|
HC TX MISSED AB 1ST TRI SURG
|
Facility
|
IP
|
$8,104.44
|
|
|
Service Code
|
CPT 59820
|
| Hospital Charge Code |
76100343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,105.80 |
| Max. Negotiated Rate |
$7,294.00 |
| Rate for Payer: Aetna Commercial |
$6,888.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,267.89
|
| Rate for Payer: Cash Price |
$6,483.55
|
| Rate for Payer: Cofinity Advantage |
$5,673.11
|
| Rate for Payer: Cofinity Commercial |
$6,969.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,483.55
|
| Rate for Payer: Healthscope Commercial |
$7,294.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,888.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,078.33
|
| Rate for Payer: PHP Commercial |
$6,888.77
|
| Rate for Payer: Priority Health SBD |
$5,105.80
|
|
|
HC TX SUPERFICIAL WOUND DEHISCENCE, SIMPLE CLOSURE
|
Facility
|
IP
|
$791.16
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
76100243
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$498.43 |
| Max. Negotiated Rate |
$712.04 |
| Rate for Payer: Aetna Commercial |
$672.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$514.25
|
| Rate for Payer: Cash Price |
$632.93
|
| Rate for Payer: Cofinity Advantage |
$553.81
|
| Rate for Payer: Cofinity Commercial |
$680.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$632.93
|
| Rate for Payer: Healthscope Commercial |
$712.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$672.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$593.37
|
| Rate for Payer: PHP Commercial |
$672.49
|
| Rate for Payer: Priority Health SBD |
$498.43
|
|
|
HC TX SUPERFICIAL WOUND DEHISCENCE, SIMPLE CLOSURE
|
Facility
|
OP
|
$791.16
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
76100243
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$310.93 |
| Max. Negotiated Rate |
$2,381.49 |
| Rate for Payer: Aetna Commercial |
$672.49
|
| Rate for Payer: Aetna Medicare |
$765.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$514.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$920.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$920.51
|
| Rate for Payer: BCBS Complete |
$404.44
|
| Rate for Payer: BCBS MAPPO |
$736.41
|
| Rate for Payer: BCBS Trust/PPO |
$478.99
|
| Rate for Payer: BCN Commercial |
$478.99
|
| Rate for Payer: BCN Medicare Advantage |
$736.41
|
| Rate for Payer: Cash Price |
$632.93
|
| Rate for Payer: Cash Price |
$632.93
|
| Rate for Payer: Cash Price |
$632.93
|
| Rate for Payer: Cofinity Advantage |
$553.81
|
| Rate for Payer: Cofinity Commercial |
$680.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$632.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$736.41
|
| Rate for Payer: Healthscope Commercial |
$712.04
|
| Rate for Payer: Mclaren Medicaid |
$385.14
|
| Rate for Payer: Mclaren Medicare |
$736.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$773.23
|
| Rate for Payer: Meridian Medicaid |
$773.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$846.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$810.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$672.49
|
| Rate for Payer: Nomi Health Commercial |
$2,209.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$593.37
|
| Rate for Payer: PACE Medicare |
$699.59
|
| Rate for Payer: PACE SWMI |
$736.41
|
| Rate for Payer: PHP Commercial |
$672.49
|
| Rate for Payer: PHP Medicare Advantage |
$736.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,381.49
|
| Rate for Payer: Priority Health Medicare |
$736.41
|
| Rate for Payer: Priority Health SBD |
$498.43
|
| Rate for Payer: Priority Health Tiered Network |
$1,905.19
|
| Rate for Payer: Railroad Medicare Medicare |
$736.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$514.25
|
| Rate for Payer: UHC Core |
$412.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$736.41
|
| Rate for Payer: UHC Exchange |
$310.93
|
| Rate for Payer: UHC Medicaid |
$385.14
|
| Rate for Payer: UHCCP Medicaid |
$385.14
|
| Rate for Payer: VA VA |
$736.41
|
|
|
HC TX TARSAL BONE FX, EXCEPT TALUS/CALCANEUS; W/O MANIP
|
Facility
|
IP
|
$342.77
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
76100287
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$215.95 |
| Max. Negotiated Rate |
$308.49 |
| Rate for Payer: Aetna Commercial |
$291.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.80
|
| Rate for Payer: Cash Price |
$274.22
|
| Rate for Payer: Cofinity Advantage |
$239.94
|
| Rate for Payer: Cofinity Commercial |
