|
HC ADHESIVE RELEASER 50 ML
|
Facility
|
OP
|
$26.08
|
|
|
Service Code
|
HCPCS A4455
|
| Hospital Charge Code |
27000626
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$23.47 |
| Rate for Payer: Aetna Commercial |
$22.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.95
|
| Rate for Payer: BCBS Complete |
$10.43
|
| Rate for Payer: BCBS Trust/PPO |
$5.49
|
| Rate for Payer: Cash Price |
$20.86
|
| Rate for Payer: Cash Price |
$20.86
|
| Rate for Payer: Cofinity Commercial |
$22.43
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| Rate for Payer: Healthscope Commercial |
$23.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.17
|
| Rate for Payer: PHP Commercial |
$22.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.26
|
| Rate for Payer: Priority Health SBD |
$16.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.33
|
| Rate for Payer: UHC Exchange |
$1.94
|
|
|
HC ADL TRAINING EA 15 MIN
|
Facility
|
IP
|
$99.96
|
|
|
Service Code
|
CPT 97535
|
| Hospital Charge Code |
42000030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$62.97 |
| Max. Negotiated Rate |
$89.96 |
| Rate for Payer: Aetna Commercial |
$84.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.97
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cofinity Commercial |
$69.97
|
| Rate for Payer: Cofinity Commercial |
$85.97
|
| Rate for Payer: Healthscope Commercial |
$89.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.97
|
| Rate for Payer: PHP Commercial |
$84.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.97
|
| Rate for Payer: Priority Health SBD |
$62.97
|
|
|
HC ADL TRAINING EA 15 MIN
|
Facility
|
OP
|
$99.96
|
|
|
Service Code
|
CPT 97535
|
| Hospital Charge Code |
42000030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.88 |
| Max. Negotiated Rate |
$89.96 |
| Rate for Payer: Aetna Commercial |
$84.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.97
|
| Rate for Payer: BCBS Complete |
$39.98
|
| Rate for Payer: BCBS Trust/PPO |
$21.88
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cofinity Commercial |
$85.97
|
| Rate for Payer: Cofinity Commercial |
$69.97
|
| Rate for Payer: Healthscope Commercial |
$89.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.97
|
| Rate for Payer: PHP Commercial |
$84.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.97
|
| Rate for Payer: Priority Health SBD |
$62.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.30
|
| Rate for Payer: UHC Exchange |
$32.09
|
|
|
HC ADMIN INTRAPULMONARY SURFACTANT
|
Facility
|
OP
|
$574.00
|
|
|
Service Code
|
CPT 94610
|
| Hospital Charge Code |
46000034
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$54.68 |
| Max. Negotiated Rate |
$516.60 |
| Rate for Payer: Aetna Commercial |
$487.90
|
| Rate for Payer: Aetna Medicare |
$197.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$373.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$237.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$237.22
|
| Rate for Payer: BCBS Complete |
$109.01
|
| Rate for Payer: BCBS MAPPO |
$189.78
|
| Rate for Payer: BCBS Trust/PPO |
$64.48
|
| Rate for Payer: BCN Medicare Advantage |
$189.78
|
| Rate for Payer: Cash Price |
$459.20
|
| Rate for Payer: Cash Price |
$459.20
|
| Rate for Payer: Cofinity Commercial |
$493.64
|
| Rate for Payer: Cofinity Commercial |
$401.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.78
|
| Rate for Payer: Healthscope Commercial |
$516.60
|
| Rate for Payer: Mclaren Medicaid |
$103.81
|
| Rate for Payer: Mclaren Medicare |
$189.78
|
| Rate for Payer: Meridian Medicaid |
$109.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$199.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$487.90
|
| Rate for Payer: PACE Medicare |
$180.29
|
| Rate for Payer: PACE SWMI |
$189.78
|
| Rate for Payer: PHP Commercial |
$487.90
|
| Rate for Payer: PHP Medicare Advantage |
$189.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.80
|
| Rate for Payer: Priority Health Medicare |
$189.78
|
| Rate for Payer: Priority Health SBD |
$361.62
|
| Rate for Payer: Railroad Medicare Medicare |
