|
HC US SCROTUM AND CONTENTS
|
Facility
|
IP
|
$728.91
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
40200035
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$459.21 |
| Max. Negotiated Rate |
$656.02 |
| Rate for Payer: Aetna Commercial |
$619.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$473.79
|
| Rate for Payer: Cash Price |
$583.13
|
| Rate for Payer: Cofinity Advantage |
$510.24
|
| Rate for Payer: Cofinity Commercial |
$626.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$583.13
|
| Rate for Payer: Healthscope Commercial |
$656.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$619.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$546.68
|
| Rate for Payer: PHP Commercial |
$619.57
|
| Rate for Payer: Priority Health SBD |
$459.21
|
|
|
HC US SCROTUM AND CONTENTS
|
Facility
|
OP
|
$728.91
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
40200035
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$656.02 |
| Rate for Payer: Aetna Commercial |
$619.57
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$473.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$158.24
|
| Rate for Payer: BCN Commercial |
$158.24
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$583.13
|
| Rate for Payer: Cash Price |
$583.13
|
| Rate for Payer: Cofinity Advantage |
$510.24
|
| Rate for Payer: Cofinity Commercial |
$626.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$583.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$656.02
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$619.57
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$546.68
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$619.57
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$459.21
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$473.79
|
| Rate for Payer: UHC Core |
$379.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$286.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC U.S. SKIN PREP PACK
|
Facility
|
IP
|
$17.23
|
|
| Hospital Charge Code |
27000163
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.85 |
| Max. Negotiated Rate |
$15.51 |
| Rate for Payer: Aetna Commercial |
$14.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.20
|
| Rate for Payer: Cash Price |
$13.78
|
| Rate for Payer: Cofinity Advantage |
$12.06
|
| Rate for Payer: Cofinity Commercial |
$14.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.78
|
| Rate for Payer: Healthscope Commercial |
$15.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.92
|
| Rate for Payer: PHP Commercial |
$14.65
|
| Rate for Payer: Priority Health SBD |
$10.85
|
|
|
HC U.S. SKIN PREP PACK
|
Facility
|
OP
|
$17.23
|
|
| Hospital Charge Code |
27000163
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.77 |
| Max. Negotiated Rate |
$15.51 |
| Rate for Payer: Aetna Commercial |
$14.65
|
| Rate for Payer: Aetna Medicare |
$8.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.20
|
| Rate for Payer: BCBS Complete |
$6.89
|
| Rate for Payer: Cash Price |
$13.78
|
| Rate for Payer: Cofinity Advantage |
$12.06
|
| Rate for Payer: Cofinity Commercial |
$14.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.78
|
| Rate for Payer: Healthscope Commercial |
$15.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.92
|
| Rate for Payer: PHP Commercial |
$14.65
|
| Rate for Payer: Priority Health SBD |
$10.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.20
|
| Rate for Payer: UHC Core |
$8.98
|
| Rate for Payer: UHC Exchange |
$6.77
|
|
|
HC US SOFT TISSUE HEAD NECK
|
Facility
|
OP
|
$801.68
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
40200006
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$721.51 |
| Rate for Payer: Aetna Commercial |
$681.43
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$521.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$187.76
|
| Rate for Payer: BCN Commercial |
$187.76
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$641.34
|
| Rate for Payer: Cash Price |
$641.34
|
| Rate for Payer: Cofinity Advantage |
$561.18
|
| Rate for Payer: Cofinity Commercial |
$689.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$641.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$721.51
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$681.43
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$601.26
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$681.43
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$505.06
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$521.09
|
| Rate for Payer: UHC Core |
$417.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$315.06
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US SOFT TISSUE HEAD NECK
|
Facility
|
IP
|
$801.68
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
40200006
