|
HC ADENOVIRUS ANTIBODY
|
Facility
|
OP
|
$106.12
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200219
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$95.51 |
| Rate for Payer: Aetna Commercial |
$90.20
|
| Rate for Payer: Aetna Medicare |
$13.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: BCBS Complete |
$7.07
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$13.72
|
| Rate for Payer: BCN Commercial |
$13.72
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cofinity Advantage |
$74.28
|
| Rate for Payer: Cofinity Commercial |
$91.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$95.51
|
| Rate for Payer: Mclaren Medicaid |
$6.73
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: Meridian Medicaid |
$13.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.20
|
| Rate for Payer: Nomi Health Commercial |
$19.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.59
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$90.20
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.87
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health SBD |
$66.86
|
| Rate for Payer: Priority Health Tiered Network |
$10.30
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.31
|
| Rate for Payer: UHC Core |
$19.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.87
|
| Rate for Payer: UHC Exchange |
$19.31
|
| Rate for Payer: UHC Medicaid |
$6.73
|
| Rate for Payer: UHCCP Medicaid |
$6.73
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC ADENOVIRUS ANTIBODY
|
Facility
|
IP
|
$106.12
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200219
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$66.86 |
| Max. Negotiated Rate |
$95.51 |
| Rate for Payer: Aetna Commercial |
$90.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.98
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cofinity Advantage |
$74.28
|
| Rate for Payer: Cofinity Commercial |
$91.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.90
|
| Rate for Payer: Healthscope Commercial |
$95.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.59
|
| Rate for Payer: PHP Commercial |
$90.20
|
| Rate for Payer: Priority Health SBD |
$66.86
|
|
|
HC ADENOVIRUS PCR
|
Facility
|
OP
|
$105.06
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600279
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$94.55 |
| Rate for Payer: Aetna Commercial |
$89.30
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$19.27
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$37.42
|
| Rate for Payer: BCN Commercial |
$37.42
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$84.05
|
| Rate for Payer: Cash Price |
$84.05
|
| Rate for Payer: Cofinity Advantage |
$73.54
|
| Rate for Payer: Cofinity Commercial |
$90.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$94.55
|
| Rate for Payer: Mclaren Medicaid |
$18.35
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.30
|
| Rate for Payer: Nomi Health Commercial |
$52.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.80
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$89.30
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.35
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$66.19
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.64
|
| Rate for Payer: UHC Core |
$52.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.09
|
| Rate for Payer: UHC Exchange |
$52.64
|
| Rate for Payer: UHC Medicaid |
$18.35
|
| Rate for Payer: UHCCP Medicaid |
$18.35
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC ADENOVIRUS PCR
|
Facility
|
IP
|
$105.06
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600279
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$66.19 |
| Max. Negotiated Rate |
$94.55 |
| Rate for Payer: Aetna Commercial |
$89.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.29
|
| Rate for Payer: Cash Price |
$84.05
|
| Rate for Payer: Cofinity Advantage |
$73.54
|
| Rate for Payer: Cofinity Commercial |
$90.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.05
|
| Rate for Payer: Healthscope Commercial |
$94.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.80
|
| Rate for Payer: PHP Commercial |
$89.30
|
| Rate for Payer: Priority Health SBD |
$66.19
|
|
|
HC ADHESIVE RELEASER 50 ML
|
Facility
|
IP
|
$27.13
|
|
|
Service Code
|
HCPCS A4455
|
| Hospital Charge Code |
27000626
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.09 |
| Max. Negotiated Rate |
