|
HC COMPLEMENT C 4
|
Facility
|
OP
|
$115.26
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200151
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$115.26 |
| Rate for Payer: Aetna Commercial |
$103.73
|
| Rate for Payer: Aetna Medicare |
$12.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.00
|
| Rate for Payer: ASR ASR |
$111.80
|
| Rate for Payer: ASR Commercial |
$111.80
|
| Rate for Payer: BCBS Complete |
$6.75
|
| Rate for Payer: BCBS MAPPO |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$94.39
|
| Rate for Payer: BCN Commercial |
$89.36
|
| Rate for Payer: BCN Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$92.21
|
| Rate for Payer: Cash Price |
$92.21
|
| Rate for Payer: Cofinity Commercial |
$108.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$115.26
|
| Rate for Payer: Healthscope Whirlpool |
$111.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.00
|
| Rate for Payer: Mclaren Commercial |
$103.73
|
| Rate for Payer: Mclaren Medicaid |
$6.43
|
| Rate for Payer: Mclaren Medicare |
$12.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.60
|
| Rate for Payer: Meridian Medicaid |
$6.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.97
|
| Rate for Payer: Nomi Health Commercial |
$94.51
|
| Rate for Payer: PACE Medicare |
$11.40
|
| Rate for Payer: PACE SWMI |
$12.00
|
| Rate for Payer: PHP Commercial |
$13.20
|
| Rate for Payer: PHP Medicaid |
$6.43
|
| Rate for Payer: PHP Medicare Advantage |
$12.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.54
|
| Rate for Payer: Priority Health Medicare |
$12.00
|
| Rate for Payer: Priority Health Narrow Network |
$31.63
|
| Rate for Payer: Railroad Medicare Medicare |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.00
|
| Rate for Payer: UHC Exchange |
$18.60
|
| Rate for Payer: UHC Medicare Advantage |
$12.00
|
| Rate for Payer: UHCCP DNSP |
$12.00
|
| Rate for Payer: UHCCP Medicaid |
$6.43
|
| Rate for Payer: VA VA |
$12.00
|
|
|
HC COMPLEMENT C 5
|
Facility
|
IP
|
$72.83
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200152
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.34 |
| Max. Negotiated Rate |
$72.83 |
| Rate for Payer: Aetna Commercial |
$65.55
|
| Rate for Payer: ASR ASR |
$70.65
|
| Rate for Payer: ASR Commercial |
$70.65
|
| Rate for Payer: BCBS Trust/PPO |
$59.35
|
| Rate for Payer: BCN Commercial |
$56.47
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$68.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Healthscope Commercial |
$72.83
|
| Rate for Payer: Healthscope Whirlpool |
$70.65
|
| Rate for Payer: Mclaren Commercial |
$65.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Nomi Health Commercial |
$59.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.09
|
|
|
HC COMPLEMENT C 5
|
Facility
|
OP
|
$72.83
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200152
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$72.83 |
| Rate for Payer: Aetna Commercial |
$65.55
|
| Rate for Payer: Aetna Medicare |
$12.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.00
|
| Rate for Payer: ASR ASR |
$70.65
|
| Rate for Payer: ASR Commercial |
$70.65
|
| Rate for Payer: BCBS Complete |
$6.75
|
| Rate for Payer: BCBS MAPPO |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$59.64
|
| Rate for Payer: BCN Commercial |
$56.47
|
| Rate for Payer: BCN Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$68.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$72.83
|
| Rate for Payer: Healthscope Whirlpool |
$70.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.00
|
| Rate for Payer: Mclaren Commercial |
$65.55
|
| Rate for Payer: Mclaren Medicaid |
$6.43
|
| Rate for Payer: Mclaren Medicare |
$12.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.60
|
| Rate for Payer: Meridian Medicaid |
$6.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Nomi Health Commercial |
$59.72
|
| Rate for Payer: PACE Medicare |
$11.40
|
| Rate for Payer: PACE SWMI |
$12.00
|
| Rate for Payer: PHP Commercial |
$13.20
|
| Rate for Payer: PHP Medicaid |
$6.43
|
| Rate for Payer: PHP Medicare Advantage |
$12.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.54
|
| Rate for Payer: Priority Health Medicare |
$12.00
|
| Rate for Payer: Priority Health Narrow Network |
$31.63
|
| Rate for Payer: Railroad Medicare Medicare |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.00
|
| Rate for Payer: UHC Exchange |
$18.60
|
| Rate for Payer: UHC Medicare Advantage |
$12.00
|
| Rate for Payer: UHCCP DNSP |
$12.00
|
| Rate for Payer: UHCCP Medicaid |
$6.43
|
| Rate for Payer: VA VA |
$12.00
|
|
|
HC COMPLEMENT CH50 TOTAL
|
Facility
|
IP
|
$39.54
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