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$505.06 |
| Max. Negotiated Rate |
$721.51 |
| Rate for Payer: Aetna Commercial |
$681.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$521.09
|
| Rate for Payer: Cash Price |
$641.34
|
| Rate for Payer: Cofinity Advantage |
$561.18
|
| Rate for Payer: Cofinity Commercial |
$689.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$641.34
|
| Rate for Payer: Healthscope Commercial |
$721.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$681.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$601.26
|
| Rate for Payer: PHP Commercial |
$681.43
|
| Rate for Payer: Priority Health SBD |
$505.06
|
|
|
HC US SPINAL CANAL AND CONTENTS
|
Facility
|
OP
|
$495.72
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
40200014
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$446.15 |
| Rate for Payer: Aetna Commercial |
$421.36
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$322.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$268.03
|
| Rate for Payer: BCN Commercial |
$268.03
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$396.58
|
| Rate for Payer: Cash Price |
$396.58
|
| Rate for Payer: Cofinity Advantage |
$347.00
|
| Rate for Payer: Cofinity Commercial |
$426.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$446.15
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.36
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.79
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$421.36
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$312.30
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.22
|
| Rate for Payer: UHC Core |
$258.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$194.82
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US SPINAL CANAL AND CONTENTS
|
Facility
|
IP
|
$495.72
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
40200014
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$312.30 |
| Max. Negotiated Rate |
$446.15 |
| Rate for Payer: Aetna Commercial |
$421.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$322.22
|
| Rate for Payer: Cash Price |
$396.58
|
| Rate for Payer: Cofinity Advantage |
$347.00
|
| Rate for Payer: Cofinity Commercial |
$426.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.58
|
| Rate for Payer: Healthscope Commercial |
$446.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.79
|
| Rate for Payer: PHP Commercial |
$421.36
|
| Rate for Payer: Priority Health SBD |
$312.30
|
|
|
HC US SURGERY INTRAOPERATIVE
|
Facility
|
OP
|
$694.03
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
40200050
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$210.48 |
| Max. Negotiated Rate |
$624.63 |
| Rate for Payer: Aetna Commercial |
$589.93
|
| Rate for Payer: Aetna Medicare |
$347.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$451.12
|
| Rate for Payer: BCBS Complete |
$277.61
|
| Rate for Payer: BCBS Trust/PPO |
$210.48
|
| Rate for Payer: BCN Commercial |
$210.48
|
| Rate for Payer: Cash Price |
$555.22
|
| Rate for Payer: Cash Price |
$555.22
|
| Rate for Payer: Cofinity Advantage |
$485.82
|
| Rate for Payer: Cofinity Commercial |
$596.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$555.22
|
| Rate for Payer: Healthscope Commercial |
$624.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$555.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$589.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$520.52
|
| Rate for Payer: PHP Commercial |
$589.93
|
| Rate for Payer: Priority Health SBD |
$437.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$451.12
|
| Rate for Payer: UHC Core |
$361.59
|
| Rate for Payer: UHC Exchange |
$272.75
|
|
|
HC US SURGERY INTRAOPERATIVE
|
Facility
|
IP
|
$694.03
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
40200050
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$437.24 |
| Max. Negotiated Rate |
$624.63 |
| Rate for Payer: Aetna Commercial |
$589.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$451.12
|
| Rate for Payer: Cash Price |
$555.22
|
| Rate for Payer: Cofinity Advantage |
$485.82
|
| Rate for Payer: Cofinity Commercial |
$596.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$555.22
|
| Rate for Payer: Healthscope Commercial |
$624.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$589.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$520.52
|
| Rate for Payer: PHP Commercial |
$589.93
|
| Rate for Payer: Priority Health SBD |
$437.24
|
|
|
HC USTEKINUMAB AND AB
|
Facility
|
OP
|
$169.59
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100673
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$152.63 |
| Rate for Payer: Aetna Commercial |
$144.15
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: BCBS Complete |
$9.48