$24.42 |
| Rate for Payer: Aetna Commercial |
$23.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.63
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Cofinity Advantage |
$18.99
|
| Rate for Payer: Cofinity Commercial |
$23.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.70
|
| Rate for Payer: Healthscope Commercial |
$24.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.35
|
| Rate for Payer: PHP Commercial |
$23.06
|
| Rate for Payer: Priority Health SBD |
$17.09
|
|
|
HC ADHESIVE RELEASER 50 ML
|
Facility
|
OP
|
$27.13
|
|
|
Service Code
|
HCPCS A4455
|
| Hospital Charge Code |
27000626
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$24.42 |
| Rate for Payer: Aetna Commercial |
$23.06
|
| Rate for Payer: Aetna Medicare |
$13.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.63
|
| Rate for Payer: BCBS Complete |
$10.85
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Cofinity Advantage |
$18.99
|
| Rate for Payer: Cofinity Commercial |
$23.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.70
|
| Rate for Payer: Healthscope Commercial |
$24.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.35
|
| Rate for Payer: PHP Commercial |
$23.06
|
| Rate for Payer: Priority Health SBD |
$17.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.63
|
| Rate for Payer: UHC Core |
$14.13
|
| Rate for Payer: UHC Exchange |
$10.66
|
|
|
HC ADJT TIS REARRGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQ CM
|
Facility
|
OP
|
$6,690.76
|
|
|
Service Code
|
CPT 14061
|
| Hospital Charge Code |
76100556
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,075.21 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna Commercial |
$5,687.15
|
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,348.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,998.93
|
| Rate for Payer: BCN Commercial |
$1,998.93
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Cash Price |
$5,352.61
|
| Rate for Payer: Cash Price |
$5,352.61
|
| Rate for Payer: Cash Price |
$5,352.61
|
| Rate for Payer: Cofinity Advantage |
$4,683.53
|
| Rate for Payer: Cofinity Commercial |
$5,754.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,352.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Healthscope Commercial |
$6,021.68
|
| Rate for Payer: Mclaren Medicaid |
$1,075.21
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$2,158.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,687.15
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,018.07
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Commercial |
$5,687.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,648.46
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health SBD |
$4,215.18
|
| Rate for Payer: Priority Health Tiered Network |
$5,318.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,348.99
|
| Rate for Payer: UHC Core |
$3,485.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Exchange |
$2,629.47
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
HC ADJT TIS REARRGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQ CM
|
Facility
|
IP
|
$6,690.76
|
|
|
Service Code
|
CPT 14061
|
| Hospital Charge Code |
76100556
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,215.18 |
| Max. Negotiated Rate |
$6,021.68 |
| Rate for Payer: Aetna Commercial |
$5,687.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,348.99
|
| Rate for Payer: Cash Price |
$5,352.61
|
| Rate for Payer: Cofinity Advantage |
$4,683.53
|
| Rate for Payer: Cofinity Commercial |
$5,754.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,352.61
|
| Rate for Payer: Healthscope Commercial |
$6,021.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,687.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,018.07
|
| Rate for Payer: PHP Commercial |
$5,687.15
|
| Rate for Payer: Priority Health SBD |
$4,215.18
|
|
|
HC ADJT TIS TRNSFR/REARRGMT DEFEC EA ADDL 30 SQ CM
|
Facility
|
OP
|
$1,988.00
|
|
|
Service Code
|
CPT 14302
|
| Hospital Charge Code |
76100553
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$594.43 |
| Max. Negotiated Rate |
$1,789.20 |
| Rate for Payer: Aetna Commercial |
$1,689.80
|
| Rate for Payer: Aetna Medicare |
$994.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,292.20
|
| Rate for Payer: BCBS Complete |
$795.20
|
| Rate for Payer: BCBS Trust/PPO |
$594.43
|
| Rate for Payer: BCN Commercial |
$594.43
|
| Rate for Payer: Cash Price |
$1,590.40
