|
HC AEP HEARING STATUS DETER BROADBAND STIMULI I&R
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
CPT 92651
|
| Hospital Charge Code |
76100497
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$81.21 |
| Max. Negotiated Rate |
$436.07 |
| Rate for Payer: Aetna Commercial |
$134.30
|
| Rate for Payer: Aetna Medicare |
$290.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$349.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$349.11
|
| Rate for Payer: BCBS Complete |
$160.42
|
| Rate for Payer: BCBS MAPPO |
$279.29
|
| Rate for Payer: BCBS Trust/PPO |
$228.74
|
| Rate for Payer: BCN Medicare Advantage |
$279.29
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cofinity Commercial |
$110.60
|
| Rate for Payer: Cofinity Commercial |
$135.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.29
|
| Rate for Payer: Healthscope Commercial |
$142.20
|
| Rate for Payer: Mclaren Medicaid |
$152.77
|
| Rate for Payer: Mclaren Medicare |
$279.29
|
| Rate for Payer: Meridian Medicaid |
$160.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$293.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$321.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.30
|
| Rate for Payer: PACE Medicare |
$265.33
|
| Rate for Payer: PACE SWMI |
$279.29
|
| Rate for Payer: PHP Commercial |
$134.30
|
| Rate for Payer: PHP Medicare Advantage |
$279.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$436.07
|
| Rate for Payer: Priority Health Medicare |
$279.29
|
| Rate for Payer: Priority Health Narrow Network |
$348.85
|
| Rate for Payer: Priority Health SBD |
$99.54
|
| Rate for Payer: Railroad Medicare Medicare |
$279.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.29
|
| Rate for Payer: UHC Exchange |
$81.21
|
| Rate for Payer: UHC Medicare Advantage |
$287.67
|
| Rate for Payer: VA VA |
$279.29
|
|
|
HC AEP HEARING STATUS DETER BROADBAND STIMULI I&R
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
CPT 92651
|
| Hospital Charge Code |
76100497
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$99.54 |
| Max. Negotiated Rate |
$142.20 |
| Rate for Payer: Aetna Commercial |
$134.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.70
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cofinity Commercial |
$110.60
|
| Rate for Payer: Cofinity Commercial |
$135.88
|
| Rate for Payer: Healthscope Commercial |
$142.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.30
|
| Rate for Payer: PHP Commercial |
$134.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.60
|
| Rate for Payer: Priority Health SBD |
$99.54
|
|
|
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
CPT 92652
|
| Hospital Charge Code |
47100401
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$824.04 |
| Rate for Payer: Aetna Commercial |
$238.85
|
| Rate for Payer: Aetna Medicare |
$290.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$349.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$349.11
|
| Rate for Payer: BCBS Complete |
$160.42
|
| Rate for Payer: BCBS MAPPO |
$279.29
|
| Rate for Payer: BCBS Trust/PPO |
$276.30
|
| Rate for Payer: BCN Medicare Advantage |
$279.29
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$196.70
|
| Rate for Payer: Cofinity Commercial |
$241.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.29
|
| Rate for Payer: Healthscope Commercial |
$252.90
|
| Rate for Payer: Mclaren Medicaid |
$152.77
|
| Rate for Payer: Mclaren Medicare |
$279.29
|
| Rate for Payer: Meridian Medicaid |
$160.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$293.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$321.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.85
|
| Rate for Payer: PACE Medicare |
$265.33
|
| Rate for Payer: PACE SWMI |
$279.29
|
| Rate for Payer: PHP Commercial |
$238.85
|
| Rate for Payer: PHP Medicare Advantage |
$279.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$824.04
|
| Rate for Payer: Priority Health Medicare |
$279.29
|
| Rate for Payer: Priority Health Narrow Network |
$659.23
|
| Rate for Payer: Priority Health SBD |
$177.03
|
| Rate for Payer: Railroad Medicare Medicare |
$279.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.29