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$18.41
|
| Rate for Payer: BCN Commercial |
$18.41
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$135.67
|
| Rate for Payer: Cash Price |
$135.67
|
| Rate for Payer: Cofinity Advantage |
$118.71
|
| Rate for Payer: Cofinity Commercial |
$145.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$152.63
|
| Rate for Payer: Mclaren Medicaid |
$9.03
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: Meridian Medicaid |
$18.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.15
|
| Rate for Payer: Nomi Health Commercial |
$25.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.19
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$144.15
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.27
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health SBD |
$106.84
|
| Rate for Payer: Priority Health Tiered Network |
$13.82
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.91
|
| Rate for Payer: UHC Core |
$25.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.27
|
| Rate for Payer: UHC Exchange |
$25.91
|
| Rate for Payer: UHC Medicaid |
$9.03
|
| Rate for Payer: UHCCP Medicaid |
$9.03
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC USTEKINUMAB AND AB
|
Facility
|
IP
|
$169.59
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100673
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$106.84 |
| Max. Negotiated Rate |
$152.63 |
| Rate for Payer: Aetna Commercial |
$144.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.23
|
| Rate for Payer: Cash Price |
$135.67
|
| Rate for Payer: Cofinity Advantage |
$118.71
|
| Rate for Payer: Cofinity Commercial |
$145.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.67
|
| Rate for Payer: Healthscope Commercial |
$152.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.19
|
| Rate for Payer: PHP Commercial |
$144.15
|
| Rate for Payer: Priority Health SBD |
$106.84
|
|
|
HC USTEKINUMAB AND AB CMPT
|
Facility
|
OP
|
$168.54
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100674
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$151.69 |
| Rate for Payer: Aetna Commercial |
$143.26
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: BCBS Complete |
$10.24
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$19.87
|
| Rate for Payer: BCN Commercial |
$19.87
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$134.83
|
| Rate for Payer: Cash Price |
$134.83
|
| Rate for Payer: Cofinity Advantage |
$117.98
|
| Rate for Payer: Cofinity Commercial |
$144.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$151.69
|
| Rate for Payer: Mclaren Medicaid |
$9.75
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$19.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.26
|
| Rate for Payer: Nomi Health Commercial |
$27.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.41
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$143.26
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.75
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health SBD |
$106.18
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.96
|
| Rate for Payer: UHC Core |
$27.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.64
|
| Rate for Payer: UHC Exchange |
$27.96
|
| Rate for Payer: UHC Medicaid |
$9.75
|
| Rate for Payer: UHCCP Medicaid |
$9.75
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC USTEKINUMAB AND AB CMPT
|
Facility
|
IP
|
$168.54
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100674
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$106.18 |
| Max. Negotiated Rate |
$151.69 |
| Rate for Payer: Aetna Commercial |
$143.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.55
|
| Rate for Payer: Cash Price |
$134.83
|
| Rate for Payer: Cofinity Advantage |
$117.98
|
| Rate for Payer: Cofinity Commercial |
$144.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.83
|
| Rate for Payer: Healthscope Commercial |
$151.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.41
|
| Rate for Payer: PHP Commercial |
$143.26
|
| Rate for Payer: Priority Health SBD |
$106.18
|
|
|
HC US TRANSPLANTED KIDNEY
|
Facility
|
IP
|
$520.60
|
|
|
Service Code
|
CPT 76776
|
| Hospital Charge Code |
40200013
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$327.98 |
| Max. Negotiated Rate |
$468.54 |
| Rate for Payer: Aetna Commercial |
$442.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.39
|
| Rate for Payer: Cash Price |
$416.48
|
| Rate for Payer: Cofinity Advantage |
$364.42
|
| Rate for Payer: Cofinity Commercial |
$447.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.48
|
| Rate for Payer: Healthscope Commercial |
$468.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.45
|
| Rate for Payer: PHP Commercial |
$442.51
|
| Rate for Payer: Priority Health SBD |
$327.98
