|
HC BUPRENORPHINE SCRN URN
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000116
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.70 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health SBD |
$25.70
|
|
|
HC BURN CARE LARGE
|
Facility
|
IP
|
$678.09
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
36100007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$427.20 |
| Max. Negotiated Rate |
$610.28 |
| Rate for Payer: Aetna Commercial |
$576.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$440.76
|
| Rate for Payer: Cash Price |
$542.47
|
| Rate for Payer: Cofinity Commercial |
$474.66
|
| Rate for Payer: Cofinity Commercial |
$583.16
|
| Rate for Payer: Healthscope Commercial |
$610.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$576.38
|
| Rate for Payer: PHP Commercial |
$576.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.66
|
| Rate for Payer: Priority Health SBD |
$427.20
|
|
|
HC BURN CARE LARGE
|
Facility
|
OP
|
$678.09
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
36100007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$129.34 |
| Max. Negotiated Rate |
$1,118.65 |
| Rate for Payer: Aetna Commercial |
$576.38
|
| Rate for Payer: Aetna Medicare |
$368.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$440.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.50
|
| Rate for Payer: BCBS Complete |
$203.80
|
| Rate for Payer: BCBS MAPPO |
$354.80
|
| Rate for Payer: BCBS Trust/PPO |
$137.27
|
| Rate for Payer: BCN Medicare Advantage |
$354.80
|
| Rate for Payer: Cash Price |
$542.47
|
| Rate for Payer: Cash Price |
$542.47
|
| Rate for Payer: Cofinity Commercial |
$474.66
|
| Rate for Payer: Cofinity Commercial |
$583.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.80
|
| Rate for Payer: Healthscope Commercial |
$610.28
|
| Rate for Payer: Mclaren Medicaid |
$194.08
|
| Rate for Payer: Mclaren Medicare |
$354.80
|
| Rate for Payer: Meridian Medicaid |
$203.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$408.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$576.38
|
| Rate for Payer: PACE Medicare |
$337.06
|
| Rate for Payer: PACE SWMI |
$354.80
|
| Rate for Payer: PHP Commercial |
$576.38
|
| Rate for Payer: PHP Medicare Advantage |
$354.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,118.65
|
| Rate for Payer: Priority Health Medicare |
$354.80
|
| Rate for Payer: Priority Health Narrow Network |
$894.92
|
| Rate for Payer: Priority Health SBD |
$427.20
|
| Rate for Payer: Railroad Medicare Medicare |
$354.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.27
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.80
|
| Rate for Payer: UHC Exchange |
$129.34
|
| Rate for Payer: UHC Medicare Advantage |
$365.44
|
| Rate for Payer: VA VA |
$354.80
|
|
|
HC BURN CARE MEDIUM
|
Facility
|
OP
|
$521.51
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
36100006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$97.44 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$443.28
|
| Rate for Payer: Aetna Medicare |
$185.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.68
|
| Rate for Payer: BCBS Complete |
$102.32
|
| Rate for Payer: BCBS MAPPO |
$178.14
|
| Rate for Payer: BCBS Trust/PPO |
$112.88
|
| Rate for Payer: BCN Medicare Advantage |
$178.14
|
| Rate for Payer: Cash Price |
$417.21
|
| Rate for Payer: Cash Price |
$417.21
|
| Rate for Payer: Cofinity Commercial |
$365.06
|
| Rate for Payer: Cofinity Commercial |
$448.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.14
|
| Rate for Payer: Healthscope Commercial |
$469.36
|
| Rate for Payer: Mclaren Medicaid |
$97.44
|
| Rate for Payer: Mclaren Medicare |
$178.14
|
| Rate for Payer: Meridian Medicaid |
$102.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$187.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$443.28
|
| Rate for Payer: PACE Medicare |
$169.23
|
| Rate for Payer: PACE SWMI |