$294.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.22
|
| Rate for Payer: Healthscope Commercial |
$308.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.08
|
| Rate for Payer: PHP Commercial |
$291.35
|
| Rate for Payer: Priority Health SBD |
$215.95
|
|
|
HC TX TARSAL BONE FX, EXCEPT TALUS/CALCANEUS; W/O MANIP
|
Facility
|
OP
|
$342.77
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
76100287
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.09 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna Commercial |
$291.35
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$105.09
|
| Rate for Payer: BCN Commercial |
$105.09
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$274.22
|
| Rate for Payer: Cash Price |
$274.22
|
| Rate for Payer: Cash Price |
$274.22
|
| Rate for Payer: Cofinity Advantage |
$239.94
|
| Rate for Payer: Cofinity Commercial |
$294.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$308.49
|
| Rate for Payer: Mclaren Medicaid |
$128.54
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$258.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.35
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.08
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$291.35
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$794.84
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health SBD |
$215.95
|
| Rate for Payer: Priority Health Tiered Network |
$635.87
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$222.80
|
| Rate for Payer: UHC Core |
$178.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$134.71
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC TYMPANIC MEMBRANE REPAIR W/WO PREP OF PERF W/WO PATCH
|
Facility
|
OP
|
$4,370.70
|
|
|
Service Code
|
CPT 69610
|
| Hospital Charge Code |
76100523
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.81 |
| Max. Negotiated Rate |
$4,999.64 |
| Rate for Payer: Mclaren Medicare |
$1,546.00
|
| Rate for Payer: Aetna Commercial |
$3,715.09
|
| Rate for Payer: Aetna Commercial |
$5,572.64
|
| Rate for Payer: Aetna Medicare |
$1,607.84
|
| Rate for Payer: Aetna Medicare |
$1,607.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,261.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,840.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,932.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,932.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,932.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,932.50
|
| Rate for Payer: BCBS Complete |
$849.06
|
| Rate for Payer: BCBS Complete |
$849.06
|
| Rate for Payer: BCBS MAPPO |
$1,546.00
|
| Rate for Payer: BCBS MAPPO |
$1,546.00
|
| Rate for Payer: BCBS Trust/PPO |
$202.81
|
| Rate for Payer: BCBS Trust/PPO |
$202.81
|
| Rate for Payer: BCN Commercial |
$202.81
|
| Rate for Payer: BCN Commercial |
$202.81
|
| Rate for Payer: BCN Medicare Advantage |
$1,546.00
|
| Rate for Payer: BCN Medicare Advantage |
$1,546.00
|
| Rate for Payer: Cash Price |
$3,496.56
|
| Rate for Payer: Cash Price |
$3,496.56
|
| Rate for Payer: Cash Price |
$5,244.84
|
| Rate for Payer: Cash Price |
$5,244.84
|
| Rate for Payer: Cash Price |
$5,244.84
|
| Rate for Payer: Cash Price |
$3,496.56
|
| Rate for Payer: Cofinity Advantage |
$4,589.23
|
| Rate for Payer: Cofinity Advantage |
$3,059.49
|
| Rate for Payer: Cofinity Commercial |
$3,758.80
|
| Rate for Payer: Cofinity Commercial |
$5,638.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,244.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,496.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,546.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,546.00
|
| Rate for Payer: Healthscope Commercial |
$3,933.63
|
| Rate for Payer: Healthscope Commercial |
$5,900.44
|
| Rate for Payer: Mclaren Medicaid |
$808.56
|
| Rate for Payer: Mclaren Medicaid |
$808.56
|
| Rate for Payer: Mclaren Medicare |
$1,546.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,623.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,623.30
|
| Rate for Payer: Meridian Medicaid |
$1,623.30
|
| Rate for Payer: Meridian Medicaid |
$1,623.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,777.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,777.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,700.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,700.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,715.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,572.64
|
| Rate for Payer: Nomi Health Commercial |
$4,638.00
|
| Rate for Payer: Nomi Health Commercial |