30200154
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.70 |
| Max. Negotiated Rate |
$39.54 |
| Rate for Payer: Aetna Commercial |
$35.59
|
| Rate for Payer: ASR ASR |
$38.35
|
| Rate for Payer: ASR Commercial |
$38.35
|
| Rate for Payer: BCBS Trust/PPO |
$32.22
|
| Rate for Payer: BCN Commercial |
$30.66
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Cofinity Commercial |
$37.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.63
|
| Rate for Payer: Healthscope Commercial |
$39.54
|
| Rate for Payer: Healthscope Whirlpool |
$38.35
|
| Rate for Payer: Mclaren Commercial |
$35.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.61
|
| Rate for Payer: Nomi Health Commercial |
$32.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.80
|
|
|
HC COMPLEMENT CH50 TOTAL
|
Facility
|
OP
|
$39.54
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
30200154
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.89 |
| Max. Negotiated Rate |
$62.60 |
| Rate for Payer: Aetna Commercial |
$35.59
|
| Rate for Payer: Aetna Medicare |
$20.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.40
|
| Rate for Payer: ASR ASR |
$38.35
|
| Rate for Payer: ASR Commercial |
$38.35
|
| Rate for Payer: BCBS Complete |
$11.44
|
| Rate for Payer: BCBS MAPPO |
$20.32
|
| Rate for Payer: BCBS Trust/PPO |
$32.38
|
| Rate for Payer: BCN Commercial |
$30.66
|
| Rate for Payer: BCN Medicare Advantage |
$20.32
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Cofinity Commercial |
$37.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.32
|
| Rate for Payer: Healthscope Commercial |
$39.54
|
| Rate for Payer: Healthscope Whirlpool |
$38.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$20.32
|
| Rate for Payer: Mclaren Commercial |
$35.59
|
| Rate for Payer: Mclaren Medicaid |
$10.89
|
| Rate for Payer: Mclaren Medicare |
$20.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.34
|
| Rate for Payer: Meridian Medicaid |
$11.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.61
|
| Rate for Payer: Nomi Health Commercial |
$32.42
|
| Rate for Payer: PACE Medicare |
$19.30
|
| Rate for Payer: PACE SWMI |
$20.32
|
| Rate for Payer: PHP Commercial |
$22.35
|
| Rate for Payer: PHP Medicaid |
$10.89
|
| Rate for Payer: PHP Medicare Advantage |
$20.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.60
|
| Rate for Payer: Priority Health Medicare |
$20.32
|
| Rate for Payer: Priority Health Narrow Network |
$50.08
|
| Rate for Payer: Railroad Medicare Medicare |
$20.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.32
|
| Rate for Payer: UHC Exchange |
$31.50
|
| Rate for Payer: UHC Medicare Advantage |
$20.32
|
| Rate for Payer: UHCCP DNSP |
$20.32
|
| Rate for Payer: UHCCP Medicaid |
$10.89
|
| Rate for Payer: VA VA |
$20.32
|
|
|
HC COMPLEX CYSTOMETROGRAM
|
Facility
|
OP
|
$397.27
|
|
|
Service Code
|
CPT 51726
|
| Hospital Charge Code |
76100190
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.72 |
| Max. Negotiated Rate |
$397.27 |
| Rate for Payer: Aetna Commercial |
$357.54
|
| Rate for Payer: Aetna Medicare |
$238.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.86
|
| Rate for Payer: ASR ASR |
$385.35
|
| Rate for Payer: ASR Commercial |
$385.35
|
| Rate for Payer: BCBS Complete |
$134.11
|
| Rate for Payer: BCBS MAPPO |
$238.29
|
| Rate for Payer: BCBS Trust/PPO |
$325.32
|
| Rate for Payer: BCN Commercial |
$308.00
|
| Rate for Payer: BCN Medicare Advantage |
$238.29
|
| Rate for Payer: Cash Price |
$317.82
|
| Rate for Payer: Cash Price |
$317.82
|
| Rate for Payer: Cofinity Commercial |
$373.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.29
|
| Rate for Payer: Healthscope Commercial |
$397.27
|
| Rate for Payer: Healthscope Whirlpool |
$385.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$238.29
|
| Rate for Payer: Mclaren Commercial |
$357.54
|
| Rate for Payer: Mclaren Medicaid |
$127.72
|
| Rate for Payer: Mclaren Medicare |
$238.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.20
|
| Rate for Payer: Meridian Medicaid |
$134.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.68
|
| Rate for Payer: Nomi Health Commercial |
$325.76
|
| Rate for Payer: PACE Medicare |
$226.38
|
| Rate for Payer: PACE SWMI |
$238.29
|
| Rate for Payer: PHP Commercial |
$262.12
|
| Rate for Payer: PHP Medicaid |
$127.72
|
| Rate for Payer: PHP Medicare Advantage |
$238.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$348.09
|
| Rate for Payer: Priority Health Medicare |
$238.29
|
| Rate for Payer: Priority Health Narrow Network |
$278.49
|
| Rate for Payer: Railroad Medicare Medicare |