$178.14
|
| Rate for Payer: PHP Commercial |
$443.28
|
| Rate for Payer: PHP Medicare Advantage |
$178.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.49
|
| Rate for Payer: Priority Health Medicare |
$178.14
|
| Rate for Payer: Priority Health Narrow Network |
$433.19
|
| Rate for Payer: Priority Health SBD |
$328.55
|
| Rate for Payer: Railroad Medicare Medicare |
$178.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.31
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.14
|
| Rate for Payer: UHC Exchange |
$109.37
|
| Rate for Payer: UHC Medicare Advantage |
$183.48
|
| Rate for Payer: VA VA |
$178.14
|
|
|
HC BURN CARE MEDIUM
|
Facility
|
IP
|
$521.51
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
36100006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$328.55 |
| Max. Negotiated Rate |
$469.36 |
| Rate for Payer: Aetna Commercial |
$443.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.98
|
| Rate for Payer: Cash Price |
$417.21
|
| Rate for Payer: Cofinity Commercial |
$365.06
|
| Rate for Payer: Cofinity Commercial |
$448.50
|
| Rate for Payer: Healthscope Commercial |
$469.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$443.28
|
| Rate for Payer: PHP Commercial |
$443.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.06
|
| Rate for Payer: Priority Health SBD |
$328.55
|
|
|
HC BURN CARE SMALL
|
Facility
|
OP
|
$304.33
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
36100005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.01 |
| Max. Negotiated Rate |
$541.49 |
| Rate for Payer: Aetna Commercial |
$258.68
|
| Rate for Payer: Aetna Medicare |
$185.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.68
|
| Rate for Payer: BCBS Complete |
$102.32
|
| Rate for Payer: BCBS MAPPO |
$178.14
|
| Rate for Payer: BCBS Trust/PPO |
$112.88
|
| Rate for Payer: BCN Medicare Advantage |
$178.14
|
| Rate for Payer: Cash Price |
$243.46
|
| Rate for Payer: Cash Price |
$243.46
|
| Rate for Payer: Cofinity Commercial |
$261.72
|
| Rate for Payer: Cofinity Commercial |
$213.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.14
|
| Rate for Payer: Healthscope Commercial |
$273.90
|
| Rate for Payer: Mclaren Medicaid |
$97.44
|
| Rate for Payer: Mclaren Medicare |
$178.14
|
| Rate for Payer: Meridian Medicaid |
$102.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$187.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$258.68
|
| Rate for Payer: PACE Medicare |
$169.23
|
| Rate for Payer: PACE SWMI |
$178.14
|
| Rate for Payer: PHP Commercial |
$258.68
|
| Rate for Payer: PHP Medicare Advantage |
$178.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.49
|
| Rate for Payer: Priority Health Medicare |
$178.14
|
| Rate for Payer: Priority Health Narrow Network |
$433.19
|
| Rate for Payer: Priority Health SBD |
$191.73
|
| Rate for Payer: Railroad Medicare Medicare |
$178.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.14
|
| Rate for Payer: UHC Exchange |
$55.01
|
| Rate for Payer: UHC Medicare Advantage |
$183.48
|
| Rate for Payer: VA VA |
$178.14
|
|
|
HC BURN CARE SMALL
|
Facility
|
IP
|
$304.33
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
36100005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$191.73 |
| Max. Negotiated Rate |
$273.90 |
| Rate for Payer: Aetna Commercial |
$258.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.81
|
| Rate for Payer: Cash Price |
$243.46
|
| Rate for Payer: Cofinity Commercial |
$261.72
|
| Rate for Payer: Cofinity Commercial |
$213.03
|
| Rate for Payer: Healthscope Commercial |
$273.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$258.68
|
| Rate for Payer: PHP Commercial |
$258.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.03
|
| Rate for Payer: Priority Health SBD |
$191.73
|
|
|
HC BURN R&B
|
Facility
|
IP
|
$7,293.00
|
|
| Hospital Charge Code |
20700001
|
|
Hospital Revenue Code
|
207
|
| Min. Negotiated Rate |
