|
HC VERT AUG W MECH DEV THOR 1ST
|
Facility
|
OP
|
$11,679.94
|
|
|
Service Code
|
CPT 22513
|
| Hospital Charge Code |
36100467
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,781.35 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Commercial |
$9,927.95
|
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,591.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$4,205.20
|
| Rate for Payer: BCN Commercial |
$4,205.20
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Cash Price |
$9,343.95
|
| Rate for Payer: Cash Price |
$9,343.95
|
| Rate for Payer: Cash Price |
$9,343.95
|
| Rate for Payer: Cofinity Advantage |
$8,175.96
|
| Rate for Payer: Cofinity Commercial |
$10,044.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,343.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Healthscope Commercial |
$10,511.95
|
| Rate for Payer: Mclaren Medicaid |
$3,781.35
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,927.95
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,759.95
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Commercial |
$9,927.95
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health SBD |
$7,358.36
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
HC VERT AUG W MECH DEV THOR 1ST
|
Facility
|
IP
|
$11,679.94
|
|
|
Service Code
|
CPT 22513
|
| Hospital Charge Code |
36100467
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,358.36 |
| Max. Negotiated Rate |
$10,511.95 |
| Rate for Payer: Aetna Commercial |
$9,927.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,591.96
|
| Rate for Payer: Cash Price |
$9,343.95
|
| Rate for Payer: Cofinity Advantage |
$8,175.96
|
| Rate for Payer: Cofinity Commercial |
$10,044.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,343.95
|
| Rate for Payer: Healthscope Commercial |
$10,511.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,927.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,759.95
|
| Rate for Payer: PHP Commercial |
$9,927.95
|
| Rate for Payer: Priority Health SBD |
$7,358.36
|
|
|
HC VERTEBROPLASTY CEMENT
|
Facility
|
OP
|
$1,276.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27800112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$501.48 |
| Max. Negotiated Rate |
$1,148.44 |
| Rate for Payer: Aetna Commercial |
$1,084.63
|
| Rate for Payer: Aetna Medicare |
$638.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$829.43
|
| Rate for Payer: BCBS Complete |
$510.42
|
| Rate for Payer: Cash Price |
$1,020.83
|
| Rate for Payer: Cofinity Advantage |
$893.23
|
| Rate for Payer: Cofinity Commercial |
$1,097.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,020.83
|
| Rate for Payer: Healthscope Commercial |
$1,148.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,020.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,084.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$957.03
|
| Rate for Payer: PHP Commercial |
$1,084.63
|
| Rate for Payer: Priority Health SBD |
$803.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$829.43
|
| Rate for Payer: UHC Core |
$664.82
|
| Rate for Payer: UHC Exchange |
$501.48
|
|
|
HC VERTEBROPLASTY CEMENT
|
Facility
|
IP
|
$1,276.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27800112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$803.91 |
| Max. Negotiated Rate |
$1,148.44 |
| Rate for Payer: Aetna Commercial |
$1,084.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$829.43
|
| Rate for Payer: Cash Price |
$1,020.83
|
| Rate for Payer: Cofinity Advantage |
$893.23
|
| Rate for Payer: Cofinity Commercial |
$1,097.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,020.83
|
| Rate for Payer: Healthscope Commercial |
$1,148.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,084.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$957.03
|
| Rate for Payer: PHP Commercial |
$1,084.63
|
| Rate for Payer: Priority Health SBD |
$803.91
|
|
|
HC VERTEBROPLASTY SACRUM BIL W WO BONE BX AND IMAGING
|
Facility
|
OP
|
$6,388.10
|
|
|
Service Code
|
CPT 0201T
|
| Hospital Charge Code |
36100298
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,781.35 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Commercial |
$5,429.89
|
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,152.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Cash Price |
$5,110.48
|
| Rate for Payer: Cash Price |
