|
HC CRYOSURGERY ANAL LESION(S)
|
Facility
|
OP
|
$542.50
|
|
|
Service Code
|
CPT 46916
|
| Hospital Charge Code |
76100353
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.05 |
| Max. Negotiated Rate |
$541.49 |
| Rate for Payer: Aetna Commercial |
$461.12
|
| Rate for Payer: Aetna Medicare |
$185.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.62
|
| 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 |
$61.05
|
| Rate for Payer: BCN Medicare Advantage |
$178.14
|
| Rate for Payer: Cash Price |
$434.00
|
| Rate for Payer: Cash Price |
$434.00
|
| Rate for Payer: Cofinity Commercial |
$466.55
|
| Rate for Payer: Cofinity Commercial |
$379.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.14
|
| Rate for Payer: Healthscope Commercial |
$488.25
|
| 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 |
$461.12
|
| Rate for Payer: PACE Medicare |
$169.23
|
| Rate for Payer: PACE SWMI |
$178.14
|
| Rate for Payer: PHP Commercial |
$461.12
|
| 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 |
$379.75
|
| 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 |
$341.78
|
| Rate for Payer: Railroad Medicare Medicare |
$178.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.14
|
| Rate for Payer: UHC Exchange |
$140.15
|
| Rate for Payer: UHC Medicare Advantage |
$183.48
|
| Rate for Payer: VA VA |
$178.14
|
|
|
HC CRYPTOCOCCAL ANTIGEN FLUID
|
Facility
|
OP
|
$45.90
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
30200210
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.79 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: Aetna Medicare |
$16.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.09
|
| Rate for Payer: BCBS Complete |
$9.23
|
| Rate for Payer: BCBS MAPPO |
$16.07
|
| Rate for Payer: BCBS Trust/PPO |
$12.58
|
| Rate for Payer: BCN Medicare Advantage |
$16.07
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$32.13
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.07
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Mclaren Medicaid |
$8.79
|
| Rate for Payer: Mclaren Medicare |
$16.07
|
| Rate for Payer: Meridian Medicaid |
$9.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.02
|
| Rate for Payer: PACE Medicare |
$15.27
|
| Rate for Payer: PACE SWMI |
$16.07
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: PHP Medicare Advantage |
$16.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.13
|
| Rate for Payer: Priority Health Medicare |
$16.07
|
| Rate for Payer: Priority Health SBD |
$28.92
|
| Rate for Payer: Railroad Medicare Medicare |
$16.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.28
|
| Rate for Payer: UHC Core |
$20.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.07
|
| Rate for Payer: UHC Exchange |
$16.07
|
| Rate for Payer: UHC Medicare Advantage |
$16.55
|
| Rate for Payer: VA VA |
$16.07
|
|
|
HC CRYPTOCOCCAL ANTIGEN FLUID
|
Facility
|
IP
|
$45.90
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
30200210
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.92 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.84
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$32.13
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.02
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.13
|
| Rate for Payer: Priority Health SBD |
$28.92
|
|
|
HC CRYPTOCOCCUS NEOFORMANS GATTII
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600265
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health SBD |
$32.13
|
|
|
HC CRYPTOCOCCUS NEOFORMANS GATTII
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600265
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$59.65 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| 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 |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$27.48
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$59.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC CRYPTOSPORIDIUM SCREEN
|