$4,594.59 |
| Max. Negotiated Rate |
$6,563.70 |
| Rate for Payer: Aetna Commercial |
$6,199.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,740.45
|
| Rate for Payer: Cash Price |
$5,834.40
|
| Rate for Payer: Cofinity Commercial |
$5,105.10
|
| Rate for Payer: Cofinity Commercial |
$6,271.98
|
| Rate for Payer: Healthscope Commercial |
$6,563.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,199.05
|
| Rate for Payer: PHP Commercial |
$6,199.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,105.10
|
| Rate for Payer: Priority Health SBD |
$4,594.59
|
|
|
HC BX VULVA PERINEUM ADDL LESION
|
Facility
|
IP
|
$219.48
|
|
|
Service Code
|
CPT 56606
|
| Hospital Charge Code |
76100202
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.27 |
| Max. Negotiated Rate |
$197.53 |
| Rate for Payer: Aetna Commercial |
$186.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.66
|
| Rate for Payer: Cash Price |
$175.58
|
| Rate for Payer: Cofinity Commercial |
$188.75
|
| Rate for Payer: Cofinity Commercial |
$153.64
|
| Rate for Payer: Healthscope Commercial |
$197.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$186.56
|
| Rate for Payer: PHP Commercial |
$186.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.64
|
| Rate for Payer: Priority Health SBD |
$138.27
|
|
|
HC BX VULVA PERINEUM ADDL LESION
|
Facility
|
OP
|
$219.48
|
|
|
Service Code
|
CPT 56606
|
| Hospital Charge Code |
76100202
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.49 |
| Max. Negotiated Rate |
$221.51 |
| Rate for Payer: Aetna Commercial |
$186.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.66
|
| Rate for Payer: BCBS Complete |
$87.79
|
| Rate for Payer: BCBS Trust/PPO |
$221.51
|
| Rate for Payer: Cash Price |
$175.58
|
| Rate for Payer: Cash Price |
$175.58
|
| Rate for Payer: Cofinity Commercial |
$188.75
|
| Rate for Payer: Cofinity Commercial |
$153.64
|
| Rate for Payer: Healthscope Commercial |
$197.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$186.56
|
| Rate for Payer: PHP Commercial |
$186.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.64
|
| Rate for Payer: Priority Health SBD |
$138.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.34
|
| Rate for Payer: UHC Exchange |
$28.49
|
|
|
HC C1 ESTERASE INHIBITOR FUNCTION
|
Facility
|
OP
|
$74.46
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
30200153
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.56 |
| Max. Negotiated Rate |
$67.01 |
| Rate for Payer: Aetna Commercial |
$63.29
|
| Rate for Payer: Aetna Medicare |
$12.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.00
|
| Rate for Payer: BCBS Complete |
$6.89
|
| Rate for Payer: BCBS MAPPO |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$9.40
|
| Rate for Payer: BCN Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$59.57
|
| Rate for Payer: Cash Price |
$59.57
|
| Rate for Payer: Cofinity Commercial |
$64.04
|
| Rate for Payer: Cofinity Commercial |
$52.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$67.01
|
| Rate for Payer: Mclaren Medicaid |
$6.56
|
| Rate for Payer: Mclaren Medicare |
$12.00
|
| Rate for Payer: Meridian Medicaid |
$6.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.29
|
| Rate for Payer: PACE Medicare |
$11.40
|
| Rate for Payer: PACE SWMI |
$12.00
|
| Rate for Payer: PHP Commercial |
$63.29
|
| Rate for Payer: PHP Medicare Advantage |
$12.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.12
|
| Rate for Payer: Priority Health Medicare |
$12.00
|
| Rate for Payer: Priority Health SBD |
$46.91
|
| Rate for Payer: Railroad Medicare Medicare |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.40
|
| Rate for Payer: UHC Core |
$20.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.00
|
| Rate for Payer: UHC Exchange |
$12.00
|
| Rate for Payer: UHC Medicare Advantage |
$12.36
|
| Rate for Payer: VA VA |
$12.00
|
|
|
HC C1 ESTERASE INHIBITOR FUNCTION
|
Facility