|
| Rate for Payer: UHC Exchange |
$110.02
|
| Rate for Payer: UHC Medicare Advantage |
$287.67
|
| Rate for Payer: VA VA |
$279.29
|
|
|
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
CPT 92652
|
| Hospital Charge Code |
47100401
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$177.03 |
| Max. Negotiated Rate |
$252.90 |
| Rate for Payer: Aetna Commercial |
$238.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.65
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$196.70
|
| Rate for Payer: Cofinity Commercial |
$241.66
|
| Rate for Payer: Healthscope Commercial |
$252.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.85
|
| Rate for Payer: PHP Commercial |
$238.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.70
|
| Rate for Payer: Priority Health SBD |
$177.03
|
|
|
HC AEROBIKA
|
Facility
|
OP
|
$147.32
|
|
| Hospital Charge Code |
27000612
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$58.93 |
| Max. Negotiated Rate |
$132.59 |
| Rate for Payer: Aetna Commercial |
$125.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.76
|
| Rate for Payer: BCBS Complete |
$58.93
|
| Rate for Payer: Cash Price |
$117.86
|
| Rate for Payer: Cofinity Commercial |
$103.12
|
| Rate for Payer: Cofinity Commercial |
$126.70
|
| Rate for Payer: Healthscope Commercial |
$132.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.22
|
| Rate for Payer: PHP Commercial |
$125.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.12
|
| Rate for Payer: Priority Health SBD |
$92.81
|
|
|
HC AEROBIKA
|
Facility
|
IP
|
$147.32
|
|
| Hospital Charge Code |
27000612
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$92.81 |
| Max. Negotiated Rate |
$132.59 |
| Rate for Payer: Aetna Commercial |
$125.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.76
|
| Rate for Payer: Cash Price |
$117.86
|
| Rate for Payer: Cofinity Commercial |
$103.12
|
| Rate for Payer: Cofinity Commercial |
$126.70
|
| Rate for Payer: Healthscope Commercial |
$132.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.22
|
| Rate for Payer: PHP Commercial |
$125.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.12
|
| Rate for Payer: Priority Health SBD |
$92.81
|
|
|
HC AERONEB SUPPLY
|
Facility
|
OP
|
$163.93
|
|
| Hospital Charge Code |
27000465
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$65.57 |
| Max. Negotiated Rate |
$147.54 |
| Rate for Payer: Aetna Commercial |
$139.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.55
|
| Rate for Payer: BCBS Complete |
$65.57
|
| Rate for Payer: Cash Price |
$131.14
|
| Rate for Payer: Cofinity Commercial |
$114.75
|
| Rate for Payer: Cofinity Commercial |
$140.98
|
| Rate for Payer: Healthscope Commercial |
$147.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$139.34
|
| Rate for Payer: PHP Commercial |
$139.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.75
|
| Rate for Payer: Priority Health SBD |
$103.28
|
|
|
HC AERONEB SUPPLY
|
Facility
|
IP
|
$163.93
|
|
| Hospital Charge Code |
27000465
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$103.28 |
| Max. Negotiated Rate |
$147.54 |
| Rate for Payer: Aetna Commercial |
$139.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.55
|
| Rate for Payer: Cash Price |
$131.14
|
| Rate for Payer: Cofinity Commercial |
$114.75
|
| Rate for Payer: Cofinity Commercial |
$140.98
|
| Rate for Payer: Healthscope Commercial |
$147.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$139.34
|
| Rate for Payer: PHP Commercial |
$139.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.75
|
| Rate for Payer: Priority Health SBD |
$103.28
|
|
|
HC AEROSOLIZED MEDICATION
|
Facility
|
OP
|
$146.74
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
41000012
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$237.22 |
| Rate for Payer: Aetna Commercial |
$124.73
|
| Rate for Payer: Aetna Medicare |
$197.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.38
|
| 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 |
$39.92
|
| Rate for Payer: BCN Medicare Advantage |
$189.78
|
| Rate for Payer: Cash Price |
$117.39
|
| Rate for Payer: Cash Price |
$117.39
|