$5,110.48
|
| Rate for Payer: Cofinity Advantage |
$4,471.67
|
| Rate for Payer: Cofinity Commercial |
$5,493.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,110.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Healthscope Commercial |
$5,749.29
|
| Rate for Payer: Mclaren Medicaid |
$3,781.35
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,429.89
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,791.07
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Commercial |
$5,429.89
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health SBD |
$4,024.50
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
HC VERTEBROPLASTY SACRUM BIL W WO BONE BX AND IMAGING
|
Facility
|
IP
|
$6,388.10
|
|
|
Service Code
|
CPT 0201T
|
| Hospital Charge Code |
36100298
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,024.50 |
| Max. Negotiated Rate |
$5,749.29 |
| Rate for Payer: Aetna Commercial |
$5,429.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,152.27
|
| Rate for Payer: Cash Price |
$5,110.48
|
| Rate for Payer: Cofinity Advantage |
$4,471.67
|
| Rate for Payer: Cofinity Commercial |
$5,493.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,110.48
|
| Rate for Payer: Healthscope Commercial |
$5,749.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,429.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,791.07
|
| Rate for Payer: PHP Commercial |
$5,429.89
|
| Rate for Payer: Priority Health SBD |
$4,024.50
|
|
|
HC VERTEBROPLASTY SACRUM UNI W WO BONE BX AND IMAGING
|
Facility
|
IP
|
$5,110.48
|
|
|
Service Code
|
CPT 0200T
|
| Hospital Charge Code |
36100299
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,219.60 |
| Max. Negotiated Rate |
$4,599.43 |
| Rate for Payer: Aetna Commercial |
$4,343.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,321.81
|
| Rate for Payer: Cash Price |
$4,088.38
|
| Rate for Payer: Cofinity Advantage |
$3,577.34
|
| Rate for Payer: Cofinity Commercial |
$4,395.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,088.38
|
| Rate for Payer: Healthscope Commercial |
$4,599.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,343.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,832.86
|
| Rate for Payer: PHP Commercial |
$4,343.91
|
| Rate for Payer: Priority Health SBD |
$3,219.60
|
|
|
HC VERTEBROPLASTY SACRUM UNI W WO BONE BX AND IMAGING
|
Facility
|
OP
|
$5,110.48
|
|
|
Service Code
|
CPT 0200T
|
| Hospital Charge Code |
36100299
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,219.60 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Commercial |
$4,343.91
|
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,321.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Cash Price |
$4,088.38
|
| Rate for Payer: Cash Price |
$4,088.38
|
| Rate for Payer: Cofinity Advantage |
$3,577.34
|
| Rate for Payer: Cofinity Commercial |
$4,395.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,088.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Healthscope Commercial |
$4,599.43
|
| Rate for Payer: Mclaren Medicaid |
$3,781.35
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,343.91
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,832.86
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Commercial |
$4,343.91
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health SBD |
$3,219.60
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
HC VEST SUPPLY
|
Facility
|
IP
|
$474.00
|
|
| Hospital Charge Code |
27000169
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$298.62 |
| Max. Negotiated Rate |
$426.60 |
| Rate for Payer: Aetna Commercial |
$402.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$308.10
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cofinity Advantage |
$331.80
|
| Rate for Payer: Cofinity Commercial |
$407.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$379.20
|
| Rate for Payer: Healthscope Commercial |
$426.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$402.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$355.50
|
| Rate for Payer: PHP Commercial |
$402.90
|
| Rate for Payer: Priority Health SBD |
$298.62
|
|
|
HC VEST SUPPLY
|
Facility
|
OP
|
$474.00
|
|
| Hospital Charge Code |
27000169
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$186.28 |
| Max. Negotiated Rate |
$426.60 |
| Rate for Payer: Aetna Commercial |