Facility
|
OP
|
$44.88
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
30600120
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$40.39 |
| Rate for Payer: Aetna Commercial |
$38.15
|
| Rate for Payer: Aetna Medicare |
$14.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.28
|
| Rate for Payer: BCBS Complete |
$7.94
|
| Rate for Payer: BCBS MAPPO |
$13.82
|
| Rate for Payer: BCBS Trust/PPO |
$10.83
|
| Rate for Payer: BCN Medicare Advantage |
$13.82
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cofinity Commercial |
$31.42
|
| Rate for Payer: Cofinity Commercial |
$38.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.82
|
| Rate for Payer: Healthscope Commercial |
$40.39
|
| Rate for Payer: Mclaren Medicaid |
$7.56
|
| Rate for Payer: Mclaren Medicare |
$13.82
|
| Rate for Payer: Meridian Medicaid |
$7.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.15
|
| Rate for Payer: PACE Medicare |
$13.13
|
| Rate for Payer: PACE SWMI |
$13.82
|
| Rate for Payer: PHP Commercial |
$38.15
|
| Rate for Payer: PHP Medicare Advantage |
$13.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.42
|
| Rate for Payer: Priority Health Medicare |
$13.82
|
| Rate for Payer: Priority Health SBD |
$28.27
|
| Rate for Payer: Railroad Medicare Medicare |
$13.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.58
|
| Rate for Payer: UHC Core |
$20.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.82
|
| Rate for Payer: UHC Exchange |
$13.82
|
| Rate for Payer: UHC Medicare Advantage |
$14.23
|
| Rate for Payer: VA VA |
$13.82
|
|
|
HC CRYPTOSPORIDIUM SCREEN
|
Facility
|
IP
|
$44.88
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
30600120
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.27 |
| Max. Negotiated Rate |
$40.39 |
| Rate for Payer: Aetna Commercial |
$38.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.17
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cofinity Commercial |
$31.42
|
| Rate for Payer: Cofinity Commercial |
$38.60
|
| Rate for Payer: Healthscope Commercial |
$40.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.15
|
| Rate for Payer: PHP Commercial |
$38.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.42
|
| Rate for Payer: Priority Health SBD |
$28.27
|
|
|
HC CRYSTALS BODY FLUID
|
Facility
|
IP
|
$46.31
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
30000002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.18 |
| Max. Negotiated Rate |
$41.68 |
| Rate for Payer: Aetna Commercial |
$39.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.10
|
| Rate for Payer: Cash Price |
$37.05
|
| Rate for Payer: Cofinity Commercial |
$32.42
|
| Rate for Payer: Cofinity Commercial |
$39.83
|
| Rate for Payer: Healthscope Commercial |
$41.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.36
|
| Rate for Payer: PHP Commercial |
$39.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.42
|
| Rate for Payer: Priority Health SBD |
$29.18
|
|
|
HC CRYSTALS BODY FLUID
|
Facility
|
OP
|
$46.31
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
30000002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$41.68 |
| Rate for Payer: Aetna Commercial |
$39.36
|
| Rate for Payer: Aetna Medicare |
$7.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.16
|
| Rate for Payer: BCBS Complete |
$4.21
|
| Rate for Payer: BCBS MAPPO |
$7.33
|
| Rate for Payer: BCBS Trust/PPO |
$4.31
|
| Rate for Payer: BCN Medicare Advantage |
$7.33
|
| Rate for Payer: Cash Price |
$37.05
|
| Rate for Payer: Cash Price |
$37.05
|
| Rate for Payer: Cofinity Commercial |
$39.83
|
| Rate for Payer: Cofinity Commercial |
$32.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.33
|
| Rate for Payer: Healthscope Commercial |
$41.68
|
| Rate for Payer: Mclaren Medicaid |
$4.01
|
| Rate for Payer: Mclaren Medicare |
$7.33
|
| Rate for Payer: Meridian Medicaid |
$4.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.36
|