| Rate for Payer: Cofinity Commercial |
$126.20
|
| Rate for Payer: Cofinity Commercial |
$102.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.78
|
| Rate for Payer: Healthscope Commercial |
$132.07
|
| 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 |
$124.73
|
| Rate for Payer: PACE Medicare |
$180.29
|
| Rate for Payer: PACE SWMI |
$189.78
|
| Rate for Payer: PHP Commercial |
$124.73
|
| 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 |
$102.72
|
| Rate for Payer: Priority Health Medicare |
$189.78
|
| Rate for Payer: Priority Health SBD |
$92.45
|
| Rate for Payer: Railroad Medicare Medicare |
$189.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.78
|
| Rate for Payer: UHC Exchange |
$7.86
|
| Rate for Payer: UHC Medicare Advantage |
$195.47
|
| Rate for Payer: VA VA |
$189.78
|
|
|
HC AEROSOLIZED MEDICATION
|
Facility
|
IP
|
$146.74
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
41000012
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$92.45 |
| Max. Negotiated Rate |
$132.07 |
| Rate for Payer: Aetna Commercial |
$124.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.38
|
| Rate for Payer: Cash Price |
$117.39
|
| Rate for Payer: Cofinity Commercial |
$102.72
|
| Rate for Payer: Cofinity Commercial |
$126.20
|
| Rate for Payer: Healthscope Commercial |
$132.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.73
|
| Rate for Payer: PHP Commercial |
$124.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.72
|
| Rate for Payer: Priority Health SBD |
$92.45
|
|
|
HC AFB CULTURE
|
Facility
|
IP
|
$89.40
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
30600089
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$56.32 |
| Max. Negotiated Rate |
$80.46 |
| Rate for Payer: Aetna Commercial |
$75.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.11
|
| Rate for Payer: Cash Price |
$71.52
|
| Rate for Payer: Cofinity Commercial |
$76.88
|
| Rate for Payer: Cofinity Commercial |
$62.58
|
| Rate for Payer: Healthscope Commercial |
$80.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.99
|
| Rate for Payer: PHP Commercial |
$75.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.58
|
| Rate for Payer: Priority Health SBD |
$56.32
|
|
|
HC AFB CULTURE
|
Facility
|
OP
|
$89.40
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
30600089
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.91 |
| Max. Negotiated Rate |
$80.46 |
| Rate for Payer: Aetna Commercial |
$75.99
|
| Rate for Payer: Aetna Medicare |
$11.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.50
|
| Rate for Payer: BCBS Complete |
$6.20
|
| Rate for Payer: BCBS MAPPO |
$10.80
|
| Rate for Payer: BCBS Trust/PPO |
$8.46
|
| Rate for Payer: BCN Medicare Advantage |
$10.80
|
| Rate for Payer: Cash Price |
$71.52
|
| Rate for Payer: Cash Price |
$71.52
|
| Rate for Payer: Cofinity Commercial |
$76.88
|
| Rate for Payer: Cofinity Commercial |
$62.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.80
|
| Rate for Payer: Healthscope Commercial |
$80.46
|
| Rate for Payer: Mclaren Medicaid |
$5.91
|
| Rate for Payer: Mclaren Medicare |
$10.80
|
| Rate for Payer: Meridian Medicaid |
$6.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.99
|
| Rate for Payer: PACE Medicare |
$10.26
|
| Rate for Payer: PACE SWMI |
$10.80
|
| Rate for Payer: PHP Commercial |
$75.99
|
| Rate for Payer: PHP Medicare Advantage |
$10.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.58
|
| Rate for Payer: Priority Health Medicare |
$10.80
|
| Rate for Payer: Priority Health SBD |
$56.32
|
| Rate for Payer: Railroad Medicare Medicare |
$10.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.96
|
| Rate for Payer: UHC Core |
$18.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.80
|
| Rate for Payer: UHC Exchange |
$10.80
|
| Rate for Payer: UHC Medicare Advantage |
$11.12
|
| Rate for Payer: VA VA |
$10.80
|
|
|
HC AFB SMEAR
|
Facility
|
IP
|
$57.50
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
30600105
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.22 |
| Max. Negotiated Rate |
$51.75 |
| Rate for Payer: Aetna Commercial |
$48.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.38