$402.90
|
| Rate for Payer: Aetna Medicare |
$237.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$308.10
|
| Rate for Payer: BCBS Complete |
$189.60
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cofinity Advantage |
$331.80
|
| Rate for Payer: Cofinity Commercial |
$407.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$379.20
|
| Rate for Payer: Healthscope Commercial |
$426.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$379.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$402.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$355.50
|
| Rate for Payer: PHP Commercial |
$402.90
|
| Rate for Payer: Priority Health SBD |
$298.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.10
|
| Rate for Payer: UHC Core |
$246.95
|
| Rate for Payer: UHC Exchange |
$186.28
|
|
|
HC VIABAHN 2
|
Facility
|
IP
|
$8,276.28
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,214.06 |
| Max. Negotiated Rate |
$7,448.65 |
| Rate for Payer: Aetna Commercial |
$7,034.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,379.58
|
| Rate for Payer: Cash Price |
$6,621.02
|
| Rate for Payer: Cofinity Advantage |
$5,793.40
|
| Rate for Payer: Cofinity Commercial |
$7,117.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,621.02
|
| Rate for Payer: Healthscope Commercial |
$7,448.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,034.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,207.21
|
| Rate for Payer: PHP Commercial |
$7,034.84
|
| Rate for Payer: Priority Health SBD |
$5,214.06
|
|
|
HC VIABAHN 2
|
Facility
|
OP
|
$8,276.28
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.58 |
| Max. Negotiated Rate |
$7,448.65 |
| Rate for Payer: Aetna Commercial |
$7,034.84
|
| Rate for Payer: Aetna Medicare |
$4,138.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,379.58
|
| Rate for Payer: BCBS Complete |
$3,310.51
|
| Rate for Payer: Cash Price |
$6,621.02
|
| Rate for Payer: Cofinity Advantage |
$5,793.40
|
| Rate for Payer: Cofinity Commercial |
$7,117.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,621.02
|
| Rate for Payer: Healthscope Commercial |
$7,448.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,621.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,034.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,207.21
|
| Rate for Payer: PHP Commercial |
$7,034.84
|
| Rate for Payer: Priority Health SBD |
$5,214.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,379.58
|
| Rate for Payer: UHC Core |
$4,311.94
|
| Rate for Payer: UHC Exchange |
$3,252.58
|
|
|
HC VISCOSITY
|
Facility
|
IP
|
$72.17
|
|
|
Service Code
|
CPT 85810
|
| Hospital Charge Code |
30500065
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$45.47 |
| Max. Negotiated Rate |
$64.95 |
| Rate for Payer: Aetna Commercial |
$61.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.91
|
| Rate for Payer: Cash Price |
$57.74
|
| Rate for Payer: Cofinity Advantage |
$50.52
|
| Rate for Payer: Cofinity Commercial |
$62.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.74
|
| Rate for Payer: Healthscope Commercial |
$64.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.13
|
| Rate for Payer: PHP Commercial |
$61.34
|
| Rate for Payer: Priority Health SBD |
$45.47
|
|
|
HC VISCOSITY
|
Facility
|
OP
|
$72.17
|
|
|
Service Code
|
CPT 85810
|
| Hospital Charge Code |
30500065
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$64.95 |
| Rate for Payer: Aetna Commercial |
$61.34
|
| Rate for Payer: Aetna Medicare |
$12.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.59
|
| Rate for Payer: BCBS Complete |
$6.41
|
| Rate for Payer: BCBS MAPPO |
$11.67
|
| Rate for Payer: BCBS Trust/PPO |
$12.44
|
| Rate for Payer: BCN Commercial |
$12.44
|
| Rate for Payer: BCN Medicare Advantage |
$11.67
|
| Rate for Payer: Cash Price |
$57.74
|
| Rate for Payer: Cash Price |
$57.74
|
| Rate for Payer: Cofinity Advantage |
$50.52
|
| Rate for Payer: Cofinity Commercial |
$62.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.67
|
| Rate for Payer: Healthscope Commercial |
$64.95
|
| Rate for Payer: Mclaren Medicaid |
$6.10
|
| Rate for Payer: Mclaren Medicare |
$11.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.25
|
| Rate for Payer: Meridian Medicaid |
$12.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.34
|
| Rate for Payer: Nomi Health Commercial |