$189.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.78
|
| Rate for Payer: UHC Exchange |
$54.68
|
| Rate for Payer: UHC Medicare Advantage |
$195.47
|
| Rate for Payer: VA VA |
$189.78
|
|
|
HC ADMIN INTRAPULMONARY SURFACTANT
|
Facility
|
IP
|
$574.00
|
|
|
Service Code
|
CPT 94610
|
| Hospital Charge Code |
46000034
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$361.62 |
| Max. Negotiated Rate |
$516.60 |
| Rate for Payer: Aetna Commercial |
$487.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$373.10
|
| Rate for Payer: Cash Price |
$459.20
|
| Rate for Payer: Cofinity Commercial |
$401.80
|
| Rate for Payer: Cofinity Commercial |
$493.64
|
| Rate for Payer: Healthscope Commercial |
$516.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$487.90
|
| Rate for Payer: PHP Commercial |
$487.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.80
|
| Rate for Payer: Priority Health SBD |
$361.62
|
|
|
HC ADMIN RSV MONOC ANTB IM INJ
|
Facility
|
IP
|
$83.04
|
|
|
Service Code
|
CPT 96381
|
| Hospital Charge Code |
77100066
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$52.32 |
| Max. Negotiated Rate |
$74.74 |
| Rate for Payer: Aetna Commercial |
$70.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.98
|
| Rate for Payer: Cash Price |
$66.43
|
| Rate for Payer: Cofinity Commercial |
$71.41
|
| Rate for Payer: Cofinity Commercial |
$58.13
|
| Rate for Payer: Healthscope Commercial |
$74.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.58
|
| Rate for Payer: PHP Commercial |
$70.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.13
|
| Rate for Payer: Priority Health SBD |
$52.32
|
|
|
HC ADMIN RSV MONOC ANTB IM INJ
|
Facility
|
OP
|
$83.04
|
|
|
Service Code
|
CPT 96381
|
| Hospital Charge Code |
77100066
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$19.32 |
| Max. Negotiated Rate |
$74.74 |
| Rate for Payer: Aetna Commercial |
$70.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.98
|
| Rate for Payer: BCBS Complete |
$33.22
|
| Rate for Payer: Cash Price |
$66.43
|
| Rate for Payer: Cash Price |
$66.43
|
| Rate for Payer: Cofinity Commercial |
$58.13
|
| Rate for Payer: Cofinity Commercial |
$71.41
|
| Rate for Payer: Healthscope Commercial |
$74.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.58
|
| Rate for Payer: PHP Commercial |
$70.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.13
|
| Rate for Payer: Priority Health SBD |
$52.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.25
|
| Rate for Payer: UHC Exchange |
$19.32
|
|
|
HC ADMIN RSV MONOC ANTB IM W/COUNSELING
|
Facility
|
OP
|
$83.04
|
|
|
Service Code
|
CPT 96380
|
| Hospital Charge Code |
77100065
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$22.27 |
| Max. Negotiated Rate |
$74.74 |
| Rate for Payer: Aetna Commercial |
$70.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.98
|
| Rate for Payer: BCBS Complete |
$33.22
|
| Rate for Payer: Cash Price |
$66.43
|
| Rate for Payer: Cash Price |
$66.43
|
| Rate for Payer: Cofinity Commercial |
$58.13
|
| Rate for Payer: Cofinity Commercial |
$71.41
|
| Rate for Payer: Healthscope Commercial |
$74.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.58
|
| Rate for Payer: PHP Commercial |
$70.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.13
|
| Rate for Payer: Priority Health SBD |
$52.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.50
|
| Rate for Payer: UHC Exchange |
$22.27
|
|
|
HC ADMIN RSV MONOC ANTB IM W/COUNSELING
|
Facility
|
IP
|
$83.04
|
|
|
Service Code
|
CPT 96380
|
| Hospital Charge Code |
77100065
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$52.32 |
| Max. Negotiated Rate |
$74.74 |
| Rate for Payer: Aetna Commercial |
$70.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.98
|
| Rate for Payer: Cash Price |
$66.43
|
| Rate for Payer: Cofinity Commercial |
$58.13
|
| Rate for Payer: Cofinity Commercial |
$71.41
|
| Rate for Payer: Healthscope Commercial |
$74.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.58
|
| Rate for Payer: PHP Commercial |
$70.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.13
|
