|
HC SURGERY FROZEN EA ADDL
|
Facility
|
IP
|
$74.70
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
31000057
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$47.06 |
| Max. Negotiated Rate |
$67.23 |
| Rate for Payer: Aetna Commercial |
$63.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.55
|
| Rate for Payer: Cash Price |
$59.76
|
| Rate for Payer: Cofinity Commercial |
$52.29
|
| Rate for Payer: Cofinity Commercial |
$64.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.76
|
| Rate for Payer: Healthscope Commercial |
$67.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.49
|
| Rate for Payer: PHP Commercial |
$63.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.55
|
| Rate for Payer: Priority Health SBD |
$47.06
|
|
|
HC SURGERY FROZEN EA ADDL
|
Facility
|
OP
|
$74.70
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
31000057
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$29.88 |
| Max. Negotiated Rate |
$67.23 |
| Rate for Payer: Aetna Commercial |
$63.49
|
| Rate for Payer: Aetna Medicare |
$37.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.55
|
| Rate for Payer: BCBS Complete |
$29.88
|
| Rate for Payer: Cash Price |
$59.76
|
| Rate for Payer: Cofinity Commercial |
$52.29
|
| Rate for Payer: Cofinity Commercial |
$64.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.76
|
| Rate for Payer: Healthscope Commercial |
$67.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.49
|
| Rate for Payer: PHP Commercial |
$63.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.55
|
| Rate for Payer: Priority Health SBD |
$47.06
|
|
|
HC SURGICAL HAND
|
Facility
|
IP
|
$704.42
|
|
| Hospital Charge Code |
45000053
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$443.78 |
| Max. Negotiated Rate |
$633.98 |
| Rate for Payer: Aetna Commercial |
$598.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$457.87
|
| Rate for Payer: Cash Price |
$563.54
|
| Rate for Payer: Cofinity Commercial |
$493.09
|
| Rate for Payer: Cofinity Commercial |
$605.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$493.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$563.54
|
| Rate for Payer: Healthscope Commercial |
$633.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$598.76
|
| Rate for Payer: PHP Commercial |
$598.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$457.87
|
| Rate for Payer: Priority Health SBD |
$443.78
|
|
|
HC SURGICAL HAND
|
Facility
|
OP
|
$704.42
|
|
| Hospital Charge Code |
45000053
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$281.77 |
| Max. Negotiated Rate |
$633.98 |
| Rate for Payer: Aetna Commercial |
$598.76
|
| Rate for Payer: Aetna Medicare |
$352.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$457.87
|
| Rate for Payer: BCBS Complete |
$281.77
|
| Rate for Payer: Cash Price |
$563.54
|
| Rate for Payer: Cofinity Commercial |
$493.09
|
| Rate for Payer: Cofinity Commercial |
$605.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$493.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$563.54
|
| Rate for Payer: Healthscope Commercial |
$633.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$598.76
|
| Rate for Payer: PHP Commercial |
$598.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$457.87
|
| Rate for Payer: Priority Health SBD |
$443.78
|
|
|
HC SURG SUPPLY MISC
|
Facility
|
OP
|
$86.43
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
62300132
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$34.57 |
| Max. Negotiated Rate |
$77.79 |
| Rate for Payer: Aetna Commercial |
$73.47
|
| Rate for Payer: Aetna Medicare |
$43.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.18
|
| Rate for Payer: BCBS Complete |
$34.57
|
| Rate for Payer: Cash Price |
$69.14
|
| Rate for Payer: Cofinity Commercial |
$60.50
|
| Rate for Payer: Cofinity Commercial |
$74.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.14
|
| Rate for Payer: Healthscope Commercial |
$77.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.47
|
| Rate for Payer: PHP Commercial |
$73.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.18