$17.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.13
|
| Rate for Payer: PACE Medicare |
$11.09
|
| Rate for Payer: PACE SWMI |
$11.67
|
| Rate for Payer: PHP Commercial |
$61.34
|
| Rate for Payer: PHP Medicare Advantage |
$11.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11.67
|
| Rate for Payer: Priority Health Medicare |
$11.67
|
| Rate for Payer: Priority Health SBD |
$45.47
|
| Rate for Payer: Priority Health Tiered Network |
$9.34
|
| Rate for Payer: Railroad Medicare Medicare |
$11.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.51
|
| Rate for Payer: UHC Core |
$17.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.67
|
| Rate for Payer: UHC Exchange |
$17.51
|
| Rate for Payer: UHC Medicaid |
$6.10
|
| Rate for Payer: UHCCP Medicaid |
$6.10
|
| Rate for Payer: VA VA |
$11.67
|
|
|
HC VISIPAQUE 320 PER ML
|
Facility
|
IP
|
$2.90
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600019
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$2.61 |
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.89
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cofinity Advantage |
$2.03
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.32
|
| Rate for Payer: Healthscope Commercial |
$2.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.46
|
| Rate for Payer: Priority Health SBD |
$1.83
|
|
|
HC VISIPAQUE 320 PER ML
|
Facility
|
OP
|
$2.90
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600019
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$2.61 |
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: Aetna Medicare |
$1.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.89
|
| Rate for Payer: BCBS Complete |
$1.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.37
|
| Rate for Payer: BCN Commercial |
$0.37
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cofinity Advantage |
$2.03
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.32
|
| Rate for Payer: Healthscope Commercial |
$2.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.46
|
| Rate for Payer: Priority Health SBD |
$1.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
|
|
HC VISUAL ACUITY SCREEN
|
Facility
|
IP
|
$40.52
|
|
|
Service Code
|
CPT 99173
|
| Hospital Charge Code |
51000099
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.53 |
| Max. Negotiated Rate |
$36.47 |
| Rate for Payer: Aetna Commercial |
$34.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.34
|
| Rate for Payer: Cash Price |
$32.42
|
| Rate for Payer: Cofinity Advantage |
$28.36
|
| Rate for Payer: Cofinity Commercial |
$34.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.42
|
| Rate for Payer: Healthscope Commercial |
$36.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.39
|
| Rate for Payer: PHP Commercial |
$34.44
|
| Rate for Payer: Priority Health SBD |
$25.53
|
|
|
HC VISUAL ACUITY SCREEN
|
Facility
|
OP
|
$40.52
|
|
|
Service Code
|
CPT 99173
|
| Hospital Charge Code |
51000099
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.31 |
| Max. Negotiated Rate |
$36.47 |
| Rate for Payer: Aetna Commercial |
$34.44
|
| Rate for Payer: Aetna Medicare |
$20.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.34
|
| Rate for Payer: BCBS Complete |
$16.21
|
| Rate for Payer: BCBS Trust/PPO |
$13.31
|
| Rate for Payer: BCN Commercial |
$13.31
|
| Rate for Payer: Cash Price |
$32.42
|
| Rate for Payer: Cash Price |
$32.42
|
| Rate for Payer: Cofinity Advantage |
$28.36
|
| Rate for Payer: Cofinity Commercial |
$34.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.42
|
| Rate for Payer: Healthscope Commercial |
$36.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.39
|
| Rate for Payer: PHP Commercial |
$34.44
|
| Rate for Payer: Priority Health SBD |
$25.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.34
|
| Rate for Payer: UHC Core |
$21.11
|
| Rate for Payer: UHC Exchange |
$15.92
|
|
|
HC VISUAL AUDIOMETRY VRA
|
Facility
|
OP
|
$216.41
|
|
|
Service Code
|
CPT 92579
|
| Hospital Charge Code |
47100013
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$85.05 |
| Max. Negotiated Rate |
$695.77 |
| Rate for Payer: Aetna Commercial |
$183.95
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.67
|
| 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 |
$88.84
|
| Rate for Payer: BCN Commercial |
$88.84
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$173.13
