|
HC HCV GENOTYPE RESOLUTION
|
Facility
|
OP
|
$403.49
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
30600262
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$137.99 |
| Max. Negotiated Rate |
$796.06 |
| Rate for Payer: Aetna Commercial |
$363.14
|
| Rate for Payer: Aetna Medicare |
$257.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$321.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$321.81
|
| Rate for Payer: ASR ASR |
$391.39
|
| Rate for Payer: ASR Commercial |
$391.39
|
| Rate for Payer: BCBS Complete |
$144.89
|
| Rate for Payer: BCBS MAPPO |
$257.45
|
| Rate for Payer: BCBS Trust/PPO |
$330.42
|
| Rate for Payer: BCN Commercial |
$312.83
|
| Rate for Payer: BCN Medicare Advantage |
$257.45
|
| Rate for Payer: Cash Price |
$322.79
|
| Rate for Payer: Cash Price |
$322.79
|
| Rate for Payer: Cofinity Commercial |
$379.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.45
|
| Rate for Payer: Healthscope Commercial |
$403.49
|
| Rate for Payer: Healthscope Whirlpool |
$391.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$257.45
|
| Rate for Payer: Mclaren Commercial |
$363.14
|
| Rate for Payer: Mclaren Medicaid |
$137.99
|
| Rate for Payer: Mclaren Medicare |
$257.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$270.32
|
| Rate for Payer: Meridian Medicaid |
$144.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$296.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.97
|
| Rate for Payer: Nomi Health Commercial |
$330.86
|
| Rate for Payer: PACE Medicare |
$244.58
|
| Rate for Payer: PACE SWMI |
$257.45
|
| Rate for Payer: PHP Commercial |
$283.20
|
| Rate for Payer: PHP Medicaid |
$137.99
|
| Rate for Payer: PHP Medicare Advantage |
$257.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$796.06
|
| Rate for Payer: Priority Health Medicare |
$257.45
|
| Rate for Payer: Priority Health Narrow Network |
$636.85
|
| Rate for Payer: Railroad Medicare Medicare |
$257.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$257.45
|
| Rate for Payer: UHC Exchange |
$399.05
|
| Rate for Payer: UHC Medicare Advantage |
$257.45
|
| Rate for Payer: UHCCP DNSP |
$257.45
|
| Rate for Payer: UHCCP Medicaid |
$137.99
|
| Rate for Payer: VA VA |
$257.45
|
|
|
HC HDL CHOLESTEROL
|
Facility
|
IP
|
$31.21
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
30100282
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.29 |
| Max. Negotiated Rate |
$31.21 |
| Rate for Payer: Aetna Commercial |
$28.09
|
| Rate for Payer: ASR ASR |
$30.27
|
| Rate for Payer: ASR Commercial |
$30.27
|
| Rate for Payer: BCBS Trust/PPO |
$25.43
|
| Rate for Payer: BCN Commercial |
$24.20
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$29.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$31.21
|
| Rate for Payer: Healthscope Whirlpool |
$30.27
|
| Rate for Payer: Mclaren Commercial |
$28.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$25.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.46
|
|
|
HC HDL CHOLESTEROL
|
Facility
|
OP
|
$31.21
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
30100282
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$35.14 |
| Rate for Payer: Aetna Commercial |
$28.09
|
| Rate for Payer: Aetna Medicare |
$8.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.24
|
| Rate for Payer: ASR ASR |
$30.27
|
| Rate for Payer: ASR Commercial |
$30.27
|
| Rate for Payer: BCBS Complete |
$4.61
|
| Rate for Payer: BCBS MAPPO |
$8.19
|
| Rate for Payer: BCBS Trust/PPO |
$25.56
|
| Rate for Payer: BCN Commercial |
$24.20
|
| Rate for Payer: BCN Medicare Advantage |
$8.19
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$29.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.19
|
| Rate for Payer: Healthscope Commercial |
$31.21
|
| Rate for Payer: Healthscope Whirlpool |
$30.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.19
|
| Rate for Payer: Mclaren Commercial |
$28.09
|
| Rate for Payer: Mclaren Medicaid |
$4.39
|
| Rate for Payer: Mclaren Medicare |
$8.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.60
|
| Rate for Payer: Meridian Medicaid |
$4.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$25.59
|
| Rate for Payer: PACE Medicare |
$7.78
|
| Rate for Payer: PACE SWMI |
$8.19
|
| Rate for Payer: PHP Commercial |
$9.01
|
| Rate for Payer: PHP Medicaid |
$4.39
|
| Rate for Payer: PHP Medicare Advantage |
$8.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.14
|
| Rate for Payer: Priority Health Medicare |
$8.19
|
| Rate for Payer: Priority Health Narrow Network |
$28.11
|
| Rate for Payer: Railroad Medicare Medicare |