| Rate for Payer: Priority Health SBD |
$52.32
|
|
|
HC ADMIN TOCILIZUMAB COVID 19 1ST DOSE
|
Facility
|
IP
|
$524.28
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
77100044
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$330.30 |
| Max. Negotiated Rate |
$471.85 |
| Rate for Payer: Aetna Commercial |
$445.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.78
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cofinity Commercial |
$367.00
|
| Rate for Payer: Cofinity Commercial |
$450.88
|
| Rate for Payer: Healthscope Commercial |
$471.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.64
|
| Rate for Payer: PHP Commercial |
$445.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: Priority Health SBD |
$330.30
|
|
|
HC ADMIN TOCILIZUMAB COVID 19 1ST DOSE
|
Facility
|
OP
|
$524.28
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
77100044
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$230.13 |
| Max. Negotiated Rate |
$525.89 |
| Rate for Payer: Aetna Commercial |
$445.64
|
| Rate for Payer: Aetna Medicare |
$437.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$525.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$525.89
|
| Rate for Payer: BCBS Complete |
$241.66
|
| Rate for Payer: BCBS MAPPO |
$420.71
|
| Rate for Payer: BCN Medicare Advantage |
$420.71
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cofinity Commercial |
$367.00
|
| Rate for Payer: Cofinity Commercial |
$450.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$420.71
|
| Rate for Payer: Healthscope Commercial |
$471.85
|
| Rate for Payer: Mclaren Medicaid |
$230.13
|
| Rate for Payer: Mclaren Medicare |
$420.71
|
| Rate for Payer: Meridian Medicaid |
$241.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$441.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$483.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.64
|
| Rate for Payer: PACE Medicare |
$399.67
|
| Rate for Payer: PACE SWMI |
$420.71
|
| Rate for Payer: PHP Commercial |
$445.64
|
| Rate for Payer: PHP Medicare Advantage |
$420.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$230.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: Priority Health Medicare |
$420.71
|
| Rate for Payer: Priority Health SBD |
$330.30
|
| Rate for Payer: Railroad Medicare Medicare |
$420.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$420.71
|
| Rate for Payer: UHC Medicare Advantage |
$433.33
|
| Rate for Payer: VA VA |
$420.71
|
|
|
HC ADMIN TOCILIZUMAB COVID 19 2ND DOSE
|
Facility
|
IP
|
$524.28
|
|
|
Service Code
|
HCPCS M0250
|
| Hospital Charge Code |
77100045
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$330.30 |
| Max. Negotiated Rate |
$471.85 |
| Rate for Payer: Aetna Commercial |
$445.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.78
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cofinity Commercial |
$450.88
|
| Rate for Payer: Cofinity Commercial |
$367.00
|
| Rate for Payer: Healthscope Commercial |
$471.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.64
|
| Rate for Payer: PHP Commercial |
$445.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: Priority Health SBD |
$330.30
|
|
|
HC ADMIN TOCILIZUMAB COVID 19 2ND DOSE
|
Facility
|
OP
|
$524.28
|
|
|
Service Code
|
HCPCS M0250
|
| Hospital Charge Code |
77100045
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$230.13 |
| Max. Negotiated Rate |
$525.89 |
| Rate for Payer: Aetna Commercial |
$445.64
|
| Rate for Payer: Aetna Medicare |
$437.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$525.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$525.89
|
| Rate for Payer: BCBS Complete |
$241.66
|
| Rate for Payer: BCBS MAPPO |
$420.71
|
| Rate for Payer: BCN Medicare Advantage |
$420.71
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cofinity Commercial |
$450.88
|
| Rate for Payer: Cofinity Commercial |
$367.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$420.71
|
| Rate for Payer: Healthscope Commercial |
$471.85
|
| Rate for Payer: Mclaren Medicaid |
$230.13
|
| Rate for Payer: Mclaren Medicare |
$420.71
|
| Rate for Payer: Meridian Medicaid |