$4,638.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,917.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,278.03
|
| Rate for Payer: PACE Medicare |
$1,468.70
|
| Rate for Payer: PACE Medicare |
$1,468.70
|
| Rate for Payer: PACE SWMI |
$1,546.00
|
| Rate for Payer: PACE SWMI |
$1,546.00
|
| Rate for Payer: PHP Commercial |
$3,715.09
|
| Rate for Payer: PHP Commercial |
$5,572.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,546.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,546.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$808.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$808.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,999.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,999.64
|
| Rate for Payer: Priority Health Medicare |
$1,546.00
|
| Rate for Payer: Priority Health Medicare |
$1,546.00
|
| Rate for Payer: Priority Health SBD |
$4,130.31
|
| Rate for Payer: Priority Health SBD |
$2,753.54
|
| Rate for Payer: Priority Health Tiered Network |
$3,999.71
|
| Rate for Payer: Priority Health Tiered Network |
$3,999.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1,546.00
|
| Rate for Payer: Railroad Medicare Medicare |
$1,546.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,840.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,261.43
|
| Rate for Payer: UHC Core |
$3,415.70
|
| Rate for Payer: UHC Core |
$2,277.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,546.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,546.00
|
| Rate for Payer: UHC Exchange |
$2,576.53
|
| Rate for Payer: UHC Exchange |
$1,717.69
|
| Rate for Payer: UHC Medicaid |
$808.56
|
| Rate for Payer: UHC Medicaid |
$808.56
|
| Rate for Payer: UHCCP Medicaid |
$808.56
|
| Rate for Payer: UHCCP Medicaid |
$808.56
|
| Rate for Payer: VA VA |
$1,546.00
|
| Rate for Payer: VA VA |
$1,546.00
|
|
|
HC TYMPANIC MEMBRANE REPAIR W/WO PREP OF PERF W/WO PATCH
|
Facility
|
IP
|
$4,370.70
|
|
|
Service Code
|
CPT 69610
|
| Hospital Charge Code |
76100523
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,753.54 |
| Max. Negotiated Rate |
$3,933.63 |
| Rate for Payer: Aetna Commercial |
$3,715.09
|
| Rate for Payer: Aetna Commercial |
$5,572.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,840.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,261.43
|
| Rate for Payer: Cash Price |
$3,496.56
|
| Rate for Payer: Cash Price |
$5,244.84
|
| Rate for Payer: Cofinity Advantage |
$3,059.49
|
| Rate for Payer: Cofinity Advantage |
$4,589.23
|
| Rate for Payer: Cofinity Commercial |
$3,758.80
|
| Rate for Payer: Cofinity Commercial |
$5,638.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,244.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,496.56
|
| Rate for Payer: Healthscope Commercial |
$5,900.44
|
| Rate for Payer: Healthscope Commercial |
$3,933.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,715.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,572.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,278.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,917.04
|
| Rate for Payer: PHP Commercial |
$3,715.09
|
| Rate for Payer: PHP Commercial |
$5,572.64
|
| Rate for Payer: Priority Health SBD |
$2,753.54
|
| Rate for Payer: Priority Health SBD |
$4,130.31
|
|
|
HC TYMPANOMETRY
|
Facility
|
OP
|
$34.96
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
47100008
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$13.74 |
| Max. Negotiated Rate |
$120.34 |
| Rate for Payer: Aetna Commercial |
$29.72
|
| Rate for Payer: Aetna Medicare |
$38.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.52
|
| Rate for Payer: BCBS Complete |
$20.44
|
| Rate for Payer: BCBS MAPPO |
$37.22
|
| Rate for Payer: BCBS Trust/PPO |
$39.97
|
| Rate for Payer: BCN Commercial |
$39.97
|
| Rate for Payer: BCN Medicare Advantage |
$37.22
|
| Rate for Payer: Cash Price |
$27.97
|
| Rate for Payer: Cash Price |
$27.97
|
| Rate for Payer: Cofinity Advantage |
$24.47
|
| Rate for Payer: Cofinity Commercial |
$30.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.22
|
| Rate for Payer: Healthscope Commercial |
$31.46
|
| Rate for Payer: Mclaren Medicaid |
$19.47
|
| Rate for Payer: Mclaren Medicare |
$37.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.08
|
| Rate for Payer: Meridian Medicaid |
$39.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.72
|
| Rate for Payer: Nomi Health Commercial |
$111.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.22
|