| Rate for Payer: PACE Medicare |
$6.96
|
| Rate for Payer: PACE SWMI |
$7.33
|
| Rate for Payer: PHP Commercial |
$39.36
|
| Rate for Payer: PHP Medicare Advantage |
$7.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.42
|
| Rate for Payer: Priority Health Medicare |
$7.33
|
| Rate for Payer: Priority Health SBD |
$29.18
|
| Rate for Payer: Railroad Medicare Medicare |
$7.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.80
|
| Rate for Payer: UHC Core |
$12.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.33
|
| Rate for Payer: UHC Exchange |
$7.33
|
| Rate for Payer: UHC Medicare Advantage |
$7.55
|
| Rate for Payer: VA VA |
$7.33
|
|
|
HC C-SECTION (OB SURGERY)
|
Facility
|
IP
|
$2,937.41
|
|
| Hospital Charge Code |
36000024
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,850.57 |
| Max. Negotiated Rate |
$2,643.67 |
| Rate for Payer: Aetna Commercial |
$2,496.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,909.32
|
| Rate for Payer: Cash Price |
$2,349.93
|
| Rate for Payer: Cofinity Commercial |
$2,056.19
|
| Rate for Payer: Cofinity Commercial |
$2,526.17
|
| Rate for Payer: Healthscope Commercial |
$2,643.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,496.80
|
| Rate for Payer: PHP Commercial |
$2,496.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,056.19
|
| Rate for Payer: Priority Health SBD |
$1,850.57
|
|
|
HC C-SECTION (OB SURGERY)
|
Facility
|
OP
|
$2,937.41
|
|
| Hospital Charge Code |
36000024
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,174.96 |
| Max. Negotiated Rate |
$2,643.67 |
| Rate for Payer: Aetna Commercial |
$2,496.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,909.32
|
| Rate for Payer: BCBS Complete |
$1,174.96
|
| Rate for Payer: Cash Price |
$2,349.93
|
| Rate for Payer: Cofinity Commercial |
$2,056.19
|
| Rate for Payer: Cofinity Commercial |
$2,526.17
|
| Rate for Payer: Healthscope Commercial |
$2,643.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,496.80
|
| Rate for Payer: PHP Commercial |
$2,496.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,056.19
|
| Rate for Payer: Priority Health SBD |
$1,850.57
|
|
|
HC C-SECTION W/STERIL (OB SURGERY
|
Facility
|
OP
|
$3,607.43
|
|
| Hospital Charge Code |
36000025
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,442.97 |
| Max. Negotiated Rate |
$3,246.69 |
| Rate for Payer: Aetna Commercial |
$3,066.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,344.83
|
| Rate for Payer: BCBS Complete |
$1,442.97
|
| Rate for Payer: Cash Price |
$2,885.94
|
| Rate for Payer: Cofinity Commercial |
$2,525.20
|
| Rate for Payer: Cofinity Commercial |
$3,102.39
|
| Rate for Payer: Healthscope Commercial |
$3,246.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,066.32
|
| Rate for Payer: PHP Commercial |
$3,066.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,525.20
|
| Rate for Payer: Priority Health SBD |
$2,272.68
|
|
|
HC C-SECTION W/STERIL (OB SURGERY
|
Facility
|
IP
|
$3,607.43
|
|
| Hospital Charge Code |
36000025
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,272.68 |
| Max. Negotiated Rate |
$3,246.69 |
| Rate for Payer: Aetna Commercial |
$3,066.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,344.83
|
| Rate for Payer: Cash Price |
$2,885.94
|
| Rate for Payer: Cofinity Commercial |
$2,525.20
|
| Rate for Payer: Cofinity Commercial |
$3,102.39
|
| Rate for Payer: Healthscope Commercial |
$3,246.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,066.32
|
| Rate for Payer: PHP Commercial |
$3,066.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,525.20
|
| Rate for Payer: Priority Health SBD |
$2,272.68
|
|
|
HC CSF LACTATE
|
Facility
|
IP
|
$21.42
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
30100482
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.49 |
| Max. Negotiated Rate |
$19.28 |
| Rate for Payer: Aetna Commercial |
$18.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.92
