,667.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,171.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,481.14
|
| Rate for Payer: Healthscope Commercial |
$2,791.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,636.22
|
| Rate for Payer: PHP Commercial |
$2,636.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,015.93
|
| Rate for Payer: Priority Health SBD |
$1,953.90
|
|
|
HC SRS CRANIAL LESION LIN ACC
|
Facility
|
OP
|
$3,101.43
|
|
|
Service Code
|
CPT 77372
|
| Hospital Charge Code |
33300032
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,953.90 |
| Max. Negotiated Rate |
$20,986.54 |
| Rate for Payer: Aetna Commercial |
$2,636.22
|
| Rate for Payer: Aetna Medicare |
$7,753.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,015.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,319.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,319.40
|
| Rate for Payer: BCBS Complete |
$4,195.97
|
| Rate for Payer: BCBS MAPPO |
$7,455.52
|
| Rate for Payer: BCN Medicare Advantage |
$7,455.52
|
| Rate for Payer: Cash Price |
$2,481.14
|
| Rate for Payer: Cash Price |
$2,481.14
|
| Rate for Payer: Cofinity Commercial |
$2,667.23
|
| Rate for Payer: Cofinity Commercial |
$2,171.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,171.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,481.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,455.52
|
| Rate for Payer: Healthscope Commercial |
$2,791.29
|
| Rate for Payer: Mclaren Medicaid |
$3,996.16
|
| Rate for Payer: Mclaren Medicare |
$7,455.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,828.30
|
| Rate for Payer: Meridian Medicaid |
$4,195.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,573.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,636.22
|
| Rate for Payer: PACE Medicare |
$7,082.74
|
| Rate for Payer: PACE SWMI |
$7,455.52
|
| Rate for Payer: PHP Commercial |
$2,636.22
|
| Rate for Payer: PHP Medicare Advantage |
$7,455.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,996.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,015.93
|
| Rate for Payer: Priority Health Medicare |
$7,455.52
|
| Rate for Payer: Priority Health SBD |
$1,953.90
|
| Rate for Payer: Railroad Medicare Medicare |
$7,455.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,986.54
|
| Rate for Payer: UHC Core |
$2,295.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,455.52
|
| Rate for Payer: UHC Medicare Advantage |
$7,455.52
|
| Rate for Payer: UHCCP Medicaid |
$4,197.46
|
| Rate for Payer: VA VA |
$7,455.52
|
|
|
HC SRT UP TO 5 FRACTIONS
|
Facility
|
OP
|
$5,306.04
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
33300018
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$917.90 |
| Max. Negotiated Rate |
$4,820.52 |
| Rate for Payer: Aetna Commercial |
$4,510.13
|
| Rate for Payer: Aetna Medicare |
$1,781.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,448.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,140.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,140.62
|
| Rate for Payer: BCBS Complete |
$963.79
|
| Rate for Payer: BCBS MAPPO |
$1,712.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,712.50
|
| Rate for Payer: Cash Price |
$4,244.83
|
| Rate for Payer: Cash Price |
$4,244.83
|
| Rate for Payer: Cofinity Commercial |
$4,563.19
|
| Rate for Payer: Cofinity Commercial |
$3,714.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,714.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,244.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,712.50
|
| Rate for Payer: Healthscope Commercial |
$4,775.44
|
| Rate for Payer: Mclaren Medicaid |
$917.90
|
| Rate for Payer: Mclaren Medicare |
$1,712.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,798.12
|
| Rate for Payer: Meridian Medicaid |
$963.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,969.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,510.13
|
| Rate for Payer: PACE Medicare |
$1,626.88
|
| Rate for Payer: PACE SWMI |
$1,712.50
|
| Rate for Payer: PHP Commercial |
$4,510.13
|
| Rate for Payer: PHP Medicare Advantage |
$1,712.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$917.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,448.93
|
| Rate for Payer: Priority Health Medicare |
$1,712.50
|
| Rate for Payer: Priority Health SBD |
$3,342.81
|
| Rate for Payer: Railroad Medicare Medicare |
$1,712.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,820.52
|
| Rate for Payer: UHC Core |
$3,926.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,712.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,712.50
|
| Rate for Payer: UHCCP Medicaid |
$964.14
|
| Rate for Payer: VA VA |
$1,712.50
|
|
|
HC SRT UP TO 5 FRACTIONS
|
Facility
|
IP
|
$5,306.04