|
| Rate for Payer: Priority Health SBD |
$54.45
|
|
|
HC SURG SUPPLY MISC
|
Facility
|
IP
|
$86.43
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
62300132
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$54.45 |
| Max. Negotiated Rate |
$77.79 |
| Rate for Payer: Aetna Commercial |
$73.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.18
|
| Rate for Payer: Cash Price |
$69.14
|
| Rate for Payer: Cofinity Commercial |
$60.50
|
| Rate for Payer: Cofinity Commercial |
$74.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.14
|
| Rate for Payer: Healthscope Commercial |
$77.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.47
|
| Rate for Payer: PHP Commercial |
$73.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.18
|
| Rate for Payer: Priority Health SBD |
$54.45
|
|
|
HC SUSCEPTIBILITY DISK
|
Facility
|
OP
|
$58.65
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
30600098
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$52.78 |
| Rate for Payer: Aetna Commercial |
$49.85
|
| Rate for Payer: Aetna Medicare |
$7.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.12
|
| 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 |
$4.21
|
| Rate for Payer: BCBS MAPPO |
$7.48
|
| Rate for Payer: BCN Medicare Advantage |
$7.48
|
| Rate for Payer: Cash Price |
$46.92
|
| Rate for Payer: Cash Price |
$46.92
|
| Rate for Payer: Cofinity Commercial |
$50.44
|
| Rate for Payer: Cofinity Commercial |
$41.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.48
|
| Rate for Payer: Healthscope Commercial |
$52.78
|
| Rate for Payer: Mclaren Medicaid |
$4.01
|
| 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 |
$4.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.85
|
| Rate for Payer: PACE Medicare |
$7.11
|
| Rate for Payer: PACE SWMI |
$7.48
|
| Rate for Payer: PHP Commercial |
$49.85
|
| Rate for Payer: PHP Medicare Advantage |
$7.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.12
|
| Rate for Payer: Priority Health Medicare |
$7.48
|
| Rate for Payer: Priority Health SBD |
$36.95
|
| Rate for Payer: Railroad Medicare Medicare |
$7.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.48
|
| Rate for Payer: UHC Medicare Advantage |
$7.48
|
| Rate for Payer: UHCCP Medicaid |
$4.21
|
| Rate for Payer: VA VA |
$7.48
|
|
|
HC SUSCEPTIBILITY DISK
|
Facility
|
IP
|
$58.65
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
30600098
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.95 |
| Max. Negotiated Rate |
$52.78 |
| Rate for Payer: Aetna Commercial |
$49.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.12
|
| Rate for Payer: Cash Price |
$46.92
|
| Rate for Payer: Cofinity Commercial |
$41.05
|
| Rate for Payer: Cofinity Commercial |
$50.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.92
|
| Rate for Payer: Healthscope Commercial |
$52.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.85
|
| Rate for Payer: PHP Commercial |
$49.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.12
|
| Rate for Payer: Priority Health SBD |
$36.95
|
|
|
HC SUSCEPTIBILITY E TEST
|
Facility
|
IP
|
$32.77
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
30600097
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.65 |
| Max. Negotiated Rate |
$29.49 |
| Rate for Payer: Aetna Commercial |
$27.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.30
|
| Rate for Payer: Cash Price |
$26.22
|
| Rate for Payer: Cofinity Commercial |
$22.94
|
| Rate for Payer: Cofinity Commercial |
$28.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.22
|
| Rate for Payer: Healthscope Commercial |
$29.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.85
|
| Rate for Payer: PHP Commercial |
$27.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.30
|
| Rate for Payer: Priority Health SBD |
$20.65
|
|
|
HC SUSCEPTIBILITY E TEST
|
Facility
|
OP
|
$32.77
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
30600097
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$29.49 |
| Rate for Payer: Aetna Commercial |
$27.85
|
| Rate for Payer: Aetna Medicare |