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$18.42
|
| Rate for Payer: Cofinity Commercial |
$14.99
|
| Rate for Payer: Healthscope Commercial |
$19.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.21
|
| Rate for Payer: PHP Commercial |
$18.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.99
|
| Rate for Payer: Priority Health SBD |
$13.49
|
|
|
HC CSF LACTATE
|
Facility
|
OP
|
$21.42
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
30100482
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$19.28 |
| Rate for Payer: Aetna Commercial |
$18.21
|
| Rate for Payer: Aetna Medicare |
$12.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.46
|
| Rate for Payer: BCBS Complete |
$6.65
|
| Rate for Payer: BCBS MAPPO |
$11.57
|
| Rate for Payer: BCBS Trust/PPO |
$9.06
|
| Rate for Payer: BCN Medicare Advantage |
$11.57
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$14.99
|
| Rate for Payer: Cofinity Commercial |
$18.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.57
|
| Rate for Payer: Healthscope Commercial |
$19.28
|
| Rate for Payer: Mclaren Medicaid |
$6.33
|
| Rate for Payer: Mclaren Medicare |
$11.57
|
| Rate for Payer: Meridian Medicaid |
$6.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.21
|
| Rate for Payer: PACE Medicare |
$10.99
|
| Rate for Payer: PACE SWMI |
$11.57
|
| Rate for Payer: PHP Commercial |
$18.21
|
| Rate for Payer: PHP Medicare Advantage |
$11.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.99
|
| Rate for Payer: Priority Health Medicare |
$11.57
|
| Rate for Payer: Priority Health SBD |
$13.49
|
| Rate for Payer: Railroad Medicare Medicare |
$11.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.88
|
| Rate for Payer: UHC Core |
$18.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.57
|
| Rate for Payer: UHC Exchange |
$11.57
|
| Rate for Payer: UHC Medicare Advantage |
$11.92
|
| Rate for Payer: VA VA |
$11.57
|
|
|
HC CSU OBSERVATION PER HOUR
|
Facility
|
OP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200016
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$53.73 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.31
|
| Rate for Payer: BCBS Complete |
$53.73
|
| Rate for Payer: BCBS Trust/PPO |
$108.91
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Cofinity Commercial |
$94.03
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Meridian Medicaid |
$1,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health SBD |
$84.63
|
|
|
HC CSU OBSERVATION PER HOUR
|
Facility
|
IP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200016
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$84.63 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.31
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$94.03
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health SBD |
$84.63
|
|
|
HC CSU R&B
|
Facility
|
IP
|
$7,165.38
|
|
| Hospital Charge Code |
21000002
|
|
Hospital Revenue Code
|
210
|
| Min. Negotiated Rate |
$4,514.19 |
| Max. Negotiated Rate |
$6,448.84 |
| Rate for Payer: Aetna Commercial |
$6,090.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,657.50
|
| Rate for Payer: Cash Price |
$5,732.30
|
| Rate for Payer: Cofinity Commercial |
$5,015.77
|
| Rate for Payer: Cofinity Commercial |
$6,162.23
|
| Rate for Payer: Healthscope Commercial |
$6,448.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,090.57
|
| Rate for Payer: PHP Commercial |
$6,090.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,015.77
|
| Rate for Payer: Priority Health SBD |
$4,514.19
|
|
|
HC CT ABDOMEN AND PELVIS W CON
|
Facility
|
IP
|
$3,636.90
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
35200027
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,291.25 |
| Max. Negotiated Rate |
$3,273.21 |
| Rate for Payer: Aetna Commercial |
$3,091.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,363.98
|
| Rate for Payer: Cash Price |
$2,909.52
|
| Rate for Payer: Cofinity Commercial |