| Rate for Payer: PACE Medicare |
$35.36
|
| Rate for Payer: PACE SWMI |
$37.22
|
| Rate for Payer: PHP Commercial |
$29.72
|
| Rate for Payer: PHP Medicare Advantage |
$37.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$120.34
|
| Rate for Payer: Priority Health Medicare |
$37.22
|
| Rate for Payer: Priority Health SBD |
$22.02
|
| Rate for Payer: Priority Health Tiered Network |
$96.27
|
| Rate for Payer: Railroad Medicare Medicare |
$37.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.72
|
| Rate for Payer: UHC Core |
$18.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.22
|
| Rate for Payer: UHC Exchange |
$13.74
|
| Rate for Payer: UHC Medicaid |
$19.47
|
| Rate for Payer: UHCCP Medicaid |
$19.47
|
| Rate for Payer: VA VA |
$37.22
|
|
|
HC TYMPANOMETRY
|
Facility
|
IP
|
$34.96
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
47100008
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$22.02 |
| Max. Negotiated Rate |
$31.46 |
| Rate for Payer: Aetna Commercial |
$29.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.72
|
| Rate for Payer: Cash Price |
$27.97
|
| Rate for Payer: Cofinity Advantage |
$24.47
|
| Rate for Payer: Cofinity Commercial |
$30.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.97
|
| Rate for Payer: Healthscope Commercial |
$31.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.22
|
| Rate for Payer: PHP Commercial |
$29.72
|
| Rate for Payer: Priority Health SBD |
$22.02
|
|
|
HC TYMPANOMETRY & REFLEX THRESH
|
Facility
|
IP
|
$151.90
|
|
|
Service Code
|
CPT 92550
|
| Hospital Charge Code |
76100503
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$95.70 |
| Max. Negotiated Rate |
$136.71 |
| Rate for Payer: Aetna Commercial |
$129.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.73
|
| Rate for Payer: Cash Price |
$121.52
|
| Rate for Payer: Cofinity Advantage |
$106.33
|
| Rate for Payer: Cofinity Commercial |
$130.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.52
|
| Rate for Payer: Healthscope Commercial |
$136.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.92
|
| Rate for Payer: PHP Commercial |
$129.12
|
| Rate for Payer: Priority Health SBD |
$95.70
|
|
|
HC TYMPANOMETRY & REFLEX THRESH
|
Facility
|
OP
|
$151.90
|
|
|
Service Code
|
CPT 92550
|
| Hospital Charge Code |
76100503
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$42.95 |
| Max. Negotiated Rate |
$695.77 |
| Rate for Payer: Aetna Commercial |
$129.12
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$42.95
|
| Rate for Payer: BCN Commercial |
$42.95
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$121.52
|
| Rate for Payer: Cash Price |
$121.52
|
| Rate for Payer: Cofinity Advantage |
$106.33
|
| Rate for Payer: Cofinity Commercial |
$130.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$136.71
|
| Rate for Payer: Mclaren Medicaid |
$112.52
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.12
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.92
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$129.12
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$95.70
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.73
|
| Rate for Payer: UHC Core |
$79.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$59.70
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC TYMPANOSTOMY LOCAL/TOPICAL ANES
|
Facility
|
OP
|
$1,369.17
|
|
|
Service Code
|
CPT 69433
|
| Hospital Charge Code |
76100486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$241.80 |
| Max. Negotiated Rate |
$1,737.88 |
| Rate for Payer: Aetna Commercial |
$1,163.79
|
| Rate for Payer: Aetna Commercial |
$1,745.69
|
| Rate for Payer: Aetna Medicare |
$558.89
|
| Rate for Payer: Aetna Medicare |
$558.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,334.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$889.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.74
|
| Rate for Payer: BCBS Complete |
$295.13
|
| Rate for Payer: BCBS Complete |
$295.13
|
| Rate for Payer: BCBS MAPPO |
$537.39
|
| Rate for Payer: BCBS MAPPO |
$537.39
|
| Rate for Payer: BCBS Trust/PPO |
$241.80
|
| Rate for Payer: BCBS Trust/PPO |
$241.80
|
| Rate for Payer: BCN Commercial |
$241.80
|
| Rate for Payer: BCN Commercial |
$241.80
|
| Rate for Payer: BCN Medicare Advantage |
$537.39
|
| Rate for Payer: BCN Medicare Advantage |
$537.39
|
| Rate for Payer: Cash Price |
$1,095.34
|
| Rate for Payer: Cash Price |
$1,095.34
|
| Rate for Payer: Cash Price |
$1,643.00
|
| Rate for Payer: Cash Price |
$1,643.00
|