$241.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$441.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$483.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.64
|
| Rate for Payer: PACE Medicare |
$399.67
|
| Rate for Payer: PACE SWMI |
$420.71
|
| Rate for Payer: PHP Commercial |
$445.64
|
| Rate for Payer: PHP Medicare Advantage |
$420.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$230.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: Priority Health Medicare |
$420.71
|
| Rate for Payer: Priority Health SBD |
$330.30
|
| Rate for Payer: Railroad Medicare Medicare |
$420.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$420.71
|
| Rate for Payer: UHC Medicare Advantage |
$433.33
|
| Rate for Payer: VA VA |
$420.71
|
|
|
HC ADMN SARSCOV2 VACC 1 DOSE
|
Facility
|
IP
|
$83.04
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
77100064
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$52.32 |
| Max. Negotiated Rate |
$74.74 |
| Rate for Payer: Aetna Commercial |
$70.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.98
|
| Rate for Payer: Cash Price |
$66.43
|
| Rate for Payer: Cofinity Commercial |
$58.13
|
| Rate for Payer: Cofinity Commercial |
$71.41
|
| Rate for Payer: Healthscope Commercial |
$74.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.58
|
| Rate for Payer: PHP Commercial |
$70.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.13
|
| Rate for Payer: Priority Health SBD |
$52.32
|
|
|
HC ADMN SARSCOV2 VACC 1 DOSE
|
Facility
|
OP
|
$83.04
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
77100064
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$21.21 |
| Max. Negotiated Rate |
$74.74 |
| Rate for Payer: Aetna Commercial |
$70.58
|
| Rate for Payer: Aetna Medicare |
$40.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.46
|
| Rate for Payer: BCBS Complete |
$22.27
|
| Rate for Payer: BCBS MAPPO |
$38.77
|
| Rate for Payer: BCN Medicare Advantage |
$38.77
|
| Rate for Payer: Cash Price |
$66.43
|
| Rate for Payer: Cash Price |
$66.43
|
| Rate for Payer: Cofinity Commercial |
$58.13
|
| Rate for Payer: Cofinity Commercial |
$71.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.77
|
| Rate for Payer: Healthscope Commercial |
$74.74
|
| Rate for Payer: Mclaren Medicaid |
$21.21
|
| Rate for Payer: Mclaren Medicare |
$38.77
|
| Rate for Payer: Meridian Medicaid |
$22.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.58
|
| Rate for Payer: PACE Medicare |
$36.83
|
| Rate for Payer: PACE SWMI |
$38.77
|
| Rate for Payer: PHP Commercial |
$70.58
|
| Rate for Payer: PHP Medicare Advantage |
$38.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.13
|
| Rate for Payer: Priority Health Medicare |
$38.77
|
| Rate for Payer: Priority Health SBD |
$52.32
|
| Rate for Payer: Railroad Medicare Medicare |
$38.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.77
|
| Rate for Payer: UHC Medicare Advantage |
$39.93
|
| Rate for Payer: VA VA |
$38.77
|
|
|
HC ADMU OBSERVATION PER HOUR
|
Facility
|
IP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200020
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$84.63 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.31
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Cofinity Commercial |
$94.03
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health SBD |
$84.63
|
|
|
HC ADMU OBSERVATION PER HOUR
|
Facility
|
OP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200020
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$53.73 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.31
|
| Rate for Payer: BCBS Complete |
$53.73
|
| Rate for Payer: BCBS Trust/PPO |
$108.91
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Cofinity Commercial |
$94.03
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Meridian Medicaid |
$1,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health SBD |
$84.63
|
|
|
HC ADRENOCORTICOTROPIC HORMONE
|
Facility
|
IP
|
$60.50
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
30100071
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.12 |