$3,127.73
|
| Rate for Payer: Cofinity Commercial |
$2,545.83
|
| Rate for Payer: Healthscope Commercial |
$3,273.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,091.36
|
| Rate for Payer: PHP Commercial |
$3,091.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,545.83
|
| Rate for Payer: Priority Health SBD |
$2,291.25
|
|
|
HC CT ABDOMEN AND PELVIS W CON
|
Facility
|
OP
|
$3,636.90
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
35200027
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$187.18 |
| Max. Negotiated Rate |
$3,273.21 |
| Rate for Payer: Aetna Commercial |
$3,091.36
|
| Rate for Payer: Aetna Medicare |
$355.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,363.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.74
|
| Rate for Payer: BCBS Complete |
$196.55
|
| Rate for Payer: BCBS MAPPO |
$342.19
|
| Rate for Payer: BCBS Trust/PPO |
$382.81
|
| Rate for Payer: BCN Medicare Advantage |
$342.19
|
| Rate for Payer: Cash Price |
$2,909.52
|
| Rate for Payer: Cash Price |
$2,909.52
|
| Rate for Payer: Cofinity Commercial |
$2,545.83
|
| Rate for Payer: Cofinity Commercial |
$3,127.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$342.19
|
| Rate for Payer: Healthscope Commercial |
$3,273.21
|
| Rate for Payer: Mclaren Medicaid |
$187.18
|
| Rate for Payer: Mclaren Medicare |
$342.19
|
| Rate for Payer: Meridian Medicaid |
$196.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$359.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,091.36
|
| Rate for Payer: PACE Medicare |
$325.08
|
| Rate for Payer: PACE SWMI |
$342.19
|
| Rate for Payer: PHP Commercial |
$3,091.36
|
| Rate for Payer: PHP Medicare Advantage |
$342.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,545.83
|
| Rate for Payer: Priority Health Medicare |
$342.19
|
| Rate for Payer: Priority Health SBD |
$2,291.25
|
| Rate for Payer: Railroad Medicare Medicare |
$342.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$342.19
|
| Rate for Payer: UHC Exchange |
$305.83
|
| Rate for Payer: UHC Medicare Advantage |
$352.46
|
| Rate for Payer: VA VA |
$342.19
|
|
|
HC CT ABDOMEN AND PELVIS WO CON
|
Facility
|
OP
|
$2,453.20
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
35200026
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$119.26 |
| Max. Negotiated Rate |
$2,207.88 |
| Rate for Payer: Aetna Commercial |
$2,085.22
|
| Rate for Payer: Aetna Medicare |
$226.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,594.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.54
|
| Rate for Payer: BCBS Complete |
$125.24
|
| Rate for Payer: BCBS MAPPO |
$218.03
|
| Rate for Payer: BCBS Trust/PPO |
$177.06
|
| Rate for Payer: BCN Medicare Advantage |
$218.03
|
| Rate for Payer: Cash Price |
$1,962.56
|
| Rate for Payer: Cash Price |
$1,962.56
|
| Rate for Payer: Cofinity Commercial |
$1,717.24
|
| Rate for Payer: Cofinity Commercial |
$2,109.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.03
|
| Rate for Payer: Healthscope Commercial |
$2,207.88
|
| Rate for Payer: Mclaren Medicaid |
$119.26
|
| Rate for Payer: Mclaren Medicare |
$218.03
|
| Rate for Payer: Meridian Medicaid |
$125.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,085.22
|
| Rate for Payer: PACE Medicare |
$207.13
|
| Rate for Payer: PACE SWMI |
$218.03
|
| Rate for Payer: PHP Commercial |
$2,085.22
|
| Rate for Payer: PHP Medicare Advantage |
$218.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,717.24
|
| Rate for Payer: Priority Health Medicare |
$218.03
|
| Rate for Payer: Priority Health SBD |
$1,545.52
|
| Rate for Payer: Railroad Medicare Medicare |
$218.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.03
|
| Rate for Payer: UHC Exchange |
$184.35
|
| Rate for Payer: UHC Medicare Advantage |
$224.57
|
| Rate for Payer: VA VA |
$218.03
|
|
|
HC CT ABDOMEN AND PELVIS WO CON
|
Facility
|
IP
|
$2,453.20
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