| Rate for Payer: Cash Price |
$1,643.00
|
| Rate for Payer: Cash Price |
$1,095.34
|
| Rate for Payer: Cofinity Advantage |
$1,437.62
|
| Rate for Payer: Cofinity Advantage |
$958.42
|
| Rate for Payer: Cofinity Commercial |
$1,177.49
|
| Rate for Payer: Cofinity Commercial |
$1,766.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,643.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,095.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.39
|
| Rate for Payer: Healthscope Commercial |
$1,232.25
|
| Rate for Payer: Healthscope Commercial |
$1,848.38
|
| Rate for Payer: Mclaren Medicaid |
$281.05
|
| Rate for Payer: Mclaren Medicaid |
$281.05
|
| Rate for Payer: Mclaren Medicare |
$537.39
|
| Rate for Payer: Mclaren Medicare |
$537.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.26
|
| Rate for Payer: Meridian Medicaid |
$564.26
|
| Rate for Payer: Meridian Medicaid |
$564.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$618.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$618.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$591.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$591.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,163.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,745.69
|
| Rate for Payer: Nomi Health Commercial |
$1,612.17
|
| Rate for Payer: Nomi Health Commercial |
$1,612.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,540.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,026.88
|
| Rate for Payer: PACE Medicare |
$510.52
|
| Rate for Payer: PACE Medicare |
$510.52
|
| Rate for Payer: PACE SWMI |
$537.39
|
| Rate for Payer: PACE SWMI |
$537.39
|
| Rate for Payer: PHP Commercial |
$1,163.79
|
| Rate for Payer: PHP Commercial |
$1,745.69
|
| Rate for Payer: PHP Medicare Advantage |
$537.39
|
| Rate for Payer: PHP Medicare Advantage |
$537.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,737.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,737.88
|
| Rate for Payer: Priority Health Medicare |
$537.39
|
| Rate for Payer: Priority Health Medicare |
$537.39
|
| Rate for Payer: Priority Health SBD |
$1,293.86
|
| Rate for Payer: Priority Health SBD |
$862.58
|
| Rate for Payer: Priority Health Tiered Network |
$1,390.30
|
| Rate for Payer: Priority Health Tiered Network |
$1,390.30
|
| Rate for Payer: Railroad Medicare Medicare |
$537.39
|
| Rate for Payer: Railroad Medicare Medicare |
$537.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$889.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,334.94
|
| Rate for Payer: UHC Core |
$1,070.00
|
| Rate for Payer: UHC Core |
$713.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$537.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$537.39
|
| Rate for Payer: UHC Exchange |
$807.12
|
| Rate for Payer: UHC Exchange |
$538.08
|
| Rate for Payer: UHC Medicaid |
$281.05
|
| Rate for Payer: UHC Medicaid |
$281.05
|
| Rate for Payer: UHCCP Medicaid |
$281.05
|
| Rate for Payer: UHCCP Medicaid |
$281.05
|
| Rate for Payer: VA VA |
$537.39
|
| Rate for Payer: VA VA |
$537.39
|
|
|
HC TYMPANOSTOMY LOCAL/TOPICAL ANES
|
Facility
|
IP
|
$1,369.17
|
|
|
Service Code
|
CPT 69433
|
| Hospital Charge Code |
76100486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$862.58 |
| Max. Negotiated Rate |
$1,232.25 |
| Rate for Payer: Aetna Commercial |
$1,163.79
|
| Rate for Payer: Aetna Commercial |
$1,745.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$889.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,334.94
|
| Rate for Payer: Cash Price |
$1,095.34
|
| Rate for Payer: Cash Price |
$1,643.00
|
| Rate for Payer: Cofinity Advantage |
$958.42
|
| Rate for Payer: Cofinity Advantage |
$1,437.62
|
| Rate for Payer: Cofinity Commercial |
$1,177.49
|
| Rate for Payer: Cofinity Commercial |
$1,766.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,643.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,095.34
|
| Rate for Payer: Healthscope Commercial |
$1,848.38
|
| Rate for Payer: Healthscope Commercial |
$1,232.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,163.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,745.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,026.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,540.31
|
| Rate for Payer: PHP Commercial |
$1,163.79
|
| Rate for Payer: PHP Commercial |
$1,745.69
|
| Rate for Payer: Priority Health SBD |
$862.58
|
| Rate for Payer: Priority Health SBD |
$1,293.86
|
|
|
HC TYPE III HOME STUDY
|
Facility
|
OP
|
$694.43
|
|
|
Service Code