$238.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$349.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.29
|
| Rate for Payer: UHC Exchange |
$369.35
|
| Rate for Payer: UHC Medicare Advantage |
$238.29
|
| Rate for Payer: UHCCP DNSP |
$238.29
|
| Rate for Payer: UHCCP Medicaid |
$127.72
|
| Rate for Payer: VA VA |
$238.29
|
|
|
HC COMPLEX CYSTOMETROGRAM
|
Facility
|
IP
|
$397.27
|
|
|
Service Code
|
CPT 51726
|
| Hospital Charge Code |
76100190
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$258.23 |
| Max. Negotiated Rate |
$397.27 |
| Rate for Payer: Aetna Commercial |
$357.54
|
| Rate for Payer: ASR ASR |
$385.35
|
| Rate for Payer: ASR Commercial |
$385.35
|
| Rate for Payer: BCBS Trust/PPO |
$323.74
|
| Rate for Payer: BCN Commercial |
$308.00
|
| Rate for Payer: Cash Price |
$317.82
|
| Rate for Payer: Cofinity Commercial |
$373.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.82
|
| Rate for Payer: Healthscope Commercial |
$397.27
|
| Rate for Payer: Healthscope Whirlpool |
$385.35
|
| Rate for Payer: Mclaren Commercial |
$357.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.68
|
| Rate for Payer: Nomi Health Commercial |
$325.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$349.60
|
|
|
HC COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE
|
Facility
|
OP
|
$877.06
|
|
|
Service Code
|
CPT 51727
|
| Hospital Charge Code |
76100220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.53 |
| Max. Negotiated Rate |
$1,013.65 |
| Rate for Payer: Aetna Commercial |
$789.35
|
| Rate for Payer: Aetna Medicare |
$653.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$817.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$817.46
|
| Rate for Payer: ASR ASR |
$850.75
|
| Rate for Payer: ASR Commercial |
$850.75
|
| Rate for Payer: BCBS Complete |
$368.05
|
| Rate for Payer: BCBS MAPPO |
$653.97
|
| Rate for Payer: BCBS Trust/PPO |
$718.22
|
| Rate for Payer: BCN Commercial |
$679.98
|
| Rate for Payer: BCN Medicare Advantage |
$653.97
|
| Rate for Payer: Cash Price |
$701.65
|
| Rate for Payer: Cash Price |
$701.65
|
| Rate for Payer: Cofinity Commercial |
$824.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$701.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$653.97
|
| Rate for Payer: Healthscope Commercial |
$877.06
|
| Rate for Payer: Healthscope Whirlpool |
$850.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$653.97
|
| Rate for Payer: Mclaren Commercial |
$789.35
|
| Rate for Payer: Mclaren Medicaid |
$350.53
|
| Rate for Payer: Mclaren Medicare |
$653.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$686.67
|
| Rate for Payer: Meridian Medicaid |
$368.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$752.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$745.50
|
| Rate for Payer: Nomi Health Commercial |
$719.19
|
| Rate for Payer: PACE Medicare |
$621.27
|
| Rate for Payer: PACE SWMI |
$653.97
|
| Rate for Payer: PHP Commercial |
$719.37
|
| Rate for Payer: PHP Medicaid |
$350.53
|
| Rate for Payer: PHP Medicare Advantage |
$653.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$350.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$570.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$768.48
|
| Rate for Payer: Priority Health Medicare |
$653.97
|
| Rate for Payer: Priority Health Narrow Network |
$614.82
|
| Rate for Payer: Railroad Medicare Medicare |
$653.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$771.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$653.97
|
| Rate for Payer: UHC Exchange |
$1,013.65
|
| Rate for Payer: UHC Medicare Advantage |
$653.97
|
| Rate for Payer: UHCCP DNSP |
$653.97
|
| Rate for Payer: UHCCP Medicaid |
$350.53
|
| Rate for Payer: VA VA |
$653.97
|
|
|
HC COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE
|
Facility
|
IP
|
$877.06
|
|
|
Service Code
|
CPT 51727
|
| Hospital Charge Code |
76100220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$570.09 |
| Max. Negotiated Rate |
$877.06 |
| Rate for Payer: Aetna Commercial |
$789.35
|
| Rate for Payer: ASR ASR |
$850.75
|
| Rate for Payer: ASR Commercial |
$850.75
|
| Rate for Payer: BCBS Trust/PPO |
$714.72
|
| Rate for Payer: BCN Commercial |
$679.98
|
| Rate for Payer: Cash Price |
$701.65
|
| Rate for Payer: Cofinity Commercial |
$824.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$701.65
|
| Rate for Payer: Healthscope Commercial |
$877.06
|
| Rate for Payer: Healthscope Whirlpool |
$850.75
|
| Rate for Payer: Mclaren Commercial |
$789.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$745.50
|
| Rate for Payer: Nomi Health Commercial |
$719.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$570.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$771.81