|
| Rate for Payer: Cash Price |
$1,590.40
|
| Rate for Payer: Cofinity Advantage |
$1,391.60
|
| Rate for Payer: Cofinity Commercial |
$1,709.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,590.40
|
| Rate for Payer: Healthscope Commercial |
$1,789.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,590.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,689.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,491.00
|
| Rate for Payer: PHP Commercial |
$1,689.80
|
| Rate for Payer: Priority Health SBD |
$1,252.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,292.20
|
| Rate for Payer: UHC Core |
$1,035.75
|
| Rate for Payer: UHC Exchange |
$781.28
|
|
|
HC ADJT TIS TRNSFR/REARRGMT DEFEC EA ADDL 30 SQ CM
|
Facility
|
IP
|
$1,988.00
|
|
|
Service Code
|
CPT 14302
|
| Hospital Charge Code |
76100553
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,252.44 |
| Max. Negotiated Rate |
$1,789.20 |
| Rate for Payer: Aetna Commercial |
$1,689.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,292.20
|
| Rate for Payer: Cash Price |
$1,590.40
|
| Rate for Payer: Cofinity Advantage |
$1,391.60
|
| Rate for Payer: Cofinity Commercial |
$1,709.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,590.40
|
| Rate for Payer: Healthscope Commercial |
$1,789.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,689.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,491.00
|
| Rate for Payer: PHP Commercial |
$1,689.80
|
| Rate for Payer: Priority Health SBD |
$1,252.44
|
|
|
HC ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<
|
Facility
|
IP
|
$3,515.06
|
|
|
Service Code
|
CPT 14060
|
| Hospital Charge Code |
76100552
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,214.49 |
| Max. Negotiated Rate |
$3,163.55 |
| Rate for Payer: Aetna Commercial |
$2,987.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,284.79
|
| Rate for Payer: Cash Price |
$2,812.05
|
| Rate for Payer: Cofinity Advantage |
$2,460.54
|
| Rate for Payer: Cofinity Commercial |
$3,022.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,812.05
|
| Rate for Payer: Healthscope Commercial |
$3,163.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,987.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,636.30
|
| Rate for Payer: PHP Commercial |
$2,987.80
|
| Rate for Payer: Priority Health SBD |
$2,214.49
|
|
|
HC ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<
|
Facility
|
OP
|
$3,515.06
|
|
|
Service Code
|
CPT 14060
|
| Hospital Charge Code |
76100552
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,050.16 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna Commercial |
$2,987.80
|
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,284.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,050.16
|
| Rate for Payer: BCN Commercial |
$1,050.16
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Cash Price |
$2,812.05
|
| Rate for Payer: Cash Price |
$2,812.05
|
| Rate for Payer: Cash Price |
$2,812.05
|
| Rate for Payer: Cofinity Advantage |
$2,460.54
|
| Rate for Payer: Cofinity Commercial |
$3,022.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,812.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Healthscope Commercial |
$3,163.55
|
| Rate for Payer: Mclaren Medicaid |
$1,075.21
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$2,158.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,987.80
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,636.30
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Commercial |
$2,987.80
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,648.46
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health SBD |
$2,214.49
|
| Rate for Payer: Priority Health Tiered Network |
$5,318.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,284.79
|
| Rate for Payer: UHC Core |
$1,831.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Exchange |
$1,381.42
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
HC ADL TRAINING EA 15 MIN
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 97535
|
| Hospital Charge Code |
42000030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$88.40
|
| Rate for Payer: Aetna Medicare |
$52.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.60
|
| Rate for Payer: BCBS Complete |
$41.60
|
| Rate for Payer: BCBS Trust/PPO |
$30.15
|
| Rate for Payer: BCN Commercial |
$30.15
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cofinity Advantage |