$4.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.30
|
| 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 |
$2.67
|
| Rate for Payer: BCBS MAPPO |
$4.75
|
| Rate for Payer: BCN Medicare Advantage |
$4.75
|
| Rate for Payer: Cash Price |
$26.22
|
| Rate for Payer: Cash Price |
$26.22
|
| Rate for Payer: Cofinity Commercial |
$28.18
|
| Rate for Payer: Cofinity Commercial |
$22.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.75
|
| Rate for Payer: Healthscope Commercial |
$29.49
|
| Rate for Payer: Mclaren Medicaid |
$2.55
|
| 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 |
$2.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.85
|
| Rate for Payer: PACE Medicare |
$4.51
|
| Rate for Payer: PACE SWMI |
$4.75
|
| Rate for Payer: PHP Commercial |
$27.85
|
| Rate for Payer: PHP Medicare Advantage |
$4.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.30
|
| Rate for Payer: Priority Health Medicare |
$4.75
|
| Rate for Payer: Priority Health SBD |
$20.65
|
| Rate for Payer: Railroad Medicare Medicare |
$4.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.75
|
| Rate for Payer: UHC Medicare Advantage |
$4.75
|
| Rate for Payer: UHCCP Medicaid |
$2.67
|
| Rate for Payer: VA VA |
$4.75
|
|
|
HC SUSCEPTIBILITY, MIC
|
Facility
|
OP
|
$80.58
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
30600100
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$72.52 |
| Rate for Payer: Aetna Commercial |
$68.49
|
| Rate for Payer: Aetna Medicare |
$9.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.38
|
| 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 |
$4.87
|
| Rate for Payer: BCBS MAPPO |
$8.65
|
| Rate for Payer: BCN Medicare Advantage |
$8.65
|
| Rate for Payer: Cash Price |
$64.46
|
| Rate for Payer: Cash Price |
$64.46
|
| Rate for Payer: Cofinity Commercial |
$69.30
|
| Rate for Payer: Cofinity Commercial |
$56.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.65
|
| Rate for Payer: Healthscope Commercial |
$72.52
|
| Rate for Payer: Mclaren Medicaid |
$4.64
|
| 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 |
$4.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.49
|
| Rate for Payer: PACE Medicare |
$8.22
|
| Rate for Payer: PACE SWMI |
$8.65
|
| Rate for Payer: PHP Commercial |
$68.49
|
| Rate for Payer: PHP Medicare Advantage |
$8.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.38
|
| Rate for Payer: Priority Health Medicare |
$8.65
|
| Rate for Payer: Priority Health SBD |
$50.77
|
| Rate for Payer: Railroad Medicare Medicare |
$8.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.65
|
| Rate for Payer: UHC Medicare Advantage |
$8.65
|
| Rate for Payer: UHCCP Medicaid |
$4.87
|
| Rate for Payer: VA VA |
$8.65
|
|
|
HC SUSCEPTIBILITY, MIC
|
Facility
|
IP
|
$80.58
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
30600100
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$50.77 |
| Max. Negotiated Rate |
$72.52 |
| Rate for Payer: Aetna Commercial |
$68.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.38
|
| Rate for Payer: Cash Price |
$64.46
|
| Rate for Payer: Cofinity Commercial |
$56.41
|
| Rate for Payer: Cofinity Commercial |
$69.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.46
|
| Rate for Payer: Healthscope Commercial |
$72.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.49
|
| Rate for Payer: PHP Commercial |
$68.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.38
|
| Rate for Payer: Priority Health SBD |
$50.77
|
|
|
HC SWALLOW EVALUATION
|
Facility
|
IP
|
$333.35
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
44400004
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$210.01 |
| Max. Negotiated Rate |
$300.01 |
| Rate for Payer: Aetna Commercial |
$283.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.68
|
| Rate for Payer: Cash Price |
$266.68
|
| Rate for Payer: Cofinity Commercial |
$233.34
|
| Rate for Payer: Cofinity Commercial |
$286.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.68
|
| Rate for Payer: Healthscope Commercial |
$300.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.35
|
| Rate for Payer: PHP Commercial |