|
|
|
HC COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES
|
Facility
|
IP
|
$877.46
|
|
|
Service Code
|
CPT 51728
|
| Hospital Charge Code |
76100191
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$570.35 |
| Max. Negotiated Rate |
$877.46 |
| Rate for Payer: Aetna Commercial |
$789.71
|
| Rate for Payer: ASR ASR |
$851.14
|
| Rate for Payer: ASR Commercial |
$851.14
|
| Rate for Payer: BCBS Trust/PPO |
$715.04
|
| Rate for Payer: BCN Commercial |
$680.29
|
| Rate for Payer: Cash Price |
$701.97
|
| Rate for Payer: Cofinity Commercial |
$824.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$701.97
|
| Rate for Payer: Healthscope Commercial |
$877.46
|
| Rate for Payer: Healthscope Whirlpool |
$851.14
|
| Rate for Payer: Mclaren Commercial |
$789.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$745.84
|
| Rate for Payer: Nomi Health Commercial |
$719.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$570.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$772.16
|
|
|
HC COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES
|
Facility
|
OP
|
$877.46
|
|
|
Service Code
|
CPT 51728
|
| Hospital Charge Code |
76100191
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.53 |
| Max. Negotiated Rate |
$1,013.65 |
| Rate for Payer: Aetna Commercial |
$789.71
|
| Rate for Payer: Aetna Medicare |
$653.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$817.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$817.46
|
| Rate for Payer: ASR ASR |
$851.14
|
| Rate for Payer: ASR Commercial |
$851.14
|
| Rate for Payer: BCBS Complete |
$368.05
|
| Rate for Payer: BCBS MAPPO |
$653.97
|
| Rate for Payer: BCBS Trust/PPO |
$718.55
|
| Rate for Payer: BCN Commercial |
$680.29
|
| Rate for Payer: BCN Medicare Advantage |
$653.97
|
| Rate for Payer: Cash Price |
$701.97
|
| Rate for Payer: Cash Price |
$701.97
|
| Rate for Payer: Cofinity Commercial |
$824.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$701.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$653.97
|
| Rate for Payer: Healthscope Commercial |
$877.46
|
| Rate for Payer: Healthscope Whirlpool |
$851.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$653.97
|
| Rate for Payer: Mclaren Commercial |
$789.71
|
| Rate for Payer: Mclaren Medicaid |
$350.53
|
| Rate for Payer: Mclaren Medicare |
$653.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$686.67
|
| Rate for Payer: Meridian Medicaid |
$368.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$752.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$745.84
|
| Rate for Payer: Nomi Health Commercial |
$719.52
|
| Rate for Payer: PACE Medicare |
$621.27
|
| Rate for Payer: PACE SWMI |
$653.97
|
| Rate for Payer: PHP Commercial |
$719.37
|
| Rate for Payer: PHP Medicaid |
$350.53
|
| Rate for Payer: PHP Medicare Advantage |
$653.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$350.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$570.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$768.83
|
| Rate for Payer: Priority Health Medicare |
$653.97
|
| Rate for Payer: Priority Health Narrow Network |
$615.10
|
| Rate for Payer: Railroad Medicare Medicare |
$653.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$772.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$653.97
|
| Rate for Payer: UHC Exchange |
$1,013.65
|
| Rate for Payer: UHC Medicare Advantage |
$653.97
|
| Rate for Payer: UHCCP DNSP |
$653.97
|
| Rate for Payer: UHCCP Medicaid |
$350.53
|
| Rate for Payer: VA VA |
$653.97
|
|
|
HC COMPLEX MULTILAYER COMP DSG
|
Facility
|
OP
|
$810.90
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
76100024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.87 |
| Max. Negotiated Rate |
$810.90 |
| Rate for Payer: Aetna Commercial |
$729.81
|
| Rate for Payer: Aetna Medicare |
$154.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$193.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$193.25
|
| Rate for Payer: ASR ASR |
$786.57
|
| Rate for Payer: ASR Commercial |
$786.57
|
| Rate for Payer: BCBS Complete |
$87.01
|
| Rate for Payer: BCBS MAPPO |
$154.60
|
| Rate for Payer: BCBS Trust/PPO |
$664.05
|
| Rate for Payer: BCN Commercial |
$628.69
|
| Rate for Payer: BCN Medicare Advantage |
$154.60
|
| Rate for Payer: Cash Price |
$648.72
|
| Rate for Payer: Cash Price |
$648.72
|
| Rate for Payer: Cofinity Commercial |
$762.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$648.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.60
|
| Rate for Payer: Healthscope Commercial |
$810.90
|
| Rate for Payer: Healthscope Whirlpool |
$786.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$154.60