| Max. Negotiated Rate |
$54.45 |
| Rate for Payer: Aetna Commercial |
$51.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.32
|
| Rate for Payer: Cash Price |
$48.40
|
| Rate for Payer: Cofinity Commercial |
$42.35
|
| Rate for Payer: Cofinity Commercial |
$52.03
|
| Rate for Payer: Healthscope Commercial |
$54.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.42
|
| Rate for Payer: PHP Commercial |
$51.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.35
|
| Rate for Payer: Priority Health SBD |
$38.12
|
|
|
HC ADRENOCORTICOTROPIC HORMONE
|
Facility
|
OP
|
$60.50
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
30100071
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.13 |
| Max. Negotiated Rate |
$65.65 |
| Rate for Payer: Aetna Commercial |
$51.42
|
| Rate for Payer: Aetna Medicare |
$40.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.28
|
| Rate for Payer: BCBS Complete |
$22.18
|
| Rate for Payer: BCBS MAPPO |
$38.62
|
| Rate for Payer: BCBS Trust/PPO |
$30.25
|
| Rate for Payer: BCN Medicare Advantage |
$38.62
|
| Rate for Payer: Cash Price |
$48.40
|
| Rate for Payer: Cash Price |
$48.40
|
| Rate for Payer: Cofinity Commercial |
$52.03
|
| Rate for Payer: Cofinity Commercial |
$42.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.62
|
| Rate for Payer: Healthscope Commercial |
$54.45
|
| Rate for Payer: Mclaren Medicaid |
$21.13
|
| Rate for Payer: Mclaren Medicare |
$38.62
|
| Rate for Payer: Meridian Medicaid |
$22.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.42
|
| Rate for Payer: PACE Medicare |
$36.69
|
| Rate for Payer: PACE SWMI |
$38.62
|
| Rate for Payer: PHP Commercial |
$51.42
|
| Rate for Payer: PHP Medicare Advantage |
$38.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.35
|
| Rate for Payer: Priority Health Medicare |
$38.62
|
| Rate for Payer: Priority Health SBD |
$38.12
|
| Rate for Payer: Railroad Medicare Medicare |
$38.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.34
|
| Rate for Payer: UHC Core |
$65.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.62
|
| Rate for Payer: UHC Exchange |
$38.62
|
| Rate for Payer: UHC Medicare Advantage |
$39.78
|
| Rate for Payer: VA VA |
$38.62
|
|
|
HC ADULTERANT SURVEY URINE
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30700010
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna Commercial |
$12.75
|
| Rate for Payer: Aetna Medicare |
$2.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.71
|
| Rate for Payer: BCBS Complete |
$1.25
|
| Rate for Payer: BCBS MAPPO |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$1.70
|
| Rate for Payer: BCN Medicare Advantage |
$2.17
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$12.90
|
| Rate for Payer: Cofinity Commercial |
$10.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.17
|
| Rate for Payer: Healthscope Commercial |
$13.50
|
| Rate for Payer: Mclaren Medicaid |
$1.19
|
| Rate for Payer: Mclaren Medicare |
$2.17
|
| Rate for Payer: Meridian Medicaid |
$1.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.75
|
| Rate for Payer: PACE Medicare |
$2.06
|
| Rate for Payer: PACE SWMI |
$2.17
|
| Rate for Payer: PHP Commercial |
$12.75
|
| Rate for Payer: PHP Medicare Advantage |
$2.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.50
|
| Rate for Payer: Priority Health Medicare |
$2.17
|
| Rate for Payer: Priority Health SBD |
$9.45
|
| Rate for Payer: Railroad Medicare Medicare |
$2.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.60
|
| Rate for Payer: UHC Core |
$3.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.17
|
| Rate for Payer: UHC Exchange |
$2.17
|
| Rate for Payer: UHC Medicare Advantage |
$2.24
|
| Rate for Payer: VA VA |
$2.17
|
|
|
HC ADULTERANT SURVEY URINE
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30700010
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna Commercial |
$12.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.75
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$10.50
|
| Rate for Payer: Cofinity Commercial |
$12.90
|
| Rate for Payer: Healthscope Commercial |