|
IP
|
$74.46
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
30200153
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.91 |
| Max. Negotiated Rate |
$67.01 |
| Rate for Payer: Aetna Commercial |
$63.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.40
|
| Rate for Payer: Cash Price |
$59.57
|
| Rate for Payer: Cofinity Commercial |
$52.12
|
| Rate for Payer: Cofinity Commercial |
$64.04
|
| Rate for Payer: Healthscope Commercial |
$67.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.29
|
| Rate for Payer: PHP Commercial |
$63.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.12
|
| Rate for Payer: Priority Health SBD |
$46.91
|
|
|
HC C1 ESTERASE INHIBITOR QUANTITATIVE
|
Facility
|
OP
|
$73.05
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100257
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$65.74 |
| Rate for Payer: Aetna Commercial |
$62.09
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$13.52
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$58.44
|
| Rate for Payer: Cash Price |
$58.44
|
| Rate for Payer: Cofinity Commercial |
$62.82
|
| Rate for Payer: Cofinity Commercial |
$51.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$65.74
|
| Rate for Payer: Mclaren Medicaid |
$9.45
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Medicaid |
$9.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.09
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$62.09
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.14
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health SBD |
$46.02
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.72
|
| Rate for Payer: UHC Core |
$22.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Exchange |
$17.27
|
| Rate for Payer: UHC Medicare Advantage |
$17.79
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC C1 ESTERASE INHIBITOR QUANTITATIVE
|
Facility
|
IP
|
$73.05
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100257
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.02 |
| Max. Negotiated Rate |
$65.74 |
| Rate for Payer: Aetna Commercial |
$62.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.48
|
| Rate for Payer: Cash Price |
$58.44
|
| Rate for Payer: Cofinity Commercial |
$62.82
|
| Rate for Payer: Cofinity Commercial |
$51.14
|
| Rate for Payer: Healthscope Commercial |
$65.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.09
|
| Rate for Payer: PHP Commercial |
$62.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.14
|
| Rate for Payer: Priority Health SBD |
$46.02
|
|
|
HC C1Q BINDING
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
30200193
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.33 |
| Max. Negotiated Rate |
$99.90 |
| Rate for Payer: Aetna Commercial |
$94.35
|
| Rate for Payer: Aetna Medicare |
$25.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.46
|
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: BCBS MAPPO |
$24.37
|
| Rate for Payer: BCBS Trust/PPO |
$19.09
|
| Rate for Payer: BCN Medicare Advantage |
$24.37
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cofinity Commercial |
$77.70
|
| Rate for Payer: Cofinity Commercial |
$95.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.37
|
| Rate for Payer: Healthscope Commercial |
$99.90
|
| Rate for Payer: Mclaren Medicaid |
$13.33
|
| Rate for Payer: Mclaren Medicare |
$24.37
|
| Rate for Payer: Meridian Medicaid |
$14.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.35
|
| Rate for Payer: PACE Medicare |
$23.15
|
| Rate for Payer: PACE SWMI |
$24.37
|
| Rate for Payer: PHP Commercial |
$94.35
|
| Rate for Payer: PHP Medicare Advantage |
$24.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.70
|
| Rate for Payer: Priority Health Medicare |
$24.37
|
| Rate for Payer: Priority Health SBD |
$69.93
|
| Rate for Payer: Railroad Medicare Medicare |
$24.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.24
|