|
CPT 95800
|
| Hospital Charge Code |
92000015
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$695.77 |
| Rate for Payer: Aetna Commercial |
$590.27
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$451.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$399.72
|
| Rate for Payer: BCN Commercial |
$399.72
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$555.54
|
| Rate for Payer: Cash Price |
$555.54
|
| Rate for Payer: Cofinity Advantage |
$486.10
|
| Rate for Payer: Cofinity Commercial |
$597.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$555.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$624.99
|
| Rate for Payer: Mclaren Medicaid |
$112.52
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$590.27
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$520.82
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$590.27
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$437.49
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$451.38
|
| Rate for Payer: UHC Core |
$361.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$272.91
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC TYPE III HOME STUDY
|
Facility
|
IP
|
$694.43
|
|
|
Service Code
|
CPT 95800
|
| Hospital Charge Code |
92000015
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$437.49 |
| Max. Negotiated Rate |
$624.99 |
| Rate for Payer: Aetna Commercial |
$590.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$451.38
|
| Rate for Payer: Cash Price |
$555.54
|
| Rate for Payer: Cofinity Advantage |
$486.10
|
| Rate for Payer: Cofinity Commercial |
$597.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$555.54
|
| Rate for Payer: Healthscope Commercial |
$624.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$590.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$520.82
|
| Rate for Payer: PHP Commercial |
$590.27
|
| Rate for Payer: Priority Health SBD |
$437.49
|
|
|
HC TYPE III HOME STUDY W/EFFORT AND FLOW
|
Facility
|
IP
|
$762.72
|
|
|
Service Code
|
CPT 95806
|
| Hospital Charge Code |
92000014
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$480.51 |
| Max. Negotiated Rate |
$686.45 |
| Rate for Payer: Aetna Commercial |
$648.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$495.77
|
| Rate for Payer: Cash Price |
$610.18
|
| Rate for Payer: Cofinity Advantage |
$533.90
|
| Rate for Payer: Cofinity Commercial |
$655.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$610.18
|
| Rate for Payer: Healthscope Commercial |
$686.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$648.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$572.04
|
| Rate for Payer: PHP Commercial |
$648.31
|
| Rate for Payer: Priority Health SBD |
$480.51
|
|
|
HC TYPE III HOME STUDY W/EFFORT AND FLOW
|
Facility
|
OP
|
$762.72
|
|
|
Service Code
|
CPT 95806
|
| Hospital Charge Code |
92000014
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$695.77 |
| Rate for Payer: Aetna Commercial |
$648.31
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$495.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$235.38
|
| Rate for Payer: BCN Commercial |
$235.38
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$610.18
|
| Rate for Payer: Cash Price |
$610.18
|
| Rate for Payer: Cofinity Advantage |
$533.90
|
| Rate for Payer: Cofinity Commercial |
$655.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$610.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$686.45
|
| Rate for Payer: Mclaren Medicaid |
$112.52
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$648.31
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$572.04
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$648.31
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$480.51
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$495.77
|
| Rate for Payer: UHC Core |
$397.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$299.75
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC TYPE & SCREEN ABO
|
Facility
|
OP
|
$22.72
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
30200347
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$428.73 |
| Rate for Payer: Aetna Commercial |
$19.31
|
| Rate for Payer: Aetna Medicare |
$3.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.74
|
| Rate for Payer: BCBS Complete |
$1.64
|
| Rate for Payer: BCBS MAPPO |
$2.99
|
| Rate for Payer: BCBS Trust/PPO |
$3.18
|
| Rate for Payer: BCN Commercial |
$3.18
|
| Rate for Payer: BCN Medicare Advantage |
$2.99
|
| Rate for Payer: Cash Price |