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
33300018
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$3,342.81 |
| Max. Negotiated Rate |
$4,775.44 |
| Rate for Payer: Aetna Commercial |
$4,510.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,448.93
|
| Rate for Payer: Cash Price |
$4,244.83
|
| Rate for Payer: Cofinity Commercial |
$3,714.23
|
| Rate for Payer: Cofinity Commercial |
$4,563.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,714.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,244.83
|
| Rate for Payer: Healthscope Commercial |
$4,775.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,510.13
|
| Rate for Payer: PHP Commercial |
$4,510.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,448.93
|
| Rate for Payer: Priority Health SBD |
$3,342.81
|
|
|
HC SS2PC SPECIAL STAIN (BILL ONLY)
|
Facility
|
IP
|
$112.20
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
31200007
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$70.69 |
| Max. Negotiated Rate |
$100.98 |
| Rate for Payer: Aetna Commercial |
$95.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.93
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cofinity Commercial |
$78.54
|
| Rate for Payer: Cofinity Commercial |
$96.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.76
|
| Rate for Payer: Healthscope Commercial |
$100.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.37
|
| Rate for Payer: PHP Commercial |
$95.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.93
|
| Rate for Payer: Priority Health SBD |
$70.69
|
|
|
HC SS2PC SPECIAL STAIN (BILL ONLY)
|
Facility
|
OP
|
$112.20
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
31200007
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$67.38 |
| Max. Negotiated Rate |
$353.86 |
| Rate for Payer: Aetna Commercial |
$95.37
|
| Rate for Payer: Aetna Medicare |
$130.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.14
|
| Rate for Payer: BCBS Complete |
$70.75
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cofinity Commercial |
$96.49
|
| Rate for Payer: Cofinity Commercial |
$78.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.71
|
| Rate for Payer: Healthscope Commercial |
$100.98
|
| Rate for Payer: Mclaren Medicaid |
$67.38
|
| Rate for Payer: Mclaren Medicare |
$125.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.00
|
| Rate for Payer: Meridian Medicaid |
$70.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.37
|
| Rate for Payer: PACE Medicare |
$119.42
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Commercial |
$95.37
|
| Rate for Payer: PHP Medicare Advantage |
$125.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.93
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: Priority Health SBD |
$70.69
|
| Rate for Payer: Railroad Medicare Medicare |
$125.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.71
|
| Rate for Payer: UHC Medicare Advantage |
$125.71
|
| Rate for Payer: UHCCP Medicaid |
$70.77
|
| Rate for Payer: VA VA |
$125.71
|
|
|
HC STABILIZERS HEART ESTECH
|
Facility
|
IP
|
$933.30
|
|
| Hospital Charge Code |
27000292
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$587.98 |
| Max. Negotiated Rate |
$839.97 |
| Rate for Payer: Aetna Commercial |
$793.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$606.64
|
| Rate for Payer: Cash Price |
$746.64
|
| Rate for Payer: Cofinity Commercial |
$653.31
|
| Rate for Payer: Cofinity Commercial |
$802.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$653.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$746.64
|
| Rate for Payer: Healthscope Commercial |
$839.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$793.30
|
| Rate for Payer: PHP Commercial |
$793.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$606.64
|
| Rate for Payer: Priority Health SBD |
$587.98
|
|
|
HC STABILIZERS HEART ESTECH
|
Facility
|
OP
|
$933.30
|
|
| Hospital Charge Code |
27000292
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$373.32 |
| Max. Negotiated Rate |
$839.97 |
| Rate for Payer: Aetna Commercial |
$793.30
|
| Rate for Payer: Aetna Medicare |
$466.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$606.64
|
| Rate for Payer: BCBS Complete |
$373.32
|
| Rate for Payer: Cash Price |
$746.64
|
| Rate for Payer: Cofinity Commercial |
$653.31
|
| Rate for Payer: Cofinity Commercial |
$802.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$653.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$746.64
|
| Rate for Payer: Healthscope Commercial |
$839.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$793.30
|
| Rate for Payer: PHP Commercial |
$793.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$606.64
|
| Rate for Payer: Priority Health SBD |
$587.98
|
|
|
HC STACLOT LA.