| Rate for Payer: UHC Core |
$41.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.37
|
| Rate for Payer: UHC Exchange |
$24.37
|
| Rate for Payer: UHC Medicare Advantage |
$25.10
|
| Rate for Payer: VA VA |
$24.37
|
|
|
HC C1Q BINDING
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
30200193
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$69.93 |
| Max. Negotiated Rate |
$99.90 |
| Rate for Payer: Aetna Commercial |
$94.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.15
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cofinity Commercial |
$77.70
|
| Rate for Payer: Cofinity Commercial |
$95.46
|
| Rate for Payer: Healthscope Commercial |
$99.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.35
|
| Rate for Payer: PHP Commercial |
$94.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.70
|
| Rate for Payer: Priority Health SBD |
$69.93
|
|
|
HC C1Q COMPL COMPONENT, S
|
Facility
|
IP
|
$67.32
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200409
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$42.41 |
| Max. Negotiated Rate |
$60.59 |
| Rate for Payer: Aetna Commercial |
$57.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.76
|
| Rate for Payer: Cash Price |
$53.86
|
| Rate for Payer: Cofinity Commercial |
$47.12
|
| Rate for Payer: Cofinity Commercial |
$57.90
|
| Rate for Payer: Healthscope Commercial |
$60.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.22
|
| Rate for Payer: PHP Commercial |
$57.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.12
|
| Rate for Payer: Priority Health SBD |
$42.41
|
|
|
HC C1Q COMPL COMPONENT, S
|
Facility
|
OP
|
$67.32
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200409
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.56 |
| Max. Negotiated Rate |
$60.59 |
| Rate for Payer: Aetna Commercial |
$57.22
|
| Rate for Payer: Aetna Medicare |
$12.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.00
|
| Rate for Payer: BCBS Complete |
$6.89
|
| Rate for Payer: BCBS MAPPO |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$9.40
|
| Rate for Payer: BCN Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$53.86
|
| Rate for Payer: Cash Price |
$53.86
|
| Rate for Payer: Cofinity Commercial |
$57.90
|
| Rate for Payer: Cofinity Commercial |
$47.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$60.59
|
| Rate for Payer: Mclaren Medicaid |
$6.56
|
| Rate for Payer: Mclaren Medicare |
$12.00
|
| Rate for Payer: Meridian Medicaid |
$6.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.22
|
| Rate for Payer: PACE Medicare |
$11.40
|
| Rate for Payer: PACE SWMI |
$12.00
|
| Rate for Payer: PHP Commercial |
$57.22
|
| Rate for Payer: PHP Medicare Advantage |
$12.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.12
|
| Rate for Payer: Priority Health Medicare |
$12.00
|
| Rate for Payer: Priority Health SBD |
$42.41
|
| Rate for Payer: Railroad Medicare Medicare |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.40
|
| Rate for Payer: UHC Core |
$20.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.00
|
| Rate for Payer: UHC Exchange |
$12.00
|
| Rate for Payer: UHC Medicare Advantage |
$12.36
|
| Rate for Payer: VA VA |
$12.00
|
|
|
HC C2 COMPLEMENT, FUNCTIONAL, S
|
Facility
|
IP
|
$74.64
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
30200483
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.02 |
| Max. Negotiated Rate |
$67.18 |
| Rate for Payer: Aetna Commercial |
$63.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.52
|
| Rate for Payer: Cash Price |
$59.71
|
| Rate for Payer: Cofinity Commercial |
$64.19
|
| Rate for Payer: Cofinity Commercial |
$52.25
|
| Rate for Payer: Healthscope Commercial |
$67.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.44
|
| Rate for Payer: PHP Commercial |
$63.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.25
|
| Rate for Payer: Priority Health SBD |
$47.02
|
|
|
HC C2 COMPLEMENT, FUNCTIONAL, S