|
|
|
HC US TRANSPLANTED KIDNEY
|
Facility
|
OP
|
$520.60
|
|
|
Service Code
|
CPT 76776
|
| Hospital Charge Code |
40200013
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$468.54 |
| Rate for Payer: Aetna Commercial |
$442.51
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$250.61
|
| Rate for Payer: BCN Commercial |
$250.61
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$416.48
|
| Rate for Payer: Cash Price |
$416.48
|
| Rate for Payer: Cofinity Advantage |
$364.42
|
| Rate for Payer: Cofinity Commercial |
$447.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$468.54
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.51
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.45
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$442.51
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$327.98
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$338.39
|
| Rate for Payer: UHC Core |
$271.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$204.60
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC UVULECTOMY EXCISION UVULA
|
Facility
|
OP
|
$8,219.16
|
|
|
Service Code
|
CPT 42140
|
| Hospital Charge Code |
76100468
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,256.18 |
| Max. Negotiated Rate |
$10,683.35 |
| Rate for Payer: Aetna Commercial |
$6,986.29
|
| Rate for Payer: Aetna Medicare |
$3,435.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,342.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,129.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,129.43
|
| Rate for Payer: BCBS Complete |
$1,814.30
|
| Rate for Payer: BCBS MAPPO |
$3,303.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,256.18
|
| Rate for Payer: BCN Commercial |
$1,256.18
|
| Rate for Payer: BCN Medicare Advantage |
$3,303.54
|
| Rate for Payer: Cash Price |
$6,575.33
|
| Rate for Payer: Cash Price |
$6,575.33
|
| Rate for Payer: Cash Price |
$6,575.33
|
| Rate for Payer: Cofinity Advantage |
$5,753.41
|
| Rate for Payer: Cofinity Commercial |
$7,068.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,575.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,303.54
|
| Rate for Payer: Healthscope Commercial |
$7,397.24
|
| Rate for Payer: Mclaren Medicaid |
$1,727.75
|
| Rate for Payer: Mclaren Medicare |
$3,303.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,468.72
|
| Rate for Payer: Meridian Medicaid |
$3,468.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,799.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,633.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,986.29
|
| Rate for Payer: Nomi Health Commercial |
$9,910.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,164.37
|
| Rate for Payer: PACE Medicare |
$3,138.36
|
| Rate for Payer: PACE SWMI |
$3,303.54
|
| Rate for Payer: PHP Commercial |
$6,986.29
|
| Rate for Payer: PHP Medicare Advantage |
$3,303.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,727.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,683.35
|
| Rate for Payer: Priority Health Medicare |
$3,303.54
|
| Rate for Payer: Priority Health SBD |
$5,178.07
|
| Rate for Payer: Priority Health Tiered Network |
$8,546.68
|
| Rate for Payer: Railroad Medicare Medicare |
$3,303.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,342.45
|
| Rate for Payer: UHC Core |
$4,282.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,303.54
|
| Rate for Payer: UHC Exchange |
$3,230.13
|
| Rate for Payer: UHC Medicaid |
$1,727.75
|
| Rate for Payer: UHCCP Medicaid |
$1,727.75
|
| Rate for Payer: VA VA |
$3,303.54
|
|
|
HC UVULECTOMY EXCISION UVULA
|
Facility
|
IP
|
$8,219.16
|
|
|
Service Code
|
CPT 42140
|
| Hospital Charge Code |
76100468
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,178.07 |
| Max. Negotiated Rate |
$7,397.24 |
| Rate for Payer: Aetna Commercial |
$6,986.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,342.45
|
| Rate for Payer: Cash Price |
$6,575.33
|
| Rate for Payer: Cofinity Advantage |
$5,753.41
|
| Rate for Payer: Cofinity Commercial |
$7,068.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,575.33
|
| Rate for Payer: Healthscope Commercial |
$7,397.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,986.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,164.37
|
| Rate for Payer: PHP Commercial |
$6,986.29
|
| Rate for Payer: Priority Health SBD |
$5,178.07
|
|
|
HC V5011 FITTING ORIENTATION CHECKING OF HEARING AID
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT V5011
|
| Hospital Charge Code |
47000008
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$39.32 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Advantage |
$43.69
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.81
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health SBD |
$39.32
|
|
|