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cofinity Commercial |
$40.25
|
| Rate for Payer: Cofinity Commercial |
$49.45
|
| Rate for Payer: Healthscope Commercial |
$51.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.88
|
| Rate for Payer: PHP Commercial |
$48.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.25
|
| Rate for Payer: Priority Health SBD |
$36.22
|
|
|
HC AFB SMEAR
|
Facility
|
OP
|
$57.50
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
30600105
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$51.75 |
| Rate for Payer: Aetna Commercial |
$48.88
|
| Rate for Payer: Aetna Medicare |
$5.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.74
|
| Rate for Payer: BCBS Complete |
$3.10
|
| Rate for Payer: BCBS MAPPO |
$5.39
|
| Rate for Payer: BCBS Trust/PPO |
$4.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.39
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cofinity Commercial |
$49.45
|
| Rate for Payer: Cofinity Commercial |
$40.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.39
|
| Rate for Payer: Healthscope Commercial |
$51.75
|
| Rate for Payer: Mclaren Medicaid |
$2.95
|
| Rate for Payer: Mclaren Medicare |
$5.39
|
| Rate for Payer: Meridian Medicaid |
$3.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.88
|
| Rate for Payer: PACE Medicare |
$5.12
|
| Rate for Payer: PACE SWMI |
$5.39
|
| Rate for Payer: PHP Commercial |
$48.88
|
| Rate for Payer: PHP Medicare Advantage |
$5.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.25
|
| Rate for Payer: Priority Health Medicare |
$5.39
|
| Rate for Payer: Priority Health SBD |
$36.22
|
| Rate for Payer: Railroad Medicare Medicare |
$5.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.47
|
| Rate for Payer: UHC Core |
$9.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.39
|
| Rate for Payer: UHC Exchange |
$5.39
|
| Rate for Payer: UHC Medicare Advantage |
$5.55
|
| Rate for Payer: VA VA |
$5.39
|
|
|
HC AFFINITY 1.5 X 1.5 PER SQ CM
|
Facility
|
OP
|
$706.86
|
|
|
Service Code
|
HCPCS Q4159
|
| Hospital Charge Code |
63600124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$282.74 |
| Max. Negotiated Rate |
$636.17 |
| Rate for Payer: Aetna Commercial |
$600.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$459.46
|
| Rate for Payer: BCBS Complete |
$282.74
|
| Rate for Payer: BCBS Trust/PPO |
$619.49
|
| Rate for Payer: Cash Price |
$565.49
|
| Rate for Payer: Cash Price |
$565.49
|
| Rate for Payer: Cofinity Commercial |
$607.90
|
| Rate for Payer: Cofinity Commercial |
$494.80
|
| Rate for Payer: Healthscope Commercial |
$636.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$600.83
|
| Rate for Payer: PHP Commercial |
$600.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$494.80
|
| Rate for Payer: Priority Health SBD |
$445.32
|
|
|
HC AFFINITY 1.5 X 1.5 PER SQ CM
|
Facility
|
IP
|
$706.86
|
|
|
Service Code
|
HCPCS Q4159
|
| Hospital Charge Code |
63600124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$445.32 |
| Max. Negotiated Rate |
$636.17 |
| Rate for Payer: Aetna Commercial |
$600.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$459.46
|
| Rate for Payer: Cash Price |
$565.49
|
| Rate for Payer: Cofinity Commercial |
$494.80
|
| Rate for Payer: Cofinity Commercial |
$607.90
|
| Rate for Payer: Healthscope Commercial |
$636.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$600.83
|
| Rate for Payer: PHP Commercial |
$600.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$494.80
|
| Rate for Payer: Priority Health SBD |
$445.32
|
|
|
HC AFFINITY 2.5 X 2.5 PER SQ CM
|
Facility
|
IP
|
$426.26
|
|
|
Service Code
|
HCPCS Q4159
|
| Hospital Charge Code |
63600125
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$268.54 |
| Max. Negotiated Rate |
$383.63 |
| Rate for Payer: Aetna Commercial |
$362.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.07
|
| Rate for Payer: Cash Price |
$341.01
|
| Rate for Payer: Cofinity Commercial |
$298.38
|
| Rate for Payer: Cofinity Commercial |
$366.58
|
| Rate for Payer: Healthscope Commercial |
$383.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$362.32
|
| Rate for Payer: PHP Commercial |