$18.18
|
| Rate for Payer: Cash Price |
$18.18
|
| Rate for Payer: Cofinity Advantage |
$15.90
|
| Rate for Payer: Cofinity Commercial |
$19.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.99
|
| Rate for Payer: Healthscope Commercial |
$20.45
|
| Rate for Payer: Mclaren Medicaid |
$1.56
|
| Rate for Payer: Mclaren Medicare |
$2.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.14
|
| Rate for Payer: Meridian Medicaid |
$3.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.31
|
| Rate for Payer: Nomi Health Commercial |
$8.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.04
|
| Rate for Payer: PACE Medicare |
$2.84
|
| Rate for Payer: PACE SWMI |
$2.99
|
| Rate for Payer: PHP Commercial |
$19.31
|
| Rate for Payer: PHP Medicare Advantage |
$2.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.73
|
| Rate for Payer: Priority Health Medicare |
$2.99
|
| Rate for Payer: Priority Health SBD |
$14.31
|
| Rate for Payer: Priority Health Tiered Network |
$342.98
|
| Rate for Payer: Railroad Medicare Medicare |
$2.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.49
|
| Rate for Payer: UHC Core |
$4.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.99
|
| Rate for Payer: UHC Exchange |
$4.49
|
| Rate for Payer: UHC Medicaid |
$1.56
|
| Rate for Payer: UHCCP Medicaid |
$1.56
|
| Rate for Payer: VA VA |
$2.99
|
|
|
HC TYPE & SCREEN ABO
|
Facility
|
IP
|
$22.72
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
30200347
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$20.45 |
| Rate for Payer: Aetna Commercial |
$19.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.77
|
| Rate for Payer: Cash Price |
$18.18
|
| Rate for Payer: Cofinity Advantage |
$15.90
|
| Rate for Payer: Cofinity Commercial |
$19.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.18
|
| Rate for Payer: Healthscope Commercial |
$20.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.04
|
| Rate for Payer: PHP Commercial |
$19.31
|
| Rate for Payer: Priority Health SBD |
$14.31
|
|
|
HC TYPE & SCREEN ANTIBODY
|
Facility
|
IP
|
$38.61
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
30200340
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.32 |
| Max. Negotiated Rate |
$34.75 |
| Rate for Payer: Aetna Commercial |
$32.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.10
|
| Rate for Payer: Cash Price |
$30.89
|
| Rate for Payer: Cofinity Advantage |
$27.03
|
| Rate for Payer: Cofinity Commercial |
$33.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.89
|
| Rate for Payer: Healthscope Commercial |
$34.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.96
|
| Rate for Payer: PHP Commercial |
$32.82
|
| Rate for Payer: Priority Health SBD |
$24.32
|
|
|
HC TYPE & SCREEN ANTIBODY
|
Facility
|
OP
|
$38.61
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
30200340
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$167.92 |
| Rate for Payer: Aetna Commercial |
$32.82
|
| Rate for Payer: Aetna Medicare |
$10.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.21
|
| Rate for Payer: BCBS Complete |
$5.37
|
| Rate for Payer: BCBS MAPPO |
$9.77
|
| Rate for Payer: BCBS Trust/PPO |
$10.42
|
| Rate for Payer: BCN Commercial |
$10.42
|
| Rate for Payer: BCN Medicare Advantage |
$9.77
|
| Rate for Payer: Cash Price |
$30.89
|
| Rate for Payer: Cash Price |
$30.89
|
| Rate for Payer: Cofinity Advantage |
$27.03
|
| Rate for Payer: Cofinity Commercial |
$33.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.77
|
| Rate for Payer: Healthscope Commercial |
$34.75
|
| Rate for Payer: Mclaren Medicaid |
$5.11
|
| Rate for Payer: Mclaren Medicare |
$9.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.26
|
| Rate for Payer: Meridian Medicaid |
$10.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.82
|
| Rate for Payer: Nomi Health Commercial |
$29.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.96
|
| Rate for Payer: PACE Medicare |
$9.28
|
| Rate for Payer: PACE SWMI |
$9.77
|
| Rate for Payer: PHP Commercial |
$32.82
|
| Rate for Payer: PHP Medicare Advantage |
$9.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$167.92
|
| Rate for Payer: Priority Health Medicare |
$9.77
|
| Rate for Payer: Priority Health SBD |
$24.32
|
| Rate for Payer: Priority Health Tiered Network |
$134.34
|
| Rate for Payer: Railroad Medicare Medicare |
$9.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.66
|
| Rate for Payer: UHC Core |
$14.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9.77
|
| Rate for Payer: UHC Exchange |