HC V5011 FITTING ORIENTATION CHECKING OF HEARING AID
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT V5011
|
| Hospital Charge Code |
47000008
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$24.53 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna Medicare |
$31.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: BCBS Complete |
$24.97
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Advantage |
$43.69
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.81
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health SBD |
$39.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.57
|
| Rate for Payer: UHC Core |
$32.52
|
| Rate for Payer: UHC Exchange |
$24.53
|
|
|
HC V5160 DISPENSING FEE BINAURAL
|
Facility
|
OP
|
$494.19
|
|
|
Service Code
|
CPT V5160
|
| Hospital Charge Code |
47000006
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$194.22 |
| Max. Negotiated Rate |
$444.77 |
| Rate for Payer: Aetna Commercial |
$420.06
|
| Rate for Payer: Aetna Medicare |
$247.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.22
|
| Rate for Payer: BCBS Complete |
$197.68
|
| Rate for Payer: Cash Price |
$395.35
|
| Rate for Payer: Cofinity Advantage |
$345.93
|
| Rate for Payer: Cofinity Commercial |
$425.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.35
|
| Rate for Payer: Healthscope Commercial |
$444.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$395.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$370.64
|
| Rate for Payer: PHP Commercial |
$420.06
|
| Rate for Payer: Priority Health SBD |
$311.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$321.22
|
| Rate for Payer: UHC Core |
$257.47
|
| Rate for Payer: UHC Exchange |
$194.22
|
|
|
HC V5160 DISPENSING FEE BINAURAL
|
Facility
|
IP
|
$494.19
|
|
|
Service Code
|
CPT V5160
|
| Hospital Charge Code |
47000006
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$311.34 |
| Max. Negotiated Rate |
$444.77 |
| Rate for Payer: Aetna Commercial |
$420.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.22
|
| Rate for Payer: Cash Price |
$395.35
|
| Rate for Payer: Cofinity Advantage |
$345.93
|
| Rate for Payer: Cofinity Commercial |
$425.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.35
|
| Rate for Payer: Healthscope Commercial |
$444.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$370.64
|
| Rate for Payer: PHP Commercial |
$420.06
|
| Rate for Payer: Priority Health SBD |
$311.34
|
|
|
HC V5241 DISPENSING FEE MONAURAL HEARING AID ANY TYPE
|
Facility
|
IP
|
$286.11
|
|
|
Service Code
|
CPT V5241
|
| Hospital Charge Code |
47000004
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$180.25 |
| Max. Negotiated Rate |
$257.50 |
| Rate for Payer: Aetna Commercial |
$243.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.97
|
| Rate for Payer: Cash Price |
$228.89
|
| Rate for Payer: Cofinity Advantage |
$200.28
|
| Rate for Payer: Cofinity Commercial |
$246.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.89
|
| Rate for Payer: Healthscope Commercial |
$257.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.58
|
| Rate for Payer: PHP Commercial |
$243.19
|
| Rate for Payer: Priority Health SBD |
$180.25
|
|
|
HC V5241 DISPENSING FEE MONAURAL HEARING AID ANY TYPE
|
Facility
|
OP
|
$286.11
|
|
|
Service Code
|
CPT V5241
|
| Hospital Charge Code |
47000004
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$112.44 |
| Max. Negotiated Rate |
$257.50 |
| Rate for Payer: Aetna Commercial |
$243.19
|
| Rate for Payer: Aetna Medicare |
$143.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.97
|
| Rate for Payer: BCBS Complete |
$114.44
|
| Rate for Payer: Cash Price |
$228.89
|
| Rate for Payer: Cofinity Advantage |
$200.28
|
| Rate for Payer: Cofinity Commercial |
$246.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.89
|
| Rate for Payer: Healthscope Commercial |
$257.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.58
|
| Rate for Payer: PHP Commercial |
$243.19
|
| Rate for Payer: Priority Health SBD |
$180.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.97
|
| Rate for Payer: UHC Core |
$149.06
|
| Rate for Payer: UHC Exchange |
$112.44
|
|
|
HC V5264 EAR MOLD INSERT NOT DISPOSABLE ANY TYPE
|
Facility
|
IP
|
$72.83
|
|
|
Service Code
|
CPT V5264
|
| Hospital Charge Code |
47000005
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna Commercial |
$61.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.34
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Advantage |
$50.98
|
| Rate for Payer: Cofinity Commercial |
$62.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Healthscope Commercial |
$65.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.62
|
| Rate for Payer: PHP Commercial |
$61.91
|
| Rate for Payer: Priority Health SBD |
$45.88
|
|