$72.80
|
| Rate for Payer: Cofinity Commercial |
$89.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.20
|
| Rate for Payer: Healthscope Commercial |
$93.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.40
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.00
|
| Rate for Payer: PHP Commercial |
$88.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$30.00
|
| Rate for Payer: Priority Health SBD |
$65.52
|
| Rate for Payer: Priority Health Tiered Network |
$24.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.60
|
| Rate for Payer: UHC Core |
$54.18
|
| Rate for Payer: UHC Exchange |
$40.87
|
|
|
HC ADL TRAINING EA 15 MIN
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 97535
|
| Hospital Charge Code |
42000030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$65.52 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna Commercial |
$88.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.60
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cofinity Advantage |
$72.80
|
| Rate for Payer: Cofinity Commercial |
$89.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.20
|
| Rate for Payer: Healthscope Commercial |
$93.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.00
|
| Rate for Payer: PHP Commercial |
$88.40
|
| Rate for Payer: Priority Health SBD |
$65.52
|
|
|
HC ADMIN DEVELOPMENTAL TEST EA ADDL 30 MIN
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 96113
|
| Hospital Charge Code |
51000132
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$152.46 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Aetna Commercial |
$205.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.30
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cofinity Advantage |
$169.40
|
| Rate for Payer: Cofinity Commercial |
$208.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.60
|
| Rate for Payer: Healthscope Commercial |
$217.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.50
|
| Rate for Payer: PHP Commercial |
$205.70
|
| Rate for Payer: Priority Health SBD |
$152.46
|
|
|
HC ADMIN DEVELOPMENTAL TEST EA ADDL 30 MIN
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 96113
|
| Hospital Charge Code |
51000132
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$95.11 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Aetna Commercial |
$205.70
|
| Rate for Payer: Aetna Medicare |
$121.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.30
|
| Rate for Payer: BCBS Complete |
$96.80
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cofinity Advantage |
$169.40
|
| Rate for Payer: Cofinity Commercial |
$208.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.60
|
| Rate for Payer: Healthscope Commercial |
$217.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.50
|
| Rate for Payer: PHP Commercial |
$205.70
|
| Rate for Payer: Priority Health SBD |
$152.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.30
|
| Rate for Payer: UHC Core |
$126.08
|
| Rate for Payer: UHC Exchange |
$95.11
|
|
|
HC ADMIN DEVELOPMENTAL TEST FIRST HOUR
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
51000131
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.05 |
| Max. Negotiated Rate |
$434.70 |
| Rate for Payer: Aetna Commercial |
$410.55
|
| Rate for Payer: Aetna Medicare |
$133.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$160.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$160.26
|
| Rate for Payer: BCBS Complete |
$70.41
|
| Rate for Payer: BCBS MAPPO |
$128.21
|
| Rate for Payer: BCN Medicare Advantage |
$128.21
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cofinity Advantage |
$338.10
|
| Rate for Payer: Cofinity Commercial |
$415.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.21
|
| Rate for Payer: Healthscope Commercial |
$434.70
|
| Rate for Payer: Mclaren Medicaid |
$67.05
|
| Rate for Payer: Mclaren Medicare |
$128.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.62
|
| Rate for Payer: Meridian Medicaid |
$134.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$147.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$141.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.55
|
| Rate for Payer: Nomi Health Commercial |
$384.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$362.25
|
| Rate for Payer: PACE Medicare |
$121.80
|
| Rate for Payer: PACE SWMI |
$128.21
|
| Rate for Payer: PHP Commercial |
$410.55
|
| Rate for Payer: PHP Medicare Advantage |