$14.66
|
| Rate for Payer: UHC Medicaid |
$5.11
|
| Rate for Payer: UHCCP Medicaid |
$5.11
|
| Rate for Payer: VA VA |
$9.77
|
|
|
HC TYRX ANTIBACTERIAL POUCH
|
Facility
|
OP
|
$2,861.10
|
|
| Hospital Charge Code |
27800115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,124.41 |
| Max. Negotiated Rate |
$2,574.99 |
| Rate for Payer: Aetna Commercial |
$2,431.93
|
| Rate for Payer: Aetna Medicare |
$1,430.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,859.71
|
| Rate for Payer: BCBS Complete |
$1,144.44
|
| Rate for Payer: Cash Price |
$2,288.88
|
| Rate for Payer: Cofinity Advantage |
$2,002.77
|
| Rate for Payer: Cofinity Commercial |
$2,460.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,288.88
|
| Rate for Payer: Healthscope Commercial |
$2,574.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,288.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,431.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,145.82
|
| Rate for Payer: PHP Commercial |
$2,431.93
|
| Rate for Payer: Priority Health SBD |
$1,802.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,859.71
|
| Rate for Payer: UHC Core |
$1,490.63
|
| Rate for Payer: UHC Exchange |
$1,124.41
|
|
|
HC TYRX ANTIBACTERIAL POUCH
|
Facility
|
IP
|
$2,861.10
|
|
| Hospital Charge Code |
27800115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,802.49 |
| Max. Negotiated Rate |
$2,574.99 |
| Rate for Payer: Aetna Commercial |
$2,431.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,859.71
|
| Rate for Payer: Cash Price |
$2,288.88
|
| Rate for Payer: Cofinity Advantage |
$2,002.77
|
| Rate for Payer: Cofinity Commercial |
$2,460.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,288.88
|
| Rate for Payer: Healthscope Commercial |
$2,574.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,431.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,145.82
|
| Rate for Payer: PHP Commercial |
$2,431.93
|
| Rate for Payer: Priority Health SBD |
$1,802.49
|
|
|
HC UA DIPSTICK AUTO
|
Facility
|
OP
|
$21.64
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
30700002
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$19.48 |
| Rate for Payer: Priority Health SBD |
$13.63
|
| Rate for Payer: Aetna Commercial |
$18.39
|
| Rate for Payer: Aetna Medicare |
$2.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.81
|
| Rate for Payer: BCBS Complete |
$1.24
|
| Rate for Payer: BCBS MAPPO |
$2.25
|
| Rate for Payer: BCBS Trust/PPO |
$2.40
|
| Rate for Payer: BCN Commercial |
$2.40
|
| Rate for Payer: BCN Medicare Advantage |
$2.25
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cofinity Advantage |
$15.15
|
| Rate for Payer: Cofinity Commercial |
$18.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.25
|
| Rate for Payer: Healthscope Commercial |
$19.48
|
| Rate for Payer: Mclaren Medicaid |
$1.18
|
| Rate for Payer: Mclaren Medicare |
$2.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.36
|
| Rate for Payer: Meridian Medicaid |
$2.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.39
|
| Rate for Payer: Nomi Health Commercial |
$3.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.23
|
| Rate for Payer: PACE Medicare |
$2.14
|
| Rate for Payer: PACE SWMI |
$2.25
|
| Rate for Payer: PHP Commercial |
$18.39
|
| Rate for Payer: PHP Medicare Advantage |
$2.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2.25
|
| Rate for Payer: Priority Health Medicare |
$2.25
|
| Rate for Payer: Priority Health Tiered Network |
$1.80
|
| Rate for Payer: Railroad Medicare Medicare |
$2.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.38
|
| Rate for Payer: UHC Core |
$3.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.25
|
| Rate for Payer: UHC Exchange |
$3.38
|
| Rate for Payer: UHC Medicaid |
$1.18
|
| Rate for Payer: UHCCP Medicaid |
$1.18
|
| Rate for Payer: VA VA |
$2.25
|
|
|
HC UA DIPSTICK AUTO
|
Facility
|
IP
|
$21.64
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
30700002
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$19.48 |
| Rate for Payer: Aetna Commercial |
$18.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.07
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cofinity Advantage |
$15.15
|
| Rate for Payer: Cofinity Commercial |
$18.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.31
|
| Rate for Payer: Healthscope Commercial |
$19.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.23
|
| Rate for Payer: PHP Commercial |
$18.39
|
| Rate for Payer: Priority Health SBD |
$13.63
|
|