|
| Rate for Payer: Mclaren Commercial |
$729.81
|
| Rate for Payer: Mclaren Medicaid |
$82.87
|
| Rate for Payer: Mclaren Medicare |
$154.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.33
|
| Rate for Payer: Meridian Medicaid |
$87.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$689.26
|
| Rate for Payer: Nomi Health Commercial |
$664.94
|
| Rate for Payer: PACE Medicare |
$146.87
|
| Rate for Payer: PACE SWMI |
$154.60
|
| Rate for Payer: PHP Commercial |
$170.06
|
| Rate for Payer: PHP Medicaid |
$82.87
|
| Rate for Payer: PHP Medicare Advantage |
$154.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$527.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$710.51
|
| Rate for Payer: Priority Health Medicare |
$154.60
|
| Rate for Payer: Priority Health Narrow Network |
$568.44
|
| Rate for Payer: Railroad Medicare Medicare |
$154.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$713.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$154.60
|
| Rate for Payer: UHC Exchange |
$239.63
|
| Rate for Payer: UHC Medicare Advantage |
$154.60
|
| Rate for Payer: UHCCP DNSP |
$154.60
|
| Rate for Payer: UHCCP Medicaid |
$82.87
|
| Rate for Payer: VA VA |
$154.60
|
|
|
HC COMPLEX MULTILAYER COMP DSG
|
Facility
|
IP
|
$810.90
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
76100024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$527.08 |
| Max. Negotiated Rate |
$810.90 |
| Rate for Payer: Aetna Commercial |
$729.81
|
| Rate for Payer: ASR ASR |
$786.57
|
| Rate for Payer: ASR Commercial |
$786.57
|
| Rate for Payer: BCBS Trust/PPO |
$660.80
|
| Rate for Payer: BCN Commercial |
$628.69
|
| Rate for Payer: Cash Price |
$648.72
|
| Rate for Payer: Cofinity Commercial |
$762.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$648.72
|
| Rate for Payer: Healthscope Commercial |
$810.90
|
| Rate for Payer: Healthscope Whirlpool |
$786.57
|
| Rate for Payer: Mclaren Commercial |
$729.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$689.26
|
| Rate for Payer: Nomi Health Commercial |
$664.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$527.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$713.59
|
|
|
HC COMPLEX UROFLOWMETRY
|
Facility
|
OP
|
$233.39
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
76100192
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$151.70 |
| Max. Negotiated Rate |
$472.90 |
| Rate for Payer: Aetna Commercial |
$210.05
|
| Rate for Payer: Aetna Medicare |
$305.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.38
|
| Rate for Payer: ASR ASR |
$226.39
|
| Rate for Payer: ASR Commercial |
$226.39
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$191.12
|
| Rate for Payer: BCN Commercial |
$180.95
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| Rate for Payer: Cash Price |
$186.71
|
| Rate for Payer: Cash Price |
$186.71
|
| Rate for Payer: Cofinity Commercial |
$219.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$233.39
|
| Rate for Payer: Healthscope Whirlpool |
$226.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.10
|
| Rate for Payer: Mclaren Commercial |
$210.05
|
| Rate for Payer: Mclaren Medicaid |
$163.53
|
| Rate for Payer: Mclaren Medicare |
$305.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.36
|
| Rate for Payer: Meridian Medicaid |
$171.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.38
|
| Rate for Payer: Nomi Health Commercial |
$191.38
|
| Rate for Payer: PACE Medicare |
$289.84
|
| Rate for Payer: PACE SWMI |
$305.10
|
| Rate for Payer: PHP Commercial |
$335.61
|
| Rate for Payer: PHP Medicaid |
$163.53
|
| Rate for Payer: PHP Medicare Advantage |
$305.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$204.50
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$163.61
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$205.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.10
|
| Rate for Payer: UHC Exchange |
$472.90
|
| Rate for Payer: UHC Medicare Advantage |
$305.10
|
| Rate for Payer: UHCCP DNSP |
$305.10
|
| Rate for Payer: UHCCP Medicaid |
$163.53
|
| Rate for Payer: VA VA |
$305.10
|
|
|
HC COMPLEX UROFLOWMETRY
|
Facility
|
IP
|
$233.39
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
76100192
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$151.70 |
| Max. Negotiated Rate |
$233.39 |
| Rate for Payer: Aetna Commercial |
$210.05
|
| Rate for Payer: ASR ASR |
$226.39
|
| Rate for Payer: ASR Commercial |
$226.39
|
| Rate for Payer: BCBS Trust/PPO |
$190.19
|
| Rate for Payer: BCN Commercial |
$180.95
|
| Rate for Payer: Cash Price |
$186.71
|
| Rate for Payer: Cofinity Commercial |
$219.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.71