|
| Rate for Payer: Cash Price |
$173.13
|
| Rate for Payer: Cofinity Advantage |
$151.49
|
| Rate for Payer: Cofinity Commercial |
$186.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$194.77
|
| 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 |
$183.95
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.31
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$183.95
|
| 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 |
$136.34
|
| 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) |
$140.67
|
| Rate for Payer: UHC Core |
$112.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$85.05
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC VISUAL AUDIOMETRY VRA
|
Facility
|
IP
|
$216.41
|
|
|
Service Code
|
CPT 92579
|
| Hospital Charge Code |
47100013
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$136.34 |
| Max. Negotiated Rate |
$194.77 |
| Rate for Payer: Aetna Commercial |
$183.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.67
|
| Rate for Payer: Cash Price |
$173.13
|
| Rate for Payer: Cofinity Advantage |
$151.49
|
| Rate for Payer: Cofinity Commercial |
$186.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.13
|
| Rate for Payer: Healthscope Commercial |
$194.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.31
|
| Rate for Payer: PHP Commercial |
$183.95
|
| Rate for Payer: Priority Health SBD |
$136.34
|
|
|
HC VITAL CAPACITY
|
Facility
|
IP
|
$273.41
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
46000016
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$172.25 |
| Max. Negotiated Rate |
$246.07 |
| Rate for Payer: Aetna Commercial |
$232.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.72
|
| Rate for Payer: Cash Price |
$218.73
|
| Rate for Payer: Cofinity Advantage |
$191.39
|
| Rate for Payer: Cofinity Commercial |
$235.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.73
|
| Rate for Payer: Healthscope Commercial |
$246.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.06
|
| Rate for Payer: PHP Commercial |
$232.40
|
| Rate for Payer: Priority Health SBD |
$172.25
|
|
|
HC VITAL CAPACITY
|
Facility
|
OP
|
$273.41
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
46000016
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$67.05 |
| Max. Negotiated Rate |
$414.63 |
| Rate for Payer: Aetna Commercial |
$232.40
|
| Rate for Payer: Aetna Medicare |
$133.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$160.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$160.26
|
| Rate for Payer: BCBS Complete |
$70.41
|
| Rate for Payer: BCBS MAPPO |
$128.21
|
| Rate for Payer: BCBS Trust/PPO |
$96.23
|
| Rate for Payer: BCN Commercial |
$96.23
|
| Rate for Payer: BCN Medicare Advantage |
$128.21
|
| Rate for Payer: Cash Price |
$218.73
|
| Rate for Payer: Cash Price |
$218.73
|
| Rate for Payer: Cofinity Advantage |
$191.39
|
| Rate for Payer: Cofinity Commercial |
$235.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.21
|
| Rate for Payer: Healthscope Commercial |
$246.07
|
| Rate for Payer: Mclaren Medicaid |
$67.05
|
| Rate for Payer: Mclaren Medicare |
$128.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.62
|
| Rate for Payer: Meridian Medicaid |
$134.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$147.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$141.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.40
|
| Rate for Payer: Nomi Health Commercial |
$384.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.06
|
| Rate for Payer: PACE Medicare |
$121.80
|
| Rate for Payer: PACE SWMI |
$128.21
|
| Rate for Payer: PHP Commercial |
$232.40
|
| Rate for Payer: PHP Medicare Advantage |
$128.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$414.63
|
| Rate for Payer: Priority Health Medicare |
$128.21
|
| Rate for Payer: Priority Health SBD |
$172.25
|
| Rate for Payer: Priority Health Tiered Network |
$331.70
|
| Rate for Payer: Railroad Medicare Medicare |
$128.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.72
|
| Rate for Payer: UHC Core |
$142.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$128.21
|
| Rate for Payer: UHC Exchange |
$107.45
|
| Rate for Payer: UHC Medicaid |
$67.05
|
| Rate for Payer: UHCCP Medicaid |
$67.05
|
| Rate for Payer: VA VA |
$128.21
|
|
|
HC VITAMIN A LEVEL
|
Facility
|
IP
|
$47.76
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