$283.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.68
|
| Rate for Payer: Priority Health SBD |
$210.01
|
|
|
HC SWALLOW EVALUATION
|
Facility
|
OP
|
$333.35
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
44400004
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$133.34 |
| Max. Negotiated Rate |
$300.01 |
| Rate for Payer: Aetna Commercial |
$283.35
|
| Rate for Payer: Aetna Medicare |
$166.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.68
|
| Rate for Payer: BCBS Complete |
$133.34
|
| Rate for Payer: Cash Price |
$266.68
|
| Rate for Payer: Cash Price |
$266.68
|
| Rate for Payer: Cofinity Commercial |
$286.68
|
| Rate for Payer: Cofinity Commercial |
$233.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.68
|
| Rate for Payer: Healthscope Commercial |
$300.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.35
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$283.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.68
|
| Rate for Payer: Priority Health SBD |
$210.01
|
| Rate for Payer: UHC Core |
$246.68
|
| Rate for Payer: UHC Exchange |
$246.68
|
|
|
HC SWALLOWING THERAPY
|
Facility
|
IP
|
$222.68
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
43000020
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$140.29 |
| Max. Negotiated Rate |
$200.41 |
| Rate for Payer: Aetna Commercial |
$189.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.74
|
| Rate for Payer: Cash Price |
$178.14
|
| Rate for Payer: Cofinity Commercial |
$155.88
|
| Rate for Payer: Cofinity Commercial |
$191.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$155.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.14
|
| Rate for Payer: Healthscope Commercial |
$200.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.28
|
| Rate for Payer: PHP Commercial |
$189.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.74
|
| Rate for Payer: Priority Health SBD |
$140.29
|
|
|
HC SWALLOWING THERAPY
|
Facility
|
OP
|
$222.68
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
43000020
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$89.07 |
| Max. Negotiated Rate |
$200.41 |
| Rate for Payer: Aetna Commercial |
$189.28
|
| Rate for Payer: Aetna Medicare |
$111.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.74
|
| Rate for Payer: BCBS Complete |
$89.07
|
| Rate for Payer: Cash Price |
$178.14
|
| Rate for Payer: Cash Price |
$178.14
|
| Rate for Payer: Cofinity Commercial |
$191.50
|
| Rate for Payer: Cofinity Commercial |
$155.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$155.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.14
|
| Rate for Payer: Healthscope Commercial |
$200.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.28
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$189.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.74
|
| Rate for Payer: Priority Health SBD |
$140.29
|
| Rate for Payer: UHC Core |
$164.78
|
| Rate for Payer: UHC Exchange |
$164.78
|
|
|
HC SWAN GANZ CATHETER
|
Facility
|
OP
|
$235.47
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200073
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.19 |
| Max. Negotiated Rate |
$211.92 |
| Rate for Payer: Aetna Commercial |
$200.15
|
| Rate for Payer: Aetna Medicare |
$117.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.06
|
| Rate for Payer: BCBS Complete |
$94.19
|
| Rate for Payer: Cash Price |
$188.38
|
| Rate for Payer: Cofinity Commercial |
$164.83
|
| Rate for Payer: Cofinity Commercial |
$202.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.38
|
| Rate for Payer: Healthscope Commercial |
$211.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.15
|
| Rate for Payer: PHP Commercial |
$200.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.06
|
| Rate for Payer: Priority Health SBD |
$148.35
|
|
|
HC SWAN GANZ CATHETER
|
Facility
|
IP
|
$235.47
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200073
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.35 |
| Max. Negotiated Rate |
$211.92 |
| Rate for Payer: Aetna Commercial |