|
| Rate for Payer: Healthscope Commercial |
$233.39
|
| Rate for Payer: Healthscope Whirlpool |
$226.39
|
| Rate for Payer: Mclaren Commercial |
$210.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.38
|
| Rate for Payer: Nomi Health Commercial |
$191.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$205.38
|
|
|
HC COMP METABOLIC PANEL
|
Facility
|
IP
|
$39.17
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
30100013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.46 |
| Max. Negotiated Rate |
$39.17 |
| Rate for Payer: Aetna Commercial |
$35.25
|
| Rate for Payer: ASR ASR |
$37.99
|
| Rate for Payer: ASR Commercial |
$37.99
|
| Rate for Payer: BCBS Trust/PPO |
$31.92
|
| Rate for Payer: BCN Commercial |
$30.37
|
| Rate for Payer: Cash Price |
$31.34
|
| Rate for Payer: Cofinity Commercial |
$36.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.34
|
| Rate for Payer: Healthscope Commercial |
$39.17
|
| Rate for Payer: Healthscope Whirlpool |
$37.99
|
| Rate for Payer: Mclaren Commercial |
$35.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.29
|
| Rate for Payer: Nomi Health Commercial |
$32.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.47
|
|
|
HC COMP METABOLIC PANEL
|
Facility
|
OP
|
$39.17
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
30100013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.66 |
| Max. Negotiated Rate |
$77.96 |
| Rate for Payer: Aetna Commercial |
$35.25
|
| Rate for Payer: Aetna Medicare |
$10.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.20
|
| Rate for Payer: ASR ASR |
$37.99
|
| Rate for Payer: ASR Commercial |
$37.99
|
| Rate for Payer: BCBS Complete |
$5.94
|
| Rate for Payer: BCBS MAPPO |
$10.56
|
| Rate for Payer: BCBS Trust/PPO |
$32.08
|
| Rate for Payer: BCN Commercial |
$30.37
|
| Rate for Payer: BCN Medicare Advantage |
$10.56
|
| Rate for Payer: Cash Price |
$31.34
|
| Rate for Payer: Cash Price |
$31.34
|
| Rate for Payer: Cofinity Commercial |
$36.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.56
|
| Rate for Payer: Healthscope Commercial |
$39.17
|
| Rate for Payer: Healthscope Whirlpool |
$37.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.56
|
| Rate for Payer: Mclaren Commercial |
$35.25
|
| Rate for Payer: Mclaren Medicaid |
$5.66
|
| Rate for Payer: Mclaren Medicare |
$10.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.09
|
| Rate for Payer: Meridian Medicaid |
$5.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.29
|
| Rate for Payer: Nomi Health Commercial |
$32.12
|
| Rate for Payer: PACE Medicare |
$10.03
|
| Rate for Payer: PACE SWMI |
$10.56
|
| Rate for Payer: PHP Commercial |
$11.62
|
| Rate for Payer: PHP Medicaid |
$5.66
|
| Rate for Payer: PHP Medicare Advantage |
$10.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.96
|
| Rate for Payer: Priority Health Medicare |
$10.56
|
| Rate for Payer: Priority Health Narrow Network |
$62.37
|
| Rate for Payer: Railroad Medicare Medicare |
$10.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.56
|
| Rate for Payer: UHC Exchange |
$16.37
|
| Rate for Payer: UHC Medicare Advantage |
$10.56
|
| Rate for Payer: UHCCP DNSP |
$10.56
|
| Rate for Payer: UHCCP Medicaid |
$5.66
|
| Rate for Payer: VA VA |
$10.56
|
|
|
HC COMPONENT POOLING
|
Facility
|
IP
|
$124.13
|
|
|
Service Code
|
CPT 86965
|
| Hospital Charge Code |
39000027
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$80.68 |
| Max. Negotiated Rate |
$124.13 |
| Rate for Payer: Aetna Commercial |
$111.72
|
| Rate for Payer: ASR ASR |
$120.41
|
| Rate for Payer: ASR Commercial |
$120.41
|
| Rate for Payer: BCBS Trust/PPO |
$101.15
|
| Rate for Payer: BCN Commercial |
$96.24
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cofinity Commercial |
$116.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.30
|
| Rate for Payer: Healthscope Commercial |
$124.13
|
| Rate for Payer: Healthscope Whirlpool |
$120.41
|
| Rate for Payer: Mclaren Commercial |
$111.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.51
|
| Rate for Payer: Nomi Health Commercial |
$101.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.23
|
|
|
HC COMPONENT POOLING
|
Facility
|
OP
|
$124.13
|
|
|
Service Code
|
CPT 86965
|
| Hospital Charge Code |
39000027
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$80.68 |
| Max. Negotiated Rate |
$260.24 |
| Rate for Payer: Aetna Commercial |
$111.72
|
| Rate for Payer: Aetna Medicare |
$167.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$209.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$209.88
|
| Rate for Payer: ASR ASR |
$120.41
|
| Rate for Payer: ASR Commercial |
$120.41
|
| Rate for Payer: BCBS Complete |