35200026
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,545.52 |
| Max. Negotiated Rate |
$2,207.88 |
| Rate for Payer: Aetna Commercial |
$2,085.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,594.58
|
| Rate for Payer: Cash Price |
$1,962.56
|
| Rate for Payer: Cofinity Commercial |
$1,717.24
|
| Rate for Payer: Cofinity Commercial |
$2,109.75
|
| Rate for Payer: Healthscope Commercial |
$2,207.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,085.22
|
| Rate for Payer: PHP Commercial |
$2,085.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,717.24
|
| Rate for Payer: Priority Health SBD |
$1,545.52
|
|
|
HC CT ABDOMEN AND PELVIS WO W CON
|
Facility
|
OP
|
$4,346.70
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
35200028
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$187.18 |
| Max. Negotiated Rate |
$3,912.03 |
| Rate for Payer: Aetna Commercial |
$3,694.70
|
| Rate for Payer: Aetna Medicare |
$355.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,825.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.74
|
| Rate for Payer: BCBS Complete |
$196.55
|
| Rate for Payer: BCBS MAPPO |
$342.19
|
| Rate for Payer: BCBS Trust/PPO |
$431.90
|
| Rate for Payer: BCN Medicare Advantage |
$342.19
|
| Rate for Payer: Cash Price |
$3,477.36
|
| Rate for Payer: Cash Price |
$3,477.36
|
| Rate for Payer: Cofinity Commercial |
$3,042.69
|
| Rate for Payer: Cofinity Commercial |
$3,738.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$342.19
|
| Rate for Payer: Healthscope Commercial |
$3,912.03
|
| Rate for Payer: Mclaren Medicaid |
$187.18
|
| Rate for Payer: Mclaren Medicare |
$342.19
|
| Rate for Payer: Meridian Medicaid |
$196.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$359.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,694.70
|
| Rate for Payer: PACE Medicare |
$325.08
|
| Rate for Payer: PACE SWMI |
$342.19
|
| Rate for Payer: PHP Commercial |
$3,694.70
|
| Rate for Payer: PHP Medicare Advantage |
$342.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,042.69
|
| Rate for Payer: Priority Health Medicare |
$342.19
|
| Rate for Payer: Priority Health SBD |
$2,738.42
|
| Rate for Payer: Railroad Medicare Medicare |
$342.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$377.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$342.19
|
| Rate for Payer: UHC Exchange |
$343.16
|
| Rate for Payer: UHC Medicare Advantage |
$352.46
|
| Rate for Payer: VA VA |
$342.19
|
|
|
HC CT ABDOMEN AND PELVIS WO W CON
|
Facility
|
IP
|
$4,346.70
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
35200028
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,738.42 |
| Max. Negotiated Rate |
$3,912.03 |
| Rate for Payer: Aetna Commercial |
$3,694.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,825.36
|
| Rate for Payer: Cash Price |
$3,477.36
|
| Rate for Payer: Cofinity Commercial |
$3,042.69
|
| Rate for Payer: Cofinity Commercial |
$3,738.16
|
| Rate for Payer: Healthscope Commercial |
$3,912.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,694.70
|
| Rate for Payer: PHP Commercial |
$3,694.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,042.69
|
| Rate for Payer: Priority Health SBD |
$2,738.42
|
|
|
HC CT ABDOMEN ANGIO
|
Facility
|
IP
|
$1,075.90
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
35200025
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$677.82 |
| Max. Negotiated Rate |
$968.31 |
| Rate for Payer: Aetna Commercial |
$914.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$699.34
|
| Rate for Payer: Cash Price |
$860.72
|
| Rate for Payer: Cofinity Commercial |
$753.13
|
| Rate for Payer: Cofinity Commercial |
$925.27
|
| Rate for Payer: Healthscope Commercial |
$968.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$914.52
|
| Rate for Payer: PHP Commercial |
$914.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$753.13
|
| Rate for Payer: Priority Health SBD |
$677.82
|
|