$8.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.19
|
| Rate for Payer: UHC Exchange |
$12.69
|
| Rate for Payer: UHC Medicare Advantage |
$8.19
|
| Rate for Payer: UHCCP DNSP |
$8.19
|
| Rate for Payer: UHCCP Medicaid |
$4.39
|
| Rate for Payer: VA VA |
$8.19
|
|
|
HC HDL CHOLESTEROL LMPP
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
30100690
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Trust/PPO |
$16.96
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
|
|
HC HDL CHOLESTEROL LMPP
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
30100690
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$35.14 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: Aetna Medicare |
$8.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.24
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Complete |
$4.61
|
| Rate for Payer: BCBS MAPPO |
$8.19
|
| Rate for Payer: BCBS Trust/PPO |
$17.04
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: BCN Medicare Advantage |
$8.19
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.19
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.19
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Mclaren Medicaid |
$4.39
|
| Rate for Payer: Mclaren Medicare |
$8.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.60
|
| Rate for Payer: Meridian Medicaid |
$4.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PACE Medicare |
$7.78
|
| Rate for Payer: PACE SWMI |
$8.19
|
| Rate for Payer: PHP Commercial |
$9.01
|
| Rate for Payer: PHP Medicaid |
$4.39
|
| Rate for Payer: PHP Medicare Advantage |
$8.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.14
|
| Rate for Payer: Priority Health Medicare |
$8.19
|
| Rate for Payer: Priority Health Narrow Network |
$28.11
|
| Rate for Payer: Railroad Medicare Medicare |
$8.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.19
|
| Rate for Payer: UHC Exchange |
$12.69
|
| Rate for Payer: UHC Medicare Advantage |
$8.19
|
| Rate for Payer: UHCCP DNSP |
$8.19
|
| Rate for Payer: UHCCP Medicaid |
$4.39
|
| Rate for Payer: VA VA |
$8.19
|
|
|
HC HDR 1 CHANNEL
|
Facility
|
OP
|
$1,989.66
|
|
|
Service Code
|
CPT 77770
|
| Hospital Charge Code |
33300055
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$364.36 |
| Max. Negotiated Rate |
$1,989.66 |
| Rate for Payer: Aetna Commercial |
$1,790.69
|
| Rate for Payer: Aetna Medicare |
$679.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$849.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$849.72
|
| Rate for Payer: ASR ASR |
$1,929.97
|
| Rate for Payer: ASR Commercial |
$1,929.97
|
| Rate for Payer: BCBS Complete |
$382.58
|
| Rate for Payer: BCBS MAPPO |
$679.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,629.33
|
| Rate for Payer: BCN Commercial |
$1,542.58
|
| Rate for Payer: BCN Medicare Advantage |
$679.78
|
| Rate for Payer: Cash Price |
$1,591.73
|
| Rate for Payer: Cash Price |
$1,591.73
|
| Rate for Payer: Cofinity Commercial |
$1,870.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,591.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$679.78
|
| Rate for Payer: Healthscope Commercial |
$1,989.66
|
| Rate for Payer: Healthscope Whirlpool |
$1,929.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$679.78
|
| Rate for Payer: Mclaren Commercial |
$1,790.69
|
| Rate for Payer: Mclaren Medicaid |
$364.36
|
| Rate for Payer: Mclaren Medicare |
$679.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$713.77
|
| Rate for Payer: Meridian Medicaid |
$382.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$781.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,691.21
|
| Rate for Payer: Nomi Health Commercial |
$1,631.52
|
| Rate for Payer: PACE Medicare |
$645.79
|
| Rate for Payer: PACE SWMI |
$679.78
|
| Rate for Payer: PHP Commercial |
$747.76
|
| Rate for Payer: PHP Medicaid |
$364.36
|
| Rate for Payer: PHP Medicare Advantage |
$679.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$364.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,293.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,743.34
|
| Rate for Payer: Priority Health Medicare |
$679.78
|
| Rate for Payer: Priority Health Narrow Network |
$1,394.75
|
| Rate for Payer: Railroad Medicare Medicare |
$679.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,750.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$679.78
|
| Rate for Payer: UHC Exchange |
$1,053.66
|
| Rate for Payer: UHC Medicare Advantage |
$679.78
|
| Rate for Payer: UHCCP DNSP |
$679.78
|
| Rate for Payer: UHCCP Medicaid |
$364.36
|
| Rate for Payer: VA VA |
$679.78
|
|
|