$362.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.38
|
| Rate for Payer: Priority Health SBD |
$268.54
|
|
|
HC AFFINITY 2.5 X 2.5 PER SQ CM
|
Facility
|
OP
|
$426.26
|
|
|
Service Code
|
HCPCS Q4159
|
| Hospital Charge Code |
63600125
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$170.50 |
| Max. Negotiated Rate |
$619.49 |
| Rate for Payer: Aetna Commercial |
$362.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.07
|
| Rate for Payer: BCBS Complete |
$170.50
|
| Rate for Payer: BCBS Trust/PPO |
$619.49
|
| Rate for Payer: Cash Price |
$341.01
|
| Rate for Payer: Cash Price |
$341.01
|
| Rate for Payer: Cofinity Commercial |
$366.58
|
| Rate for Payer: Cofinity Commercial |
$298.38
|
| Rate for Payer: Healthscope Commercial |
$383.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$362.32
|
| Rate for Payer: PHP Commercial |
$362.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.38
|
| Rate for Payer: Priority Health SBD |
$268.54
|
|
|
HC AFP SINGLE MARKER SCRN,MS
|
Facility
|
OP
|
$47.94
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
30100622
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$43.15 |
| Rate for Payer: Aetna Commercial |
$40.75
|
| Rate for Payer: Aetna Medicare |
$17.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.96
|
| Rate for Payer: BCBS Complete |
$9.63
|
| Rate for Payer: BCBS MAPPO |
$16.77
|
| Rate for Payer: BCBS Trust/PPO |
$13.13
|
| Rate for Payer: BCN Medicare Advantage |
$16.77
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cofinity Commercial |
$41.23
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.77
|
| Rate for Payer: Healthscope Commercial |
$43.15
|
| Rate for Payer: Mclaren Medicaid |
$9.17
|
| Rate for Payer: Mclaren Medicare |
$16.77
|
| Rate for Payer: Meridian Medicaid |
$9.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.75
|
| Rate for Payer: PACE Medicare |
$15.93
|
| Rate for Payer: PACE SWMI |
$16.77
|
| Rate for Payer: PHP Commercial |
$40.75
|
| Rate for Payer: PHP Medicare Advantage |
$16.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.56
|
| Rate for Payer: Priority Health Medicare |
$16.77
|
| Rate for Payer: Priority Health SBD |
$30.20
|
| Rate for Payer: Railroad Medicare Medicare |
$16.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.12
|
| Rate for Payer: UHC Core |
$28.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.77
|
| Rate for Payer: UHC Exchange |
$16.77
|
| Rate for Payer: UHC Medicare Advantage |
$17.27
|
| Rate for Payer: VA VA |
$16.77
|
|
|
HC AFP SINGLE MARKER SCRN,MS
|
Facility
|
IP
|
$47.94
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
30100622
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.20 |
| Max. Negotiated Rate |
$43.15 |
| Rate for Payer: Aetna Commercial |
$40.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.16
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Cofinity Commercial |
$41.23
|
| Rate for Payer: Healthscope Commercial |
$43.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.75
|
| Rate for Payer: PHP Commercial |
$40.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.56
|
| Rate for Payer: Priority Health SBD |
$30.20
|
|
|
HC AFTER HOURS ACCESS
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 99050
|
| Hospital Charge Code |
98300006
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna Commercial |
$17.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$17.20
|
| Rate for Payer: Cofinity Commercial |
$14.00
|
| Rate for Payer: Healthscope Commercial |
$18.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.00
|
| Rate for Payer: PHP Commercial |
$17.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
| Rate for Payer: Priority Health SBD |
$12.60
|
|
|
HC AFTER HOURS ACCESS
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 99050
|
| Hospital Charge Code |
98300006
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$63.32 |
| Rate for Payer: Aetna Commercial |
$17.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.00
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS Trust/PPO |
$63.32
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$14.00
|