|
Facility
|
IP
|
$148.92
|
|
|
Service Code
|
CPT 85597
|
| Hospital Charge Code |
30500085
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$93.82 |
| Max. Negotiated Rate |
$134.03 |
| Rate for Payer: Aetna Commercial |
$126.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.80
|
| Rate for Payer: Cash Price |
$119.14
|
| Rate for Payer: Cofinity Commercial |
$104.24
|
| Rate for Payer: Cofinity Commercial |
$128.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.14
|
| Rate for Payer: Healthscope Commercial |
$134.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.58
|
| Rate for Payer: PHP Commercial |
$126.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.80
|
| Rate for Payer: Priority Health SBD |
$93.82
|
|
|
HC STACLOT LA.
|
Facility
|
OP
|
$148.92
|
|
|
Service Code
|
CPT 85597
|
| Hospital Charge Code |
30500085
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$134.03 |
| Rate for Payer: Aetna Commercial |
$126.58
|
| Rate for Payer: Aetna Medicare |
$18.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.80
|
| 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 |
$10.12
|
| Rate for Payer: BCBS MAPPO |
$17.98
|
| Rate for Payer: BCN Medicare Advantage |
$17.98
|
| Rate for Payer: Cash Price |
$119.14
|
| Rate for Payer: Cash Price |
$119.14
|
| Rate for Payer: Cofinity Commercial |
$128.07
|
| Rate for Payer: Cofinity Commercial |
$104.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.98
|
| Rate for Payer: Healthscope Commercial |
$134.03
|
| Rate for Payer: Mclaren Medicaid |
$9.64
|
| 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 |
$10.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.58
|
| Rate for Payer: PACE Medicare |
$17.08
|
| Rate for Payer: PACE SWMI |
$17.98
|
| Rate for Payer: PHP Commercial |
$126.58
|
| Rate for Payer: PHP Medicare Advantage |
$17.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.80
|
| Rate for Payer: Priority Health Medicare |
$17.98
|
| Rate for Payer: Priority Health SBD |
$93.82
|
| Rate for Payer: Railroad Medicare Medicare |
$17.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.98
|
| Rate for Payer: UHC Medicare Advantage |
$17.98
|
| Rate for Payer: UHCCP Medicaid |
$10.12
|
| Rate for Payer: VA VA |
$17.98
|
|
|
HC STANDBY OPEN HEART/TAVR
|
Facility
|
OP
|
$2,417.64
|
|
| Hospital Charge Code |
27000151
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$967.06 |
| Max. Negotiated Rate |
$2,175.88 |
| Rate for Payer: Aetna Commercial |
$2,054.99
|
| Rate for Payer: Aetna Medicare |
$1,208.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,571.47
|
| Rate for Payer: BCBS Complete |
$967.06
|
| Rate for Payer: Cash Price |
$1,934.11
|
| Rate for Payer: Cofinity Commercial |
$1,692.35
|
| Rate for Payer: Cofinity Commercial |
$2,079.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,692.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,934.11
|
| Rate for Payer: Healthscope Commercial |
$2,175.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,054.99
|
| Rate for Payer: PHP Commercial |
$2,054.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,571.47
|
| Rate for Payer: Priority Health SBD |
$1,523.11
|
|
|
HC STANDBY OPEN HEART/TAVR
|
Facility
|
IP
|
$2,417.64
|
|
| Hospital Charge Code |
27000151
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,523.11 |
| Max. Negotiated Rate |
$2,175.88 |
| Rate for Payer: Aetna Commercial |
$2,054.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,571.47
|
| Rate for Payer: Cash Price |
$1,934.11
|
| Rate for Payer: Cofinity Commercial |
$1,692.35
|
| Rate for Payer: Cofinity Commercial |
$2,079.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,692.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,934.11
|
| Rate for Payer: Healthscope Commercial |
$2,175.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,054.99
|
| Rate for Payer: PHP Commercial |
$2,054.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,571.47
|
| Rate for Payer: Priority Health SBD |
$1,523.11
|
|
|
HC STAPHYLOCOCCUS AUREUS PCR
|
Facility
|
OP
|
$56.10
|
|
|
Service Code
|
CPT 87640
|
| Hospital Charge Code |
30600263
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$98.77 |
| Rate for Payer: Aetna Commercial |
$47.69
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.47
|
| 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 |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$44.88
|
| Rate for Payer: Cash Price |
$44.88
|
| Rate for Payer: Cofinity Commercial |
$48.25
|
| Rate for Payer: Cofinity Commercial |
$39.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$50.49
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| 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 |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.69