$94.49
|
| Rate for Payer: BCBS MAPPO |
$167.90
|
| Rate for Payer: BCBS Trust/PPO |
$101.65
|
| Rate for Payer: BCN Commercial |
$96.24
|
| Rate for Payer: BCN Medicare Advantage |
$167.90
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cofinity Commercial |
$116.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.90
|
| Rate for Payer: Healthscope Commercial |
$124.13
|
| Rate for Payer: Healthscope Whirlpool |
$120.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$167.90
|
| Rate for Payer: Mclaren Commercial |
$111.72
|
| Rate for Payer: Mclaren Medicaid |
$89.99
|
| Rate for Payer: Mclaren Medicare |
$167.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.30
|
| Rate for Payer: Meridian Medicaid |
$94.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.51
|
| Rate for Payer: Nomi Health Commercial |
$101.79
|
| Rate for Payer: PACE Medicare |
$159.50
|
| Rate for Payer: PACE SWMI |
$167.90
|
| Rate for Payer: PHP Commercial |
$184.69
|
| Rate for Payer: PHP Medicaid |
$89.99
|
| Rate for Payer: PHP Medicare Advantage |
$167.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.76
|
| Rate for Payer: Priority Health Medicare |
$167.90
|
| Rate for Payer: Priority Health Narrow Network |
$87.02
|
| Rate for Payer: Railroad Medicare Medicare |
$167.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.90
|
| Rate for Payer: UHC Exchange |
$260.24
|
| Rate for Payer: UHC Medicare Advantage |
$167.90
|
| Rate for Payer: UHCCP DNSP |
$167.90
|
| Rate for Payer: UHCCP Medicaid |
$89.99
|
| Rate for Payer: VA VA |
$167.90
|
|
|
HC COMPONENT THAWING
|
Facility
|
OP
|
$108.12
|
|
|
Service Code
|
CPT 86927
|
| Hospital Charge Code |
39000025
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$26.34 |
| Max. Negotiated Rate |
$260.24 |
| Rate for Payer: Aetna Commercial |
$97.31
|
| Rate for Payer: Aetna Medicare |
$167.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$209.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$209.88
|
| Rate for Payer: ASR ASR |
$104.88
|
| Rate for Payer: ASR Commercial |
$104.88
|
| Rate for Payer: BCBS Complete |
$94.49
|
| Rate for Payer: BCBS MAPPO |
$167.90
|
| Rate for Payer: BCBS Trust/PPO |
$88.54
|
| Rate for Payer: BCN Commercial |
$83.83
|
| Rate for Payer: BCN Medicare Advantage |
$167.90
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cofinity Commercial |
$101.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.90
|
| Rate for Payer: Healthscope Commercial |
$108.12
|
| Rate for Payer: Healthscope Whirlpool |
$104.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$167.90
|
| Rate for Payer: Mclaren Commercial |
$97.31
|
| Rate for Payer: Mclaren Medicaid |
$89.99
|
| Rate for Payer: Mclaren Medicare |
$167.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.30
|
| Rate for Payer: Meridian Medicaid |
$94.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.90
|
| Rate for Payer: Nomi Health Commercial |
$88.66
|
| Rate for Payer: PACE Medicare |
$159.50
|
| Rate for Payer: PACE SWMI |
$167.90
|
| Rate for Payer: PHP Commercial |
$184.69
|
| Rate for Payer: PHP Medicaid |
$89.99
|
| Rate for Payer: PHP Medicare Advantage |
$167.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.93
|
| Rate for Payer: Priority Health Medicare |
$167.90
|
| Rate for Payer: Priority Health Narrow Network |
$26.34
|
| Rate for Payer: Railroad Medicare Medicare |
$167.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.90
|
| Rate for Payer: UHC Exchange |
$260.24
|
| Rate for Payer: UHC Medicare Advantage |
$167.90
|
| Rate for Payer: UHCCP DNSP |
$167.90
|
| Rate for Payer: UHCCP Medicaid |
$89.99
|
| Rate for Payer: VA VA |
$167.90
|
|
|
HC COMPONENT THAWING
|
Facility
|
IP
|
$108.12
|
|
|
Service Code
|
CPT 86927
|
| Hospital Charge Code |
39000025
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$70.28 |
| Max. Negotiated Rate |
$108.12 |
| Rate for Payer: Aetna Commercial |
$97.31
|
| Rate for Payer: ASR ASR |
$104.88
|
| Rate for Payer: ASR Commercial |
$104.88
|
| Rate for Payer: BCBS Trust/PPO |
$88.11
|
| Rate for Payer: BCN Commercial |
$83.83
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cofinity Commercial |
$101.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.50
|
| Rate for Payer: Healthscope Commercial |
$108.12
|
| Rate for Payer: Healthscope Whirlpool |
$104.88
|
| Rate for Payer: Mclaren Commercial |
$97.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.90
|
| Rate for Payer: Nomi Health Commercial |
$88.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.15
|
|
|
HC COMPREHENSIVE HEARING TEST
|
Facility
|
OP
|
$212.17
|
|
|
Service Code
|
CPT 92557
|
| Hospital Charge Code |
47100012