$200.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.06
|
| Rate for Payer: Cash Price |
$188.38
|
| Rate for Payer: Cofinity Commercial |
$164.83
|
| Rate for Payer: Cofinity Commercial |
$202.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.38
|
| Rate for Payer: Healthscope Commercial |
$211.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.15
|
| Rate for Payer: PHP Commercial |
$200.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.06
|
| Rate for Payer: Priority Health SBD |
$148.35
|
|
|
HC SWAN GANZ PLACEMENT
|
Facility
|
OP
|
$1,644.87
|
|
|
Service Code
|
CPT 93503
|
| Hospital Charge Code |
48100024
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$812.06 |
| Max. Negotiated Rate |
$4,264.69 |
| Rate for Payer: Aetna Commercial |
$1,398.14
|
| Rate for Payer: Aetna Medicare |
$1,575.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,069.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,893.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,893.80
|
| Rate for Payer: BCBS Complete |
$852.66
|
| Rate for Payer: BCBS MAPPO |
$1,515.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,515.04
|
| Rate for Payer: Cash Price |
$1,315.90
|
| Rate for Payer: Cash Price |
$1,315.90
|
| Rate for Payer: Cofinity Commercial |
$1,414.59
|
| Rate for Payer: Cofinity Commercial |
$1,151.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,151.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,315.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,515.04
|
| Rate for Payer: Healthscope Commercial |
$1,480.38
|
| Rate for Payer: Mclaren Medicaid |
$812.06
|
| Rate for Payer: Mclaren Medicare |
$1,515.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,590.79
|
| Rate for Payer: Meridian Medicaid |
$852.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,742.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,398.14
|
| Rate for Payer: PACE Medicare |
$1,439.29
|
| Rate for Payer: PACE SWMI |
$1,515.04
|
| Rate for Payer: PHP Commercial |
$1,398.14
|
| Rate for Payer: PHP Medicare Advantage |
$1,515.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$812.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,069.17
|
| Rate for Payer: Priority Health Medicare |
$1,515.04
|
| Rate for Payer: Priority Health SBD |
$1,036.27
|
| Rate for Payer: Railroad Medicare Medicare |
$1,515.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,264.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,515.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,515.04
|
| Rate for Payer: UHCCP Medicaid |
$852.97
|
| Rate for Payer: VA VA |
$1,515.04
|
|
|
HC SWAN GANZ PLACEMENT
|
Facility
|
IP
|
$1,644.87
|
|
|
Service Code
|
CPT 93503
|
| Hospital Charge Code |
48100024
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,036.27 |
| Max. Negotiated Rate |
$1,480.38 |
| Rate for Payer: Aetna Commercial |
$1,398.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,069.17
|
| Rate for Payer: Cash Price |
$1,315.90
|
| Rate for Payer: Cofinity Commercial |
$1,151.41
|
| Rate for Payer: Cofinity Commercial |
$1,414.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,151.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,315.90
|
| Rate for Payer: Healthscope Commercial |
$1,480.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,398.14
|
| Rate for Payer: PHP Commercial |
$1,398.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,069.17
|
| Rate for Payer: Priority Health SBD |
$1,036.27
|
|
|
HC SWEAT CHLORIDE
|
Facility
|
OP
|
$79.25
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
30100154
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$71.33 |
| Rate for Payer: Aetna Commercial |
$67.36
|
| Rate for Payer: Aetna Medicare |
$5.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.51
|
| 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 |
$2.81
|
| Rate for Payer: BCBS MAPPO |
$5.00
|
| Rate for Payer: BCN Medicare Advantage |
$5.00
|
| Rate for Payer: Cash Price |
$63.40
|
| Rate for Payer: Cash Price |
$63.40
|
| Rate for Payer: Cofinity Commercial |
$68.16
|
| Rate for Payer: Cofinity Commercial |