$128.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$414.63
|
| Rate for Payer: Priority Health Medicare |
$128.21
|
| Rate for Payer: Priority Health SBD |
$304.29
|
| Rate for Payer: Priority Health Tiered Network |
$331.70
|
| Rate for Payer: Railroad Medicare Medicare |
$128.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$313.95
|
| Rate for Payer: UHC Core |
$251.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$128.21
|
| Rate for Payer: UHC Exchange |
$189.82
|
| Rate for Payer: UHC Medicaid |
$67.05
|
| Rate for Payer: UHCCP Medicaid |
$67.05
|
| Rate for Payer: VA VA |
$128.21
|
|
|
HC ADMIN DEVELOPMENTAL TEST FIRST HOUR
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
51000131
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$304.29 |
| Max. Negotiated Rate |
$434.70 |
| Rate for Payer: Aetna Commercial |
$410.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.95
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cofinity Advantage |
$338.10
|
| Rate for Payer: Cofinity Commercial |
$415.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.40
|
| Rate for Payer: Healthscope Commercial |
$434.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$362.25
|
| Rate for Payer: PHP Commercial |
$410.55
|
| Rate for Payer: Priority Health SBD |
$304.29
|
|
|
HC ADMIN INTRAPULMONARY SURFACTANT
|
Facility
|
IP
|
$597.19
|
|
|
Service Code
|
CPT 94610
|
| Hospital Charge Code |
46000034
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$376.23 |
| Max. Negotiated Rate |
$537.47 |
| Rate for Payer: Aetna Commercial |
$507.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$388.17
|
| Rate for Payer: Cash Price |
$477.75
|
| Rate for Payer: Cofinity Advantage |
$418.03
|
| Rate for Payer: Cofinity Commercial |
$513.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$477.75
|
| Rate for Payer: Healthscope Commercial |
$537.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$507.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$447.89
|
| Rate for Payer: PHP Commercial |
$507.61
|
| Rate for Payer: Priority Health SBD |
$376.23
|
|
|
HC ADMIN INTRAPULMONARY SURFACTANT
|
Facility
|
OP
|
$597.19
|
|
|
Service Code
|
CPT 94610
|
| Hospital Charge Code |
46000034
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$62.18 |
| Max. Negotiated Rate |
$705.61 |
| Rate for Payer: Aetna Commercial |
$507.61
|
| Rate for Payer: Aetna Medicare |
$226.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$388.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.74
|
| Rate for Payer: BCBS Complete |
$119.83
|
| Rate for Payer: BCBS MAPPO |
$218.19
|
| Rate for Payer: BCBS Trust/PPO |
$62.18
|
| Rate for Payer: BCN Commercial |
$62.18
|
| Rate for Payer: BCN Medicare Advantage |
$218.19
|
| Rate for Payer: Cash Price |
$477.75
|
| Rate for Payer: Cash Price |
$477.75
|
| Rate for Payer: Cofinity Advantage |
$418.03
|
| Rate for Payer: Cofinity Commercial |
$513.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$477.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.19
|
| Rate for Payer: Healthscope Commercial |
$537.47
|
| Rate for Payer: Mclaren Medicaid |
$114.11
|
| Rate for Payer: Mclaren Medicare |
$218.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$229.10
|
| Rate for Payer: Meridian Medicaid |
$229.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$240.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$507.61
|
| Rate for Payer: Nomi Health Commercial |
$654.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$447.89
|
| Rate for Payer: PACE Medicare |
$207.28
|
| Rate for Payer: PACE SWMI |
$218.19
|
| Rate for Payer: PHP Commercial |
$507.61
|
| Rate for Payer: PHP Medicare Advantage |
$218.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$705.61
|
| Rate for Payer: Priority Health Medicare |
$218.19
|
| Rate for Payer: Priority Health SBD |
$376.23
|
| Rate for Payer: Priority Health Tiered Network |
$564.49
|
| Rate for Payer: Railroad Medicare Medicare |
$218.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$388.17
|
| Rate for Payer: UHC Core |
$311.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$218.19
|
| Rate for Payer: UHC Exchange |
$234.70
|
| Rate for Payer: UHC Medicaid |
$114.11
|
| Rate for Payer: UHCCP Medicaid |
$114.11
|
| Rate for Payer: VA VA |
$218.19
|
|
|
HC ADMIN RSV MONOC ANTB IM INJ
|
Facility
|
OP
|
$101.64
|
|
|
Service Code
|
CPT 96381
|