HC HDR 1 CHANNEL
|
Facility
|
IP
|
$1,989.66
|
|
|
Service Code
|
CPT 77770
|
| Hospital Charge Code |
33300055
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,293.28 |
| Max. Negotiated Rate |
$1,989.66 |
| Rate for Payer: Aetna Commercial |
$1,790.69
|
| Rate for Payer: ASR ASR |
$1,929.97
|
| Rate for Payer: ASR Commercial |
$1,929.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,621.37
|
| Rate for Payer: BCN Commercial |
$1,542.58
|
| Rate for Payer: Cash Price |
$1,591.73
|
| Rate for Payer: Cofinity Commercial |
$1,870.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,591.73
|
| Rate for Payer: Healthscope Commercial |
$1,989.66
|
| Rate for Payer: Healthscope Whirlpool |
$1,929.97
|
| Rate for Payer: Mclaren Commercial |
$1,790.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,691.21
|
| Rate for Payer: Nomi Health Commercial |
$1,631.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,293.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,750.90
|
|
|
HC HDR 2-12 CHANNELS
|
Facility
|
OP
|
$2,210.05
|
|
|
Service Code
|
CPT 77771
|
| Hospital Charge Code |
33300056
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$364.36 |
| Max. Negotiated Rate |
$2,210.05 |
| Rate for Payer: Aetna Commercial |
$1,989.04
|
| Rate for Payer: Aetna Medicare |
$679.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$849.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$849.72
|
| Rate for Payer: ASR ASR |
$2,143.75
|
| Rate for Payer: ASR Commercial |
$2,143.75
|
| Rate for Payer: BCBS Complete |
$382.58
|
| Rate for Payer: BCBS MAPPO |
$679.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,809.81
|
| Rate for Payer: BCN Commercial |
$1,713.45
|
| Rate for Payer: BCN Medicare Advantage |
$679.78
|
| Rate for Payer: Cash Price |
$1,768.04
|
| Rate for Payer: Cash Price |
$1,768.04
|
| Rate for Payer: Cofinity Commercial |
$2,077.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,768.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$679.78
|
| Rate for Payer: Healthscope Commercial |
$2,210.05
|
| Rate for Payer: Healthscope Whirlpool |
$2,143.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$679.78
|
| Rate for Payer: Mclaren Commercial |
$1,989.04
|
| Rate for Payer: Mclaren Medicaid |
$364.36
|
| Rate for Payer: Mclaren Medicare |
$679.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$713.77
|
| Rate for Payer: Meridian Medicaid |
$382.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$781.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,878.54
|
| Rate for Payer: Nomi Health Commercial |
$1,812.24
|
| Rate for Payer: PACE Medicare |
$645.79
|
| Rate for Payer: PACE SWMI |
$679.78
|
| Rate for Payer: PHP Commercial |
$747.76
|
| Rate for Payer: PHP Medicaid |
$364.36
|
| Rate for Payer: PHP Medicare Advantage |
$679.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$364.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,436.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,936.45
|
| Rate for Payer: Priority Health Medicare |
$679.78
|
| Rate for Payer: Priority Health Narrow Network |
$1,549.25
|
| Rate for Payer: Railroad Medicare Medicare |
$679.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,944.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$679.78
|
| Rate for Payer: UHC Exchange |
$1,053.66
|
| Rate for Payer: UHC Medicare Advantage |
$679.78
|
| Rate for Payer: UHCCP DNSP |
$679.78
|
| Rate for Payer: UHCCP Medicaid |
$364.36
|
| Rate for Payer: VA VA |
$679.78
|
|
|
HC HDR 2-12 CHANNELS
|
Facility
|
IP
|
$2,210.05
|
|
|
Service Code
|
CPT 77771
|
| Hospital Charge Code |
33300056
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,436.53 |
| Max. Negotiated Rate |
$2,210.05 |
| Rate for Payer: Aetna Commercial |
$1,989.04
|
| Rate for Payer: ASR ASR |
$2,143.75
|
| Rate for Payer: ASR Commercial |
$2,143.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,800.97
|
| Rate for Payer: BCN Commercial |
$1,713.45
|
| Rate for Payer: Cash Price |
$1,768.04
|
| Rate for Payer: Cofinity Commercial |
$2,077.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,768.04
|
| Rate for Payer: Healthscope Commercial |
$2,210.05
|
| Rate for Payer: Healthscope Whirlpool |
$2,143.75
|
| Rate for Payer: Mclaren Commercial |
$1,989.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,878.54
|
| Rate for Payer: Nomi Health Commercial |
$1,812.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,436.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,944.84
|
|
|
HC HDR IR 192 BRACHY SOURCE NSTRD
|
Facility
|
OP
|
$562.41
|
|
|
Service Code
|