| Rate for Payer: Cofinity Commercial |
$17.20
|
| Rate for Payer: Healthscope Commercial |
$18.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.00
|
| Rate for Payer: PHP Commercial |
$17.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
| Rate for Payer: Priority Health SBD |
$12.60
|
|
|
HC ALBUMIN SERUM
|
Facility
|
IP
|
$37.90
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100072
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.88 |
| Max. Negotiated Rate |
$34.11 |
| Rate for Payer: Aetna Commercial |
$32.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.64
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Cofinity Commercial |
$26.53
|
| Rate for Payer: Cofinity Commercial |
$32.59
|
| Rate for Payer: Healthscope Commercial |
$34.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.22
|
| Rate for Payer: PHP Commercial |
$32.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.53
|
| Rate for Payer: Priority Health SBD |
$23.88
|
|
|
HC ALBUMIN SERUM
|
Facility
|
OP
|
$37.90
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100072
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$34.11 |
| Rate for Payer: Aetna Commercial |
$32.22
|
| Rate for Payer: Aetna Medicare |
$5.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.19
|
| Rate for Payer: BCBS Complete |
$2.84
|
| Rate for Payer: BCBS MAPPO |
$4.95
|
| Rate for Payer: BCN Medicare Advantage |
$4.95
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Cofinity Commercial |
$26.53
|
| Rate for Payer: Cofinity Commercial |
$32.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.95
|
| Rate for Payer: Healthscope Commercial |
$34.11
|
| Rate for Payer: Mclaren Medicaid |
$2.71
|
| Rate for Payer: Mclaren Medicare |
$4.95
|
| Rate for Payer: Meridian Medicaid |
$2.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.22
|
| Rate for Payer: PACE Medicare |
$4.70
|
| Rate for Payer: PACE SWMI |
$4.95
|
| Rate for Payer: PHP Commercial |
$32.22
|
| Rate for Payer: PHP Medicare Advantage |
$4.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.53
|
| Rate for Payer: Priority Health Medicare |
$4.95
|
| Rate for Payer: Priority Health SBD |
$23.88
|
| Rate for Payer: Railroad Medicare Medicare |
$4.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.94
|
| Rate for Payer: UHC Core |
$8.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.95
|
| Rate for Payer: UHC Exchange |
$4.95
|
| Rate for Payer: UHC Medicare Advantage |
$5.10
|
| Rate for Payer: VA VA |
$4.95
|
|
|
HC ALBUMIN URINE OR OTHER SOURCE
|
Facility
|
OP
|
$40.49
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
30100663
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.26 |
| Max. Negotiated Rate |
$36.44 |
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: Aetna Medicare |
$8.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.72
|
| Rate for Payer: BCBS Complete |
$4.47
|
| Rate for Payer: BCBS MAPPO |
$7.78
|
| Rate for Payer: BCBS Trust/PPO |
$6.10
|
| Rate for Payer: BCN Medicare Advantage |
$7.78
|
| Rate for Payer: Cash Price |
$32.39
|
| Rate for Payer: Cash Price |
$32.39
|
| Rate for Payer: Cofinity Commercial |
$28.34
|
| Rate for Payer: Cofinity Commercial |
$34.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.78
|
| Rate for Payer: Healthscope Commercial |
$36.44
|
| Rate for Payer: Mclaren Medicaid |
$4.26
|
| Rate for Payer: Mclaren Medicare |
$7.78
|
| Rate for Payer: Meridian Medicaid |
$4.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.42
|
| Rate for Payer: PACE Medicare |
$7.39
|
| Rate for Payer: PACE SWMI |
$7.78
|
| Rate for Payer: PHP Commercial |
$34.42
|
| Rate for Payer: PHP Medicare Advantage |
$7.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.34
|
| Rate for Payer: Priority Health Medicare |
$7.78
|
| Rate for Payer: Priority Health SBD |
$25.51
|
| Rate for Payer: Railroad Medicare Medicare |
$7.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.34
|
| Rate for Payer: UHC Core |
$8.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.78
|
| Rate for Payer: UHC Exchange |
$7.78
|
| Rate for Payer: UHC Medicare Advantage |
$8.01
|
| Rate for Payer: VA VA |
$7.78
|
|