| Hospital Charge Code |
77100066
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$39.94 |
| Max. Negotiated Rate |
$91.48 |
| Rate for Payer: Aetna Commercial |
$86.39
|
| Rate for Payer: Aetna Medicare |
$50.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.07
|
| Rate for Payer: BCBS Complete |
$40.66
|
| Rate for Payer: BCBS Trust/PPO |
$71.29
|
| Rate for Payer: BCN Commercial |
$71.29
|
| Rate for Payer: Cash Price |
$81.31
|
| Rate for Payer: Cash Price |
$81.31
|
| Rate for Payer: Cofinity Advantage |
$71.15
|
| Rate for Payer: Cofinity Commercial |
$87.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.31
|
| Rate for Payer: Healthscope Commercial |
$91.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.23
|
| Rate for Payer: PHP Commercial |
$86.39
|
| Rate for Payer: Priority Health SBD |
$64.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.07
|
| Rate for Payer: UHC Core |
$52.95
|
| Rate for Payer: UHC Exchange |
$39.94
|
|
|
HC ADMIN RSV MONOC ANTB IM INJ
|
Facility
|
IP
|
$101.64
|
|
|
Service Code
|
CPT 96381
|
| Hospital Charge Code |
77100066
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$64.03 |
| Max. Negotiated Rate |
$91.48 |
| Rate for Payer: Aetna Commercial |
$86.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.07
|
| Rate for Payer: Cash Price |
$81.31
|
| Rate for Payer: Cofinity Advantage |
$71.15
|
| Rate for Payer: Cofinity Commercial |
$87.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.31
|
| Rate for Payer: Healthscope Commercial |
$91.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.23
|
| Rate for Payer: PHP Commercial |
$86.39
|
| Rate for Payer: Priority Health SBD |
$64.03
|
|
|
HC ADMIN RSV MONOC ANTB IM W/COUNSELING
|
Facility
|
IP
|
$101.64
|
|
|
Service Code
|
CPT 96380
|
| Hospital Charge Code |
77100065
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$64.03 |
| Max. Negotiated Rate |
$91.48 |
| Rate for Payer: Aetna Commercial |
$86.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.07
|
| Rate for Payer: Cash Price |
$81.31
|
| Rate for Payer: Cofinity Advantage |
$71.15
|
| Rate for Payer: Cofinity Commercial |
$87.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.31
|
| Rate for Payer: Healthscope Commercial |
$91.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.23
|
| Rate for Payer: PHP Commercial |
$86.39
|
| Rate for Payer: Priority Health SBD |
$64.03
|
|
|
HC ADMIN RSV MONOC ANTB IM W/COUNSELING
|
Facility
|
OP
|
$101.64
|
|
|
Service Code
|
CPT 96380
|
| Hospital Charge Code |
77100065
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$39.94 |
| Max. Negotiated Rate |
$91.48 |
| Rate for Payer: Aetna Commercial |
$86.39
|
| Rate for Payer: Aetna Medicare |
$50.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.07
|
| Rate for Payer: BCBS Complete |
$40.66
|
| Rate for Payer: BCBS Trust/PPO |
$71.29
|
| Rate for Payer: BCN Commercial |
$71.29
|
| Rate for Payer: Cash Price |
$81.31
|
| Rate for Payer: Cash Price |
$81.31
|
| Rate for Payer: Cofinity Advantage |
$71.15
|
| Rate for Payer: Cofinity Commercial |
$87.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.31
|
| Rate for Payer: Healthscope Commercial |
$91.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.23
|
| Rate for Payer: PHP Commercial |
$86.39
|
| Rate for Payer: Priority Health SBD |
$64.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.07
|
| Rate for Payer: UHC Core |
$52.95
|
| Rate for Payer: UHC Exchange |
$39.94
|
|
|
HC ADMIN SARSCOV2 VACC EACH ADDL COMPONENT
|
Facility
|
OP
|
$33.66
|
|
|
Service Code
|
CPT 90481
|
| Hospital Charge Code |
77100067
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$13.23 |
| Max. Negotiated Rate |
$30.29 |
| Rate for Payer: Aetna Commercial |
$28.61
|
| Rate for Payer: Aetna Medicare |
$16.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.88
|
| Rate for Payer: BCBS Complete |
$13.46
|
| Rate for Payer: Cash Price |
$26.93
|
| Rate for Payer: Cofinity Advantage |
$23.56
|
| Rate for Payer: Cofinity Commercial |
$28.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.93
|
| Rate for Payer: Healthscope Commercial |
$30.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.25
|
| Rate for Payer: PHP Commercial |
$28.61
|
| Rate for Payer: Priority Health SBD |
$21.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.88
|
| Rate for Payer: UHC Core |
$17.54
|
| Rate for Payer: UHC Exchange |
$13.23
|
|