HCPCS C1717
|
| Hospital Charge Code |
27800090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$179.81 |
| Max. Negotiated Rate |
$562.41 |
| Rate for Payer: Aetna Commercial |
$506.17
|
| Rate for Payer: Aetna Medicare |
$335.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$419.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$419.34
|
| Rate for Payer: ASR ASR |
$545.54
|
| Rate for Payer: ASR Commercial |
$545.54
|
| Rate for Payer: BCBS Complete |
$188.80
|
| Rate for Payer: BCBS MAPPO |
$335.47
|
| Rate for Payer: BCBS Trust/PPO |
$460.56
|
| Rate for Payer: BCN Commercial |
$436.04
|
| Rate for Payer: BCN Medicare Advantage |
$335.47
|
| Rate for Payer: Cash Price |
$449.93
|
| Rate for Payer: Cash Price |
$449.93
|
| Rate for Payer: Cofinity Commercial |
$528.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$335.47
|
| Rate for Payer: Healthscope Commercial |
$562.41
|
| Rate for Payer: Healthscope Whirlpool |
$545.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$335.47
|
| Rate for Payer: Mclaren Commercial |
$506.17
|
| Rate for Payer: Mclaren Medicaid |
$179.81
|
| Rate for Payer: Mclaren Medicare |
$335.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$352.24
|
| Rate for Payer: Meridian Medicaid |
$188.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$385.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$478.05
|
| Rate for Payer: Nomi Health Commercial |
$461.18
|
| Rate for Payer: PACE Medicare |
$318.70
|
| Rate for Payer: PACE SWMI |
$335.47
|
| Rate for Payer: PHP Commercial |
$369.02
|
| Rate for Payer: PHP Medicaid |
$179.81
|
| Rate for Payer: PHP Medicare Advantage |
$335.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$492.78
|
| Rate for Payer: Priority Health Medicare |
$335.47
|
| Rate for Payer: Priority Health Narrow Network |
$394.25
|
| Rate for Payer: Railroad Medicare Medicare |
$335.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$494.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$335.47
|
| Rate for Payer: UHC Exchange |
$519.98
|
| Rate for Payer: UHC Medicare Advantage |
$335.47
|
| Rate for Payer: UHCCP DNSP |
$335.47
|
| Rate for Payer: UHCCP Medicaid |
$179.81
|
| Rate for Payer: VA VA |
$335.47
|
|
|
HC HDR IR 192 BRACHY SOURCE NSTRD
|
Facility
|
IP
|
$562.41
|
|
|
Service Code
|
HCPCS C1717
|
| Hospital Charge Code |
27800090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$365.57 |
| Max. Negotiated Rate |
$562.41 |
| Rate for Payer: Aetna Commercial |
$506.17
|
| Rate for Payer: ASR ASR |
$545.54
|
| Rate for Payer: ASR Commercial |
$545.54
|
| Rate for Payer: BCBS Trust/PPO |
$458.31
|
| Rate for Payer: BCN Commercial |
$436.04
|
| Rate for Payer: Cash Price |
$449.93
|
| Rate for Payer: Cofinity Commercial |
$528.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.93
|
| Rate for Payer: Healthscope Commercial |
$562.41
|
| Rate for Payer: Healthscope Whirlpool |
$545.54
|
| Rate for Payer: Mclaren Commercial |
$506.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$478.05
|
| Rate for Payer: Nomi Health Commercial |
$461.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$494.92
|
|
|
HC HDR OVER 12 CHANNELS
|
Facility
|
IP
|
$2,438.89
|
|
|
Service Code
|
CPT 77772
|
| Hospital Charge Code |
33300057
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,585.28 |
| Max. Negotiated Rate |
$2,438.89 |
| Rate for Payer: Aetna Commercial |
$2,195.00
|
| Rate for Payer: ASR ASR |
$2,365.72
|
| Rate for Payer: ASR Commercial |
$2,365.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,987.45
|
| Rate for Payer: BCN Commercial |
$1,890.87
|
| Rate for Payer: Cash Price |
$1,951.11
|
| Rate for Payer: Cofinity Commercial |
$2,292.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,951.11
|
| Rate for Payer: Healthscope Commercial |
$2,438.89
|
| Rate for Payer: Healthscope Whirlpool |
$2,365.72
|
| Rate for Payer: Mclaren Commercial |
$2,195.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,073.06
|
| Rate for Payer: Nomi Health Commercial |
$1,999.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,585.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,146.22
|
|
|
HC HDR OVER 12 CHANNELS
|
Facility
|
OP
|
$2,438.89
|
|
|
Service Code
|
CPT 77772
|
| Hospital Charge Code |
33300057
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$364.36 |
| Max. Negotiated Rate |
$2,438.89 |
| Rate for Payer: Aetna Commercial |
$2,195.00
|
| Rate for Payer: Aetna Medicare |
$679.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$849.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$849.72
|