30100458
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.09 |
| Max. Negotiated Rate |
$42.98 |
| Rate for Payer: Aetna Commercial |
$40.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.04
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cofinity Advantage |
$33.43
|
| Rate for Payer: Cofinity Commercial |
$41.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.21
|
| Rate for Payer: Healthscope Commercial |
$42.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.82
|
| Rate for Payer: PHP Commercial |
$40.60
|
| Rate for Payer: Priority Health SBD |
$30.09
|
|
|
HC VITAMIN A LEVEL
|
Facility
|
OP
|
$47.76
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
30100458
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$42.98 |
| Rate for Payer: Aetna Commercial |
$40.60
|
| Rate for Payer: Aetna Medicare |
$12.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.51
|
| Rate for Payer: BCBS Complete |
$6.38
|
| Rate for Payer: BCBS MAPPO |
$11.61
|
| Rate for Payer: BCBS Trust/PPO |
$12.38
|
| Rate for Payer: BCN Commercial |
$12.38
|
| Rate for Payer: BCN Medicare Advantage |
$11.61
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cofinity Advantage |
$33.43
|
| Rate for Payer: Cofinity Commercial |
$41.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.61
|
| Rate for Payer: Healthscope Commercial |
$42.98
|
| Rate for Payer: Mclaren Medicaid |
$6.07
|
| Rate for Payer: Mclaren Medicare |
$11.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.19
|
| Rate for Payer: Meridian Medicaid |
$12.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.60
|
| Rate for Payer: Nomi Health Commercial |
$17.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.82
|
| Rate for Payer: PACE Medicare |
$11.03
|
| Rate for Payer: PACE SWMI |
$11.61
|
| Rate for Payer: PHP Commercial |
$40.60
|
| Rate for Payer: PHP Medicare Advantage |
$11.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11.61
|
| Rate for Payer: Priority Health Medicare |
$11.61
|
| Rate for Payer: Priority Health SBD |
$30.09
|
| Rate for Payer: Priority Health Tiered Network |
$9.29
|
| Rate for Payer: Railroad Medicare Medicare |
$11.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.42
|
| Rate for Payer: UHC Core |
$17.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.61
|
| Rate for Payer: UHC Exchange |
$17.42
|
| Rate for Payer: UHC Medicaid |
$6.07
|
| Rate for Payer: UHCCP Medicaid |
$6.07
|
| Rate for Payer: VA VA |
$11.61
|
|
|
HC VITAMIN B12 LEVEL
|
Facility
|
OP
|
$63.67
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
30100185
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.89 |
| Max. Negotiated Rate |
$57.30 |
| Rate for Payer: Aetna Commercial |
$54.12
|
| Rate for Payer: Aetna Medicare |
$15.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.85
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: BCBS MAPPO |
$15.08
|
| Rate for Payer: BCBS Trust/PPO |
$16.08
|
| Rate for Payer: BCN Commercial |
$16.08
|
| Rate for Payer: BCN Medicare Advantage |
$15.08
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Advantage |
$44.57
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.08
|
| Rate for Payer: Healthscope Commercial |
$57.30
|
| Rate for Payer: Mclaren Medicaid |
$7.89
|
| Rate for Payer: Mclaren Medicare |
$15.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.83
|
| Rate for Payer: Meridian Medicaid |
$15.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.12
|
| Rate for Payer: Nomi Health Commercial |
$22.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.75
|
| Rate for Payer: PACE Medicare |
$14.33
|
| Rate for Payer: PACE SWMI |
$15.08
|
| Rate for Payer: PHP Commercial |
$54.12
|
| Rate for Payer: PHP Medicare Advantage |
$15.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15.08
|
| Rate for Payer: Priority Health Medicare |
$15.08
|
| Rate for Payer: Priority Health SBD |
$40.11
|
| Rate for Payer: Priority Health Tiered Network |
$12.06
|
| Rate for Payer: Railroad Medicare Medicare |
$15.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.62
|
| Rate for Payer: UHC Core |
$22.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.08
|
| Rate for Payer: UHC Exchange |
$22.62
|
| Rate for Payer: UHC Medicaid |
$7.89
|
| Rate for Payer: UHCCP Medicaid |
$7.89
|
| Rate for Payer: VA VA |
$15.08
|
|