$13.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.75
|
| Rate for Payer: PHP Commercial |
$12.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.50
|
| Rate for Payer: Priority Health SBD |
$9.45
|
|
|
HC ADVANCE CARE PLANNING EA ADDL 30 MIN
|
Facility
|
IP
|
$32.64
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
51000091
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.56 |
| Max. Negotiated Rate |
$29.38 |
| Rate for Payer: Aetna Commercial |
$27.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.22
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cofinity Commercial |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$28.07
|
| Rate for Payer: Healthscope Commercial |
$29.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.74
|
| Rate for Payer: PHP Commercial |
$27.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.85
|
| Rate for Payer: Priority Health SBD |
$20.56
|
|
|
HC ADVANCE CARE PLANNING EA ADDL 30 MIN
|
Facility
|
OP
|
$32.64
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
51000091
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.06 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Aetna Commercial |
$27.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.22
|
| Rate for Payer: BCBS Complete |
$13.06
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cofinity Commercial |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$28.07
|
| Rate for Payer: Healthscope Commercial |
$29.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.74
|
| Rate for Payer: PHP Commercial |
$27.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.85
|
| Rate for Payer: Priority Health SBD |
$20.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.00
|
| Rate for Payer: UHC Exchange |
$69.09
|
|
|
HC ADVANCE CARE PLANNING FIRST 30 MIN
|
Facility
|
OP
|
$32.64
|
|
|
Service Code
|
CPT 99497
|
| Hospital Charge Code |
51000090
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.56 |
| Max. Negotiated Rate |
$232.97 |
| Rate for Payer: Aetna Commercial |
$27.74
|
| Rate for Payer: Aetna Medicare |
$82.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.14
|
| Rate for Payer: BCBS Complete |
$45.56
|
| Rate for Payer: BCBS MAPPO |
$79.31
|
| Rate for Payer: BCN Medicare Advantage |
$79.31
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cofinity Commercial |
$28.07
|
| Rate for Payer: Cofinity Commercial |
$22.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.31
|
| Rate for Payer: Healthscope Commercial |
$29.38
|
| Rate for Payer: Mclaren Medicaid |
$43.38
|
| Rate for Payer: Mclaren Medicare |
$79.31
|
| Rate for Payer: Meridian Medicaid |
$45.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$83.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.74
|
| Rate for Payer: PACE Medicare |
$75.34
|
| Rate for Payer: PACE SWMI |
$79.31
|
| Rate for Payer: PHP Commercial |
$27.74
|
| Rate for Payer: PHP Medicare Advantage |
$79.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$232.97
|
| Rate for Payer: Priority Health Medicare |
$79.31
|
| Rate for Payer: Priority Health Narrow Network |
$186.38
|
| Rate for Payer: Priority Health SBD |
$20.56
|
| Rate for Payer: Railroad Medicare Medicare |
$79.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.31
|
| Rate for Payer: UHC Exchange |
$73.35
|
| Rate for Payer: UHC Medicare Advantage |
$81.69
|
| Rate for Payer: VA VA |
$79.31
|
|
|
HC ADVANCE CARE PLANNING FIRST 30 MIN
|
Facility
|
IP
|
$32.64
|
|
|
Service Code
|
CPT 99497
|
| Hospital Charge Code |
51000090
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.56 |
| Max. Negotiated Rate |
$29.38 |
| Rate for Payer: Aetna Commercial |
$27.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.22
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cofinity Commercial |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$28.07
|
| Rate for Payer: Healthscope Commercial |
$29.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.74
|
| Rate for Payer: PHP Commercial |
$27.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.85
|
| Rate for Payer: Priority Health SBD |
$20.56
|
|