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$47.69
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.47
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$35.34
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$19.76
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC STAPHYLOCOCCUS AUREUS PCR
|
Facility
|
IP
|
$56.10
|
|
|
Service Code
|
CPT 87640
|
| Hospital Charge Code |
30600263
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.34 |
| Max. Negotiated Rate |
$50.49 |
| Rate for Payer: Aetna Commercial |
$47.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.47
|
| Rate for Payer: Cash Price |
$44.88
|
| Rate for Payer: Cofinity Commercial |
$39.27
|
| Rate for Payer: Cofinity Commercial |
$48.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.88
|
| Rate for Payer: Healthscope Commercial |
$50.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.69
|
| Rate for Payer: PHP Commercial |
$47.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.47
|
| Rate for Payer: Priority Health SBD |
$35.34
|
|
|
HC STAPHYLOCOCCUS AUREUS PCR METHICILLIN RESISTANT
|
Facility
|
IP
|
$61.69
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
30600264
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$38.86 |
| Max. Negotiated Rate |
$55.52 |
| Rate for Payer: Aetna Commercial |
$52.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.10
|
| Rate for Payer: Cash Price |
$49.35
|
| Rate for Payer: Cofinity Commercial |
$43.18
|
| Rate for Payer: Cofinity Commercial |
$53.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.35
|
| Rate for Payer: Healthscope Commercial |
$55.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.44
|
| Rate for Payer: PHP Commercial |
$52.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.10
|
| Rate for Payer: Priority Health SBD |
$38.86
|
|
|
HC STAPHYLOCOCCUS AUREUS PCR METHICILLIN RESISTANT
|
Facility
|
OP
|
$61.69
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
30600264
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$98.77 |
| Rate for Payer: Aetna Commercial |
$52.44
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.10
|
| 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 |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$49.35
|
| Rate for Payer: Cash Price |
$49.35
|
| Rate for Payer: Cofinity Commercial |
$53.05
|
| Rate for Payer: Cofinity Commercial |
$43.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$55.52
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| 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 |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.44
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$52.44
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.10
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$38.86
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$19.76
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC STATLOCK
|
Facility
|
OP
|
$143.69
|
|
| Hospital Charge Code |
27000152
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.48 |
| Max. Negotiated Rate |
$129.32 |
| Rate for Payer: Aetna Commercial |
$122.14
|
| Rate for Payer: Aetna Medicare |
$71.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.40
|
| Rate for Payer: BCBS Complete |
$57.48
|
| Rate for Payer: Cash Price |
$114.95
|
| Rate for Payer: Cofinity Commercial |
$100.58
|
| Rate for Payer: Cofinity Commercial |
$123.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.95
|
| Rate for Payer: Healthscope Commercial |
$129.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.14
|
| Rate for Payer: PHP Commercial |
$122.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.40
|
| Rate for Payer: Priority Health SBD |
$90.52
|
|
|
HC STATLOCK
|
Facility
|
IP
|
$143.69
|
|
| Hospital Charge Code |
27000152
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$90.52 |
| Max. Negotiated Rate |
$129.32 |
| Rate for Payer: Aetna Commercial |
$122.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.40
|
| Rate for Payer: Cash Price |
$114.95
|
| Rate for Payer: Cofinity Commercial |
$100.58
|
| Rate for Payer: Cofinity Commercial |
$123.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.95
|
| Rate for Payer: Healthscope Commercial |
$129.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.14
|
| Rate for Payer: PHP Commercial |
$122.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.40
|
| Rate for Payer: Priority Health SBD |
$90.52
|
|
|
HC STENGER TEST PURE TONE
|
Facility
|
OP
|
$34.68
|
|
|
Service Code
|
CPT 92565
|
| Hospital Charge Code |
76100500
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$21.85 |
| Max. Negotiated Rate |
$163.07 |
| Rate for Payer: Aetna Commercial |
$29.48
|
| Rate for Payer: Aetna Medicare |
$60.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.41