|
Facility
|
OP
|
$74.64
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
30200483
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.56 |
| Max. Negotiated Rate |
$67.18 |
| Rate for Payer: Aetna Commercial |
$63.44
|
| Rate for Payer: Aetna Medicare |
$12.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.00
|
| Rate for Payer: BCBS Complete |
$6.89
|
| Rate for Payer: BCBS MAPPO |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$9.40
|
| Rate for Payer: BCN Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$59.71
|
| Rate for Payer: Cash Price |
$59.71
|
| Rate for Payer: Cofinity Commercial |
$52.25
|
| Rate for Payer: Cofinity Commercial |
$64.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$67.18
|
| Rate for Payer: Mclaren Medicaid |
$6.56
|
| Rate for Payer: Mclaren Medicare |
$12.00
|
| Rate for Payer: Meridian Medicaid |
$6.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.44
|
| Rate for Payer: PACE Medicare |
$11.40
|
| Rate for Payer: PACE SWMI |
$12.00
|
| Rate for Payer: PHP Commercial |
$63.44
|
| Rate for Payer: PHP Medicare Advantage |
$12.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.25
|
| Rate for Payer: Priority Health Medicare |
$12.00
|
| Rate for Payer: Priority Health SBD |
$47.02
|
| Rate for Payer: Railroad Medicare Medicare |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.40
|
| Rate for Payer: UHC Core |
$20.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.00
|
| Rate for Payer: UHC Exchange |
$12.00
|
| Rate for Payer: UHC Medicare Advantage |
$12.36
|
| Rate for Payer: VA VA |
$12.00
|
|
|
HC CA 125
|
Facility
|
IP
|
$143.10
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
30200185
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$90.15 |
| Max. Negotiated Rate |
$128.79 |
| Rate for Payer: Aetna Commercial |
$121.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.02
|
| Rate for Payer: Cash Price |
$114.48
|
| Rate for Payer: Cofinity Commercial |
$100.17
|
| Rate for Payer: Cofinity Commercial |
$123.07
|
| Rate for Payer: Healthscope Commercial |
$128.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$121.64
|
| Rate for Payer: PHP Commercial |
$121.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.17
|
| Rate for Payer: Priority Health SBD |
$90.15
|
|
|
HC CA 125
|
Facility
|
OP
|
$143.10
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
30200185
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$128.79 |
| Rate for Payer: Aetna Commercial |
$121.64
|
| Rate for Payer: Aetna Medicare |
$21.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.01
|
| Rate for Payer: BCBS Complete |
$11.95
|
| Rate for Payer: BCBS MAPPO |
$20.81
|
| Rate for Payer: BCBS Trust/PPO |
$16.30
|
| Rate for Payer: BCN Medicare Advantage |
$20.81
|
| Rate for Payer: Cash Price |
$114.48
|
| Rate for Payer: Cash Price |
$114.48
|
| Rate for Payer: Cofinity Commercial |
$123.07
|
| Rate for Payer: Cofinity Commercial |
$100.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$128.79
|
| Rate for Payer: Mclaren Medicaid |
$11.38
|
| Rate for Payer: Mclaren Medicare |
$20.81
|
| Rate for Payer: Meridian Medicaid |
$11.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$121.64
|
| Rate for Payer: PACE Medicare |
$19.77
|
| Rate for Payer: PACE SWMI |
$20.81
|
| Rate for Payer: PHP Commercial |
$121.64
|
| Rate for Payer: PHP Medicare Advantage |
$20.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.17
|
| Rate for Payer: Priority Health Medicare |
$20.81
|
| Rate for Payer: Priority Health SBD |
$90.15
|
| Rate for Payer: Railroad Medicare Medicare |
$20.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.97
|
| Rate for Payer: UHC Core |
$35.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.81
|
| Rate for Payer: UHC Exchange |
$20.81
|
| Rate for Payer: UHC Medicare Advantage |
$21.43
|
| Rate for Payer: VA VA |
$20.81
|
|
|
HC CADMIUM LEVEL