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$237.62 |
| Rate for Payer: Aetna Commercial |
$190.95
|
| Rate for Payer: Aetna Medicare |
$153.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.62
|
| Rate for Payer: ASR ASR |
$205.80
|
| Rate for Payer: ASR Commercial |
$205.80
|
| Rate for Payer: BCBS Complete |
$86.28
|
| Rate for Payer: BCBS MAPPO |
$153.30
|
| Rate for Payer: BCBS Trust/PPO |
$173.75
|
| Rate for Payer: BCN Commercial |
$164.50
|
| Rate for Payer: BCN Medicare Advantage |
$153.30
|
| Rate for Payer: Cash Price |
$169.74
|
| Rate for Payer: Cash Price |
$169.74
|
| Rate for Payer: Cofinity Commercial |
$199.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.30
|
| Rate for Payer: Healthscope Commercial |
$212.17
|
| Rate for Payer: Healthscope Whirlpool |
$205.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$153.30
|
| Rate for Payer: Mclaren Commercial |
$190.95
|
| Rate for Payer: Mclaren Medicaid |
$82.17
|
| Rate for Payer: Mclaren Medicare |
$153.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.96
|
| Rate for Payer: Meridian Medicaid |
$86.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.34
|
| Rate for Payer: Nomi Health Commercial |
$173.98
|
| Rate for Payer: PACE Medicare |
$145.64
|
| Rate for Payer: PACE SWMI |
$153.30
|
| Rate for Payer: PHP Commercial |
$168.63
|
| Rate for Payer: PHP Medicaid |
$82.17
|
| Rate for Payer: PHP Medicare Advantage |
$153.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$185.90
|
| Rate for Payer: Priority Health Medicare |
$153.30
|
| Rate for Payer: Priority Health Narrow Network |
$148.73
|
| Rate for Payer: Railroad Medicare Medicare |
$153.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.30
|
| Rate for Payer: UHC Exchange |
$237.62
|
| Rate for Payer: UHC Medicare Advantage |
$153.30
|
| Rate for Payer: UHCCP DNSP |
$153.30
|
| Rate for Payer: UHCCP Medicaid |
$82.17
|
| Rate for Payer: VA VA |
$153.30
|
|
|
HC COMPREHENSIVE HEARING TEST
|
Facility
|
IP
|
$212.17
|
|
|
Service Code
|
CPT 92557
|
| Hospital Charge Code |
47100012
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$137.91 |
| Max. Negotiated Rate |
$212.17 |
| Rate for Payer: Aetna Commercial |
$190.95
|
| Rate for Payer: ASR ASR |
$205.80
|
| Rate for Payer: ASR Commercial |
$205.80
|
| Rate for Payer: BCBS Trust/PPO |
$172.90
|
| Rate for Payer: BCN Commercial |
$164.50
|
| Rate for Payer: Cash Price |
$169.74
|
| Rate for Payer: Cofinity Commercial |
$199.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.74
|
| Rate for Payer: Healthscope Commercial |
$212.17
|
| Rate for Payer: Healthscope Whirlpool |
$205.80
|
| Rate for Payer: Mclaren Commercial |
$190.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.34
|
| Rate for Payer: Nomi Health Commercial |
$173.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.71
|
|
|
HC COMPRESS BURN GARM GAUNTLET-EL
|
Facility
|
IP
|
$87.72
|
|
|
Service Code
|
HCPCS A6505
|
| Hospital Charge Code |
98300069
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.02 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Aetna Commercial |
$78.95
|
| Rate for Payer: ASR ASR |
$85.09
|
| Rate for Payer: ASR Commercial |
$85.09
|
| Rate for Payer: BCBS Trust/PPO |
$71.48
|
| Rate for Payer: BCN Commercial |
$68.01
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$82.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Healthscope Commercial |
$87.72
|
| Rate for Payer: Healthscope Whirlpool |
$85.09
|
| Rate for Payer: Mclaren Commercial |
$78.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.56
|
| Rate for Payer: Nomi Health Commercial |
$71.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.19
|
|
|
HC COMPRESS BURN GARM GAUNTLET-EL
|
Facility
|
OP
|
$87.72
|
|
|
Service Code
|
HCPCS A6505
|
| Hospital Charge Code |
98300069
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Aetna Commercial |
$78.95
|
| Rate for Payer: Aetna Medicare |
$43.86
|
| Rate for Payer: ASR ASR |
$85.09
|
| Rate for Payer: ASR Commercial |
$85.09
|
| Rate for Payer: BCBS Complete |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$71.83
|
| Rate for Payer: BCN Commercial |
$68.01
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$82.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Healthscope Commercial |
$87.72
|
| Rate for Payer: Healthscope Whirlpool |
$85.09
|
| Rate for Payer: Mclaren Commercial |
$78.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.56
|
| Rate for Payer: Nomi Health Commercial |
$71.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.86
|
| Rate for Payer: Priority Health Narrow Network |
$61.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.19
|
|