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$57.93
|
| Rate for Payer: BCN Medicare Advantage |
$57.93
|
| Rate for Payer: Cash Price |
$27.74
|
| Rate for Payer: Cash Price |
$27.74
|
| Rate for Payer: Cofinity Commercial |
$24.28
|
| Rate for Payer: Cofinity Commercial |
$29.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.93
|
| Rate for Payer: Healthscope Commercial |
$31.21
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Mclaren Medicare |
$57.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.83
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.48
|
| Rate for Payer: PACE Medicare |
$55.03
|
| Rate for Payer: PACE SWMI |
$57.93
|
| Rate for Payer: PHP Commercial |
$29.48
|
| Rate for Payer: PHP Medicare Advantage |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.54
|
| Rate for Payer: Priority Health Medicare |
$57.93
|
| Rate for Payer: Priority Health SBD |
$21.85
|
| Rate for Payer: Railroad Medicare Medicare |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.07
|
| Rate for Payer: UHC Core |
$25.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.93
|
| Rate for Payer: UHC Exchange |
$25.66
|
| Rate for Payer: UHC Medicare Advantage |
$57.93
|
| Rate for Payer: UHCCP Medicaid |
$32.61
|
| Rate for Payer: VA VA |
$57.93
|
|
|
HC STENGER TEST PURE TONE
|
Facility
|
IP
|
$34.68
|
|
|
Service Code
|
CPT 92565
|
| Hospital Charge Code |
76100500
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$21.85 |
| Max. Negotiated Rate |
$31.21 |
| Rate for Payer: Aetna Commercial |
$29.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.54
|
| Rate for Payer: Cash Price |
$27.74
|
| Rate for Payer: Cofinity Commercial |
$24.28
|
| Rate for Payer: Cofinity Commercial |
$29.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.74
|
| Rate for Payer: Healthscope Commercial |
$31.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.48
|
| Rate for Payer: PHP Commercial |
$29.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.54
|
| Rate for Payer: Priority Health SBD |
$21.85
|
|
|
HC STENGER TEST SPEECH
|
Facility
|
OP
|
$1,449.42
|
|
|
Service Code
|
CPT 92577
|
| Hospital Charge Code |
76100488
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$277.37 |
| Max. Negotiated Rate |
$1,456.65 |
| Rate for Payer: Aetna Commercial |
$1,232.01
|
| Rate for Payer: Aetna Medicare |
$538.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$942.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$646.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$646.85
|
| Rate for Payer: BCBS Complete |
$291.24
|
| Rate for Payer: BCBS MAPPO |
$517.48
|
| Rate for Payer: BCN Medicare Advantage |
$517.48
|
| Rate for Payer: Cash Price |
$1,159.54
|
| Rate for Payer: Cash Price |
$1,159.54
|
| Rate for Payer: Cofinity Commercial |
$1,246.50
|
| Rate for Payer: Cofinity Commercial |
$1,014.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,014.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,159.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$517.48
|
| Rate for Payer: Healthscope Commercial |
$1,304.48
|
| Rate for Payer: Mclaren Medicaid |
$277.37
|
| Rate for Payer: Mclaren Medicare |
$517.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.35
|
| Rate for Payer: Meridian Medicaid |
$291.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,232.01
|
| Rate for Payer: PACE Medicare |
$491.61
|
| Rate for Payer: PACE SWMI |
$517.48
|
| Rate for Payer: PHP Commercial |
$1,232.01
|
| 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 |
$942.12
|
| Rate for Payer: Priority Health Medicare |
$517.48
|
| Rate for Payer: Priority Health SBD |
$913.13
|
| Rate for Payer: Railroad Medicare Medicare |
$517.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,456.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.48
|
| Rate for Payer: UHC Medicare Advantage |
$517.48
|
| Rate for Payer: UHCCP Medicaid |
$291.34
|
| Rate for Payer: VA VA |
$517.48
|
|
|
HC STENGER TEST SPEECH
|
Facility
|
IP
|
$1,449.42
|
|
|
Service Code
|
CPT 92577
|
| Hospital Charge Code |
76100488
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$913.13 |
| Max. Negotiated Rate |
$1,304.48 |
| Rate for Payer: Aetna Commercial |
$1,232.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$942.12
|
| Rate for Payer: Cash Price |
$1,159.54
|
| Rate for Payer: Cofinity Commercial |
$1,014.59
|
| Rate for Payer: Cofinity Commercial |
$1,246.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,014.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,159.54
|
| Rate for Payer: Healthscope Commercial |
$1,304.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,232.01
|
| Rate for Payer: PHP Commercial |
$1,232.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$942.12
|
| Rate for Payer: Priority Health SBD |
$913.13
|
|