$55.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.00
|
| Rate for Payer: Healthscope Commercial |
$71.33
|
| Rate for Payer: Mclaren Medicaid |
$2.68
|
| 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 |
$2.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.36
|
| Rate for Payer: PACE Medicare |
$4.75
|
| Rate for Payer: PACE SWMI |
$5.00
|
| Rate for Payer: PHP Commercial |
$67.36
|
| Rate for Payer: PHP Medicare Advantage |
$5.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.51
|
| Rate for Payer: Priority Health Medicare |
$5.00
|
| Rate for Payer: Priority Health SBD |
$49.93
|
| Rate for Payer: Railroad Medicare Medicare |
$5.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.00
|
| Rate for Payer: UHC Medicare Advantage |
$5.00
|
| Rate for Payer: UHCCP Medicaid |
$2.81
|
| Rate for Payer: VA VA |
$5.00
|
|
|
HC SWEAT CHLORIDE
|
Facility
|
IP
|
$79.25
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
30100154
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.93 |
| Max. Negotiated Rate |
$71.33 |
| Rate for Payer: Aetna Commercial |
$67.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.51
|
| Rate for Payer: Cash Price |
$63.40
|
| Rate for Payer: Cofinity Commercial |
$55.48
|
| Rate for Payer: Cofinity Commercial |
$68.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.40
|
| Rate for Payer: Healthscope Commercial |
$71.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.36
|
| Rate for Payer: PHP Commercial |
$67.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.51
|
| Rate for Payer: Priority Health SBD |
$49.93
|
|
|
HC SWEAT COLLECTION
|
Facility
|
IP
|
$99.14
|
|
|
Service Code
|
CPT 89230
|
| Hospital Charge Code |
30000004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.46 |
| Max. Negotiated Rate |
$89.23 |
| Rate for Payer: Aetna Commercial |
$84.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.44
|
| Rate for Payer: Cash Price |
$79.31
|
| Rate for Payer: Cofinity Commercial |
$69.40
|
| Rate for Payer: Cofinity Commercial |
$85.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.31
|
| Rate for Payer: Healthscope Commercial |
$89.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.27
|
| Rate for Payer: PHP Commercial |
$84.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.44
|
| Rate for Payer: Priority Health SBD |
$62.46
|
|
|
HC SWEAT COLLECTION
|
Facility
|
OP
|
$99.14
|
|
|
Service Code
|
CPT 89230
|
| Hospital Charge Code |
30000004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.93 |
| Max. Negotiated Rate |
$146.68 |
| Rate for Payer: Aetna Commercial |
$84.27
|
| Rate for Payer: Aetna Medicare |
$54.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.14
|
| Rate for Payer: BCBS Complete |
$29.33
|
| Rate for Payer: BCBS MAPPO |
$52.11
|
| Rate for Payer: BCN Medicare Advantage |
$52.11
|
| Rate for Payer: Cash Price |
$79.31
|
| Rate for Payer: Cash Price |
$79.31
|
| Rate for Payer: Cofinity Commercial |
$85.26
|
| Rate for Payer: Cofinity Commercial |
$69.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.11
|
| Rate for Payer: Healthscope Commercial |
$89.23
|
| Rate for Payer: Mclaren Medicaid |
$27.93
|
| Rate for Payer: Mclaren Medicare |
$52.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.72
|
| Rate for Payer: Meridian Medicaid |
$29.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.27
|
| Rate for Payer: PACE Medicare |
$49.50
|
| Rate for Payer: PACE SWMI |
$52.11
|
| Rate for Payer: PHP Commercial |
$84.27
|
| Rate for Payer: PHP Medicare Advantage |
$52.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.44
|
| Rate for Payer: Priority Health Medicare |
$52.11
|
| Rate for Payer: Priority Health SBD |
$62.46
|
| Rate for Payer: Railroad Medicare Medicare |
$52.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.11
|
| Rate for Payer: UHC Medicare Advantage |
$52.11
|
| Rate for Payer: UHCCP Medicaid |
$29.34
|
| Rate for Payer: VA VA |
$52.11
|
|
|
HC SWEET VERNAL IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200103
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