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
30100124
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.93 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Aetna Commercial |
$140.25
|
| Rate for Payer: Aetna Medicare |
$24.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.55
|
| Rate for Payer: BCBS Complete |
$13.58
|
| Rate for Payer: BCBS MAPPO |
$23.64
|
| Rate for Payer: BCBS Trust/PPO |
$18.51
|
| Rate for Payer: BCN Medicare Advantage |
$23.64
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cofinity Commercial |
$115.50
|
| Rate for Payer: Cofinity Commercial |
$141.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.64
|
| Rate for Payer: Healthscope Commercial |
$148.50
|
| Rate for Payer: Mclaren Medicaid |
$12.93
|
| Rate for Payer: Mclaren Medicare |
$23.64
|
| Rate for Payer: Meridian Medicaid |
$13.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.25
|
| Rate for Payer: PACE Medicare |
$22.46
|
| Rate for Payer: PACE SWMI |
$23.64
|
| Rate for Payer: PHP Commercial |
$140.25
|
| Rate for Payer: PHP Medicare Advantage |
$23.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.50
|
| Rate for Payer: Priority Health Medicare |
$23.64
|
| Rate for Payer: Priority Health SBD |
$103.95
|
| Rate for Payer: Railroad Medicare Medicare |
$23.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.37
|
| Rate for Payer: UHC Core |
$39.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.64
|
| Rate for Payer: UHC Exchange |
$23.64
|
| Rate for Payer: UHC Medicare Advantage |
$24.35
|
| Rate for Payer: VA VA |
$23.64
|
|
|
HC CADMIUM LEVEL
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
30100124
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$103.95 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Aetna Commercial |
$140.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.25
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cofinity Commercial |
$141.90
|
| Rate for Payer: Cofinity Commercial |
$115.50
|
| Rate for Payer: Healthscope Commercial |
$148.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.25
|
| Rate for Payer: PHP Commercial |
$140.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.50
|
| Rate for Payer: Priority Health SBD |
$103.95
|
|
|
HC CAFFEINE LEVEL
|
Facility
|
OP
|
$115.26
|
|
|
Service Code
|
CPT 80155
|
| Hospital Charge Code |
30100063
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.10 |
| Max. Negotiated Rate |
$103.73 |
| Rate for Payer: Aetna Commercial |
$97.97
|
| Rate for Payer: Aetna Medicare |
$40.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.21
|
| Rate for Payer: BCBS Complete |
$22.15
|
| Rate for Payer: BCBS MAPPO |
$38.57
|
| Rate for Payer: BCBS Trust/PPO |
$30.21
|
| Rate for Payer: BCN Medicare Advantage |
$38.57
|
| Rate for Payer: Cash Price |
$92.21
|
| Rate for Payer: Cash Price |
$92.21
|
| Rate for Payer: Cofinity Commercial |
$80.68
|
| Rate for Payer: Cofinity Commercial |
$99.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.57
|
| Rate for Payer: Healthscope Commercial |
$103.73
|
| Rate for Payer: Mclaren Medicaid |
$21.10
|
| Rate for Payer: Mclaren Medicare |
$38.57
|
| Rate for Payer: Meridian Medicaid |
$22.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.97
|
| Rate for Payer: PACE Medicare |
$36.64
|
| Rate for Payer: PACE SWMI |
$38.57
|
| Rate for Payer: PHP Commercial |
$97.97
|
| Rate for Payer: PHP Medicare Advantage |
$38.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.68
|
| Rate for Payer: Priority Health Medicare |
$38.57
|
| Rate for Payer: Priority Health SBD |
$72.61
|
| Rate for Payer: Railroad Medicare Medicare |
$38.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.28
|
| Rate for Payer: UHC Core |
$23.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.57
|
| Rate for Payer: UHC Exchange |
$38.57
|
| Rate for Payer: UHC Medicare Advantage |
$39.73
|
| Rate for Payer: VA VA |
$38.57
|
|