| Rate for Payer: ASR ASR |
$2,365.72
|
| Rate for Payer: ASR Commercial |
$2,365.72
|
| Rate for Payer: BCBS Complete |
$382.58
|
| Rate for Payer: BCBS MAPPO |
$679.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,997.21
|
| Rate for Payer: BCN Commercial |
$1,890.87
|
| Rate for Payer: BCN Medicare Advantage |
$679.78
|
| Rate for Payer: Cash Price |
$1,951.11
|
| Rate for Payer: Cash Price |
$1,951.11
|
| Rate for Payer: Cofinity Commercial |
$2,292.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,951.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$679.78
|
| Rate for Payer: Healthscope Commercial |
$2,438.89
|
| Rate for Payer: Healthscope Whirlpool |
$2,365.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$679.78
|
| Rate for Payer: Mclaren Commercial |
$2,195.00
|
| Rate for Payer: Mclaren Medicaid |
$364.36
|
| Rate for Payer: Mclaren Medicare |
$679.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$713.77
|
| Rate for Payer: Meridian Medicaid |
$382.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$781.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,073.06
|
| Rate for Payer: Nomi Health Commercial |
$1,999.89
|
| Rate for Payer: PACE Medicare |
$645.79
|
| Rate for Payer: PACE SWMI |
$679.78
|
| Rate for Payer: PHP Commercial |
$747.76
|
| Rate for Payer: PHP Medicaid |
$364.36
|
| Rate for Payer: PHP Medicare Advantage |
$679.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$364.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,585.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,136.96
|
| Rate for Payer: Priority Health Medicare |
$679.78
|
| Rate for Payer: Priority Health Narrow Network |
$1,709.66
|
| Rate for Payer: Railroad Medicare Medicare |
$679.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,146.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$679.78
|
| Rate for Payer: UHC Exchange |
$1,053.66
|
| Rate for Payer: UHC Medicare Advantage |
$679.78
|
| Rate for Payer: UHCCP DNSP |
$679.78
|
| Rate for Payer: UHCCP Medicaid |
$364.36
|
| Rate for Payer: VA VA |
$679.78
|
|
|
HC HDR SKIN SURFACE 1 CHANNEL
|
Facility
|
IP
|
$481.76
|
|
|
Service Code
|
CPT 77767
|
| Hospital Charge Code |
33300053
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$313.14 |
| Max. Negotiated Rate |
$481.76 |
| Rate for Payer: Aetna Commercial |
$433.58
|
| Rate for Payer: ASR ASR |
$467.31
|
| Rate for Payer: ASR Commercial |
$467.31
|
| Rate for Payer: BCBS Trust/PPO |
$392.59
|
| Rate for Payer: BCN Commercial |
$373.51
|
| Rate for Payer: Cash Price |
$385.41
|
| Rate for Payer: Cofinity Commercial |
$452.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.41
|
| Rate for Payer: Healthscope Commercial |
$481.76
|
| Rate for Payer: Healthscope Whirlpool |
$467.31
|
| Rate for Payer: Mclaren Commercial |
$433.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.50
|
| Rate for Payer: Nomi Health Commercial |
$395.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$423.95
|
|
|
HC HDR SKIN SURFACE 1 CHANNEL
|
Facility
|
OP
|
$481.76
|
|
|
Service Code
|
CPT 77767
|
| Hospital Charge Code |
33300053
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$138.11 |
| Max. Negotiated Rate |
$481.76 |
| Rate for Payer: Aetna Commercial |
$433.58
|
| Rate for Payer: Aetna Medicare |
$257.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$322.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$322.08
|
| Rate for Payer: ASR ASR |
$467.31
|
| Rate for Payer: ASR Commercial |
$467.31
|
| Rate for Payer: BCBS Complete |
$145.01
|
| Rate for Payer: BCBS MAPPO |
$257.66
|
| Rate for Payer: BCBS Trust/PPO |
$394.51
|
| Rate for Payer: BCN Commercial |
$373.51
|
| Rate for Payer: BCN Medicare Advantage |
$257.66
|
| Rate for Payer: Cash Price |
$385.41
|
| Rate for Payer: Cash Price |
$385.41
|
| Rate for Payer: Cofinity Commercial |
$452.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.66
|
| Rate for Payer: Healthscope Commercial |
$481.76
|
| Rate for Payer: Healthscope Whirlpool |
$467.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$257.66
|
| Rate for Payer: Mclaren Commercial |
$433.58
|
| Rate for Payer: Mclaren Medicaid |
$138.11
|
| Rate for Payer: Mclaren Medicare |
$257.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$270.54
|
| Rate for Payer: Meridian Medicaid |
$145.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$296.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.50
|
| Rate for Payer: Nomi Health Commercial |
$395.04
|
| Rate for Payer: PACE Medicare |
$244.78
|
| Rate for Payer: PACE SWMI |
$257.66
|
| Rate for Payer: PHP Commercial |
$283.43
|
| Rate for Payer: PHP Medicaid |
$138.11
|
| Rate for Payer: PHP Medicare Advantage |
$257.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$422.12
|
| Rate for Payer: Priority Health Medicare |
$257.66
|
| Rate for Payer: Priority Health Narrow Network |
$337.71
|
| Rate for Payer: Railroad Medicare Medicare |
$257.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$423.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$257.66
|
| Rate for Payer: UHC Exchange |
$399.37
|
| Rate for Payer: UHC Medicare Advantage |
$257.66
|
| Rate for Payer: UHCCP DNSP |
$257.66
|
| Rate for Payer: UHCCP Medicaid |
$138.11
|
| Rate for Payer: VA VA |
$257.66
|
|
|
HC HDR SKIN SURFACE 2 OR MORE CHANNELS
|
Facility
|
IP
|
$541.99
|
|
|
Service Code
|
CPT 77768
|
| Hospital Charge Code |
33300054
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$352.29 |
| Max. Negotiated Rate |
$541.99 |
| Rate for Payer: Aetna Commercial |
$487.79
|
| Rate for Payer: ASR ASR |
$525.73
|
| Rate for Payer: ASR Commercial |
$525.73
|
| Rate for Payer: BCBS Trust/PPO |
$441.67
|
| Rate for Payer: BCN Commercial |
$420.20
|
| Rate for Payer: Cash Price |
$433.59
|
| Rate for Payer: Cofinity Commercial |
$509.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.59
|
| Rate for Payer: Healthscope Commercial |
$541.99
|
| Rate for Payer: Healthscope Whirlpool |
$525.73
|
| Rate for Payer: Mclaren Commercial |
$487.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$460.69
|
| Rate for Payer: Nomi Health Commercial |
$444.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$476.95
|
|
|
HC HDR SKIN SURFACE 2 OR MORE CHANNELS
|
Facility
|
OP
|
$541.99
|
|
|
Service Code
|
CPT 77768
|
| Hospital Charge Code |
33300054
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$138.11 |
| Max. Negotiated Rate |
$541.99 |
| Rate for Payer: Aetna Commercial |
$487.79
|
| Rate for Payer: Aetna Medicare |
$257.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$322.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$322.08
|
| Rate for Payer: ASR ASR |
$525.73
|
| Rate for Payer: ASR Commercial |
$525.73
|
| Rate for Payer: BCBS Complete |
$145.01
|
| Rate for Payer: BCBS MAPPO |
$257.66
|
| Rate for Payer: BCBS Trust/PPO |
$443.84
|
| Rate for Payer: BCN Commercial |
$420.20
|
| Rate for Payer: BCN Medicare Advantage |
$257.66
|
| Rate for Payer: Cash Price |
$433.59
|
| Rate for Payer: Cash Price |
$433.59
|
| Rate for Payer: Cofinity Commercial |
$509.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.66
|
| Rate for Payer: Healthscope Commercial |
$541.99
|
| Rate for Payer: Healthscope Whirlpool |
$525.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$257.66
|
| Rate for Payer: Mclaren Commercial |
$487.79
|
| Rate for Payer: Mclaren Medicaid |
$138.11
|
| Rate for Payer: Mclaren Medicare |
$257.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$270.54
|
| Rate for Payer: Meridian Medicaid |
$145.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$296.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$460.69
|
| Rate for Payer: Nomi Health Commercial |
$444.43
|
| Rate for Payer: PACE Medicare |
$244.78
|
| Rate for Payer: PACE SWMI |
$257.66
|
| Rate for Payer: PHP Commercial |
$283.43
|
| Rate for Payer: PHP Medicaid |
$138.11
|
| Rate for Payer: PHP Medicare Advantage |
$257.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$474.89
|
| Rate for Payer: Priority Health Medicare |
$257.66
|
| Rate for Payer: Priority Health Narrow Network |
$379.93
|
| Rate for Payer: Railroad Medicare Medicare |
$257.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$476.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$257.66
|
| Rate for Payer: UHC Exchange |
$399.37
|
| Rate for Payer: UHC Medicare Advantage |
$257.66
|
| Rate for Payer: UHCCP DNSP |
$257.66
|
| Rate for Payer: UHCCP Medicaid |
$138.11
|
| Rate for Payer: VA VA |
$257.66
|
|
|
HC HEALTH & BEHAV ASSESS OR REASSESS
|
Facility
|
OP
|
$122.77
|
|
|
Service Code
|
CPT 96156
|
| Hospital Charge Code |
91400009
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$48.58 |
| Max. Negotiated Rate |
$140.48 |
| Rate for Payer: Aetna Commercial |
$110.49
|
| Rate for Payer: Aetna Medicare |
$90.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$113.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$113.29
|
| Rate for Payer: ASR ASR |
$119.09
|
| Rate for Payer: ASR Commercial |
$119.09
|
| Rate for Payer: BCBS Complete |
$51.01
|
| Rate for Payer: BCBS MAPPO |
$90.63
|
| Rate for Payer: BCBS Trust/PPO |
$100.54
|
| Rate for Payer: BCN Commercial |
$95.18
|
| Rate for Payer: BCN Medicare Advantage |
$90.63
|
| Rate for Payer: Cash Price |
$98.22
|
| Rate for Payer: Cash Price |
$98.22
|
| Rate for Payer: Cofinity Commercial |
$115.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.63
|
| Rate for Payer: Healthscope Commercial |
$122.77
|
| Rate for Payer: Healthscope Whirlpool |
$119.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$90.63
|
| Rate for Payer: Mclaren Commercial |
$110.49
|
| Rate for Payer: Mclaren Medicaid |
$48.58
|
| Rate for Payer: Mclaren Medicare |
$90.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.16
|
| Rate for Payer: Meridian Medicaid |
$51.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.35
|
| Rate for Payer: Nomi Health Commercial |
$100.67
|
| Rate for Payer: PACE Medicare |
$86.10
|
| Rate for Payer: PACE SWMI |
$90.63
|
| Rate for Payer: PHP Commercial |
$99.69
|
| Rate for Payer: PHP Medicaid |
$48.58
|
| Rate for Payer: PHP Medicare Advantage |
$90.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.91
|
| Rate for Payer: Priority Health Medicare |
$90.63
|
| Rate for Payer: Priority Health Narrow Network |
$71.93
|
| Rate for Payer: Railroad Medicare Medicare |
$90.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.63
|
| Rate for Payer: UHC Exchange |
$140.48
|
| Rate for Payer: UHC Medicare Advantage |
$90.63
|
| Rate for Payer: UHCCP DNSP |
$90.63
|
| Rate for Payer: UHCCP Medicaid |
$48.58
|
| Rate for Payer: VA VA |
$90.63
|
|
|
HC HEALTH & BEHAV ASSESS OR REASSESS
|
Facility
|
IP
|
$122.77
|
|
|
Service Code
|
CPT 96156
|
| Hospital Charge Code |
91400009
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$122.77 |
| Rate for Payer: Aetna Commercial |
$110.49
|
| Rate for Payer: ASR ASR |
$119.09
|
| Rate for Payer: ASR Commercial |
$119.09
|
| Rate for Payer: BCBS Trust/PPO |
$100.05
|
| Rate for Payer: BCN Commercial |
$95.18
|
| Rate for Payer: Cash Price |
$98.22
|
| Rate for Payer: Cofinity Commercial |
$115.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.22
|
| Rate for Payer: Healthscope Commercial |
$122.77
|
| Rate for Payer: Healthscope Whirlpool |
$119.09
|
| Rate for Payer: Mclaren Commercial |
$110.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.35
|
| Rate for Payer: Nomi Health Commercial |
$100.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.04
|
|
|
HC HEALTH & BEHAV INTERVENT INDIV EA ADD 15 MIN
|
Facility
|
IP
|
$61.38
|
|
|
Service Code
|
CPT 96159
|
| Hospital Charge Code |
91400011
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$61.38 |
| Rate for Payer: Aetna Commercial |
$55.24
|
| Rate for Payer: ASR ASR |
$59.54
|
| Rate for Payer: ASR Commercial |
$59.54
|
| Rate for Payer: BCBS Trust/PPO |
$50.02
|
| Rate for Payer: BCN Commercial |
$47.59
|
| Rate for Payer: Cash Price |
$49.10
|
| Rate for Payer: Cofinity Commercial |
$57.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.10
|
| Rate for Payer: Healthscope Commercial |
$61.38
|
| Rate for Payer: Healthscope Whirlpool |
$59.54
|
| Rate for Payer: Mclaren Commercial |
$55.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.17
|
| Rate for Payer: Nomi Health Commercial |
$50.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.01
|
|
|
HC HEALTH & BEHAV INTERVENT INDIV EA ADD 15 MIN
|
Facility
|
OP
|
$61.38
|
|
|
Service Code
|
CPT 96159
|
| Hospital Charge Code |
91400011
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$61.38 |
| Rate for Payer: Aetna Commercial |
$55.24
|
| Rate for Payer: Aetna Medicare |
$30.69
|
| Rate for Payer: ASR ASR |
$59.54
|
| Rate for Payer: ASR Commercial |
$59.54
|
| Rate for Payer: BCBS Complete |
$24.55
|
| Rate for Payer: BCBS Trust/PPO |
$50.26
|
| Rate for Payer: BCN Commercial |
$47.59
|
| Rate for Payer: Cash Price |
$49.10
|
| Rate for Payer: Cash Price |
$49.10
|
| Rate for Payer: Cofinity Commercial |
$57.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.10
|
| Rate for Payer: Healthscope Commercial |
$61.38
|
| Rate for Payer: Healthscope Whirlpool |
$59.54
|
| Rate for Payer: Mclaren Commercial |
$55.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.17
|
| Rate for Payer: Nomi Health Commercial |
$50.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.37
|
| Rate for Payer: Priority Health Narrow Network |
$19.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.01
|
|
|
HC HEALTH & BEHAV INTERVENT INDIV INIT 30 MIN
|
Facility
|
IP
|
$122.77
|
|
|
Service Code
|
CPT 96158
|
| Hospital Charge Code |
91400010
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$122.77 |
| Rate for Payer: Aetna Commercial |
$110.49
|
| Rate for Payer: ASR ASR |
$119.09
|
| Rate for Payer: ASR Commercial |
$119.09
|
| Rate for Payer: BCBS Trust/PPO |
$100.05
|
| Rate for Payer: BCN Commercial |
$95.18
|
| Rate for Payer: Cash Price |
$98.22
|
| Rate for Payer: Cofinity Commercial |
$115.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.22
|
| Rate for Payer: Healthscope Commercial |
$122.77
|
| Rate for Payer: Healthscope Whirlpool |
$119.09
|
| Rate for Payer: Mclaren Commercial |
$110.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.35
|
| Rate for Payer: Nomi Health Commercial |
$100.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.04
|
|
|
HC HEALTH & BEHAV INTERVENT INDIV INIT 30 MIN
|
Facility
|
OP
|
$122.77
|
|
|
Service Code
|
CPT 96158
|
| Hospital Charge Code |
91400010
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$71.93 |
| Max. Negotiated Rate |
$244.00 |
| Rate for Payer: Aetna Commercial |
$110.49
|
| Rate for Payer: Aetna Medicare |
$157.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$196.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$196.78
|
| Rate for Payer: ASR ASR |
$119.09
|
| Rate for Payer: ASR Commercial |
$119.09
|
| Rate for Payer: BCBS Complete |
$88.60
|
| Rate for Payer: BCBS MAPPO |
$157.42
|
| Rate for Payer: BCBS Trust/PPO |
$100.54
|
| Rate for Payer: BCN Commercial |
$95.18
|
| Rate for Payer: BCN Medicare Advantage |
$157.42
|
| Rate for Payer: Cash Price |
$98.22
|
| Rate for Payer: Cash Price |
$98.22
|
| Rate for Payer: Cofinity Commercial |
$115.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$157.42
|
| Rate for Payer: Healthscope Commercial |
$122.77
|
| Rate for Payer: Healthscope Whirlpool |
$119.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$157.42
|
| Rate for Payer: Mclaren Commercial |
$110.49
|
| Rate for Payer: Mclaren Medicaid |
$84.38
|
| Rate for Payer: Mclaren Medicare |
$157.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$165.29
|
| Rate for Payer: Meridian Medicaid |
$88.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$181.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.35
|
| Rate for Payer: Nomi Health Commercial |
$100.67
|
| Rate for Payer: PACE Medicare |
$149.55
|
| Rate for Payer: PACE SWMI |
$157.42
|
| Rate for Payer: PHP Commercial |
$173.16
|
| Rate for Payer: PHP Medicaid |
$84.38
|
| Rate for Payer: PHP Medicare Advantage |
$157.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.91
|
| Rate for Payer: Priority Health Medicare |
$157.42
|
| Rate for Payer: Priority Health Narrow Network |
$71.93
|
| Rate for Payer: Railroad Medicare Medicare |
$157.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$157.42
|
| Rate for Payer: UHC Exchange |
$244.00
|
| Rate for Payer: UHC Medicare Advantage |
$157.42
|
| Rate for Payer: UHCCP DNSP |
$157.42
|
| Rate for Payer: UHCCP Medicaid |
$84.38
|
| Rate for Payer: VA VA |
$157.42
|
|
|
HC HEARING AID CHECK BINAURAL
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
CPT 92593
|
| Hospital Charge Code |
76100499
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$39.78 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$55.08
|
| Rate for Payer: ASR ASR |
$59.36
|
| Rate for Payer: ASR Commercial |
$59.36
|
| Rate for Payer: BCBS Trust/PPO |
$49.87
|
| Rate for Payer: BCN Commercial |
$47.45
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$57.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Healthscope Whirlpool |
$59.36
|
| Rate for Payer: Mclaren Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.02
|
| Rate for Payer: Nomi Health Commercial |
$50.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.86
|
|
|
HC HEARING AID CHECK BINAURAL
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
CPT 92593
|
| Hospital Charge Code |
76100499
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$24.48 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$55.08
|
| Rate for Payer: Aetna Medicare |
$30.60
|
| Rate for Payer: ASR ASR |
$59.36
|
| Rate for Payer: ASR Commercial |
$59.36
|
| Rate for Payer: BCBS Complete |
$24.48
|
| Rate for Payer: BCBS Trust/PPO |
$50.12
|
| Rate for Payer: BCN Commercial |
$47.45
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$57.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Healthscope Whirlpool |
$59.36
|
| Rate for Payer: Mclaren Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.02
|
| Rate for Payer: Nomi Health Commercial |
$50.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.62
|
| Rate for Payer: Priority Health Narrow Network |
$42.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.86
|
|
