|
HC ADMIN SARSCOV2 VACC EACH ADDL COMPONENT
|
Facility
|
IP
|
$33.66
|
|
|
Service Code
|
CPT 90481
|
| Hospital Charge Code |
77100067
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$21.21 |
| Max. Negotiated Rate |
$30.29 |
| Rate for Payer: Aetna Commercial |
$28.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.88
|
| 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: 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
|
|
|
HC ADMIN TOCILIZUMAB COVID 19 1ST DOSE
|
Facility
|
IP
|
$545.47
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
77100044
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$343.65 |
| Max. Negotiated Rate |
$490.92 |
| Rate for Payer: Aetna Commercial |
$463.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$354.56
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cofinity Advantage |
$381.83
|
| Rate for Payer: Cofinity Commercial |
$469.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.38
|
| Rate for Payer: Healthscope Commercial |
$490.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.10
|
| Rate for Payer: PHP Commercial |
$463.65
|
| Rate for Payer: Priority Health SBD |
$343.65
|
|
|
HC ADMIN TOCILIZUMAB COVID 19 1ST DOSE
|
Facility
|
OP
|
$545.47
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
77100044
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$214.37 |
| Max. Negotiated Rate |
$1,318.08 |
| Rate for Payer: Aetna Commercial |
$463.65
|
| Rate for Payer: Aetna Medicare |
$456.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$354.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$549.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$549.20
|
| Rate for Payer: BCBS Complete |
$241.30
|
| Rate for Payer: BCBS MAPPO |
$439.36
|
| Rate for Payer: BCN Medicare Advantage |
$439.36
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cofinity Advantage |
$381.83
|
| Rate for Payer: Cofinity Commercial |
$469.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$439.36
|
| Rate for Payer: Healthscope Commercial |
$490.92
|
| Rate for Payer: Mclaren Medicaid |
$229.79
|
| Rate for Payer: Mclaren Medicare |
$439.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$461.33
|
| Rate for Payer: Meridian Medicaid |
$461.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$505.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$483.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.65
|
| Rate for Payer: Nomi Health Commercial |
$1,318.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.10
|
| Rate for Payer: PACE Medicare |
$417.39
|
| Rate for Payer: PACE SWMI |
$439.36
|
| Rate for Payer: PHP Commercial |
$463.65
|
| Rate for Payer: PHP Medicare Advantage |
$439.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$229.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$450.50
|
| Rate for Payer: Priority Health Medicare |
$439.36
|
| Rate for Payer: Priority Health SBD |
$343.65
|
| Rate for Payer: Priority Health Tiered Network |
$360.40
|
| Rate for Payer: Railroad Medicare Medicare |
$439.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$354.56
|
| Rate for Payer: UHC Core |
$284.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$439.36
|
| Rate for Payer: UHC Exchange |
$214.37
|
| Rate for Payer: UHC Medicaid |
$229.79
|
| Rate for Payer: UHCCP Medicaid |
$229.79
|
| Rate for Payer: VA VA |
$439.36
|
|
|
HC ADMIN TOCILIZUMAB COVID 19 2ND DOSE
|
Facility
|
IP
|
$545.47
|
|
|
Service Code
|
HCPCS M0250
|
| Hospital Charge Code |
77100045
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$343.65 |
| Max. Negotiated Rate |
$490.92 |
| Rate for Payer: Aetna Commercial |
$463.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$354.56
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cofinity Advantage |
$381.83
|
| Rate for Payer: Cofinity Commercial |
$469.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.38
|
| Rate for Payer: Healthscope Commercial |
$490.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.10
|
| Rate for Payer: PHP Commercial |
$463.65
|
| Rate for Payer: Priority Health SBD |
$343.65
|
|
|
HC ADMIN TOCILIZUMAB COVID 19 2ND DOSE
|
Facility
|
OP
|
$545.47
|
|
|
Service Code
|
HCPCS M0250
|
| Hospital Charge Code |
77100045
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$214.37 |
| Max. Negotiated Rate |
$1,318.08 |
| Rate for Payer: Aetna Commercial |
$463.65
|
| Rate for Payer: Aetna Medicare |
$456.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$354.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$549.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$549.20
|
| Rate for Payer: BCBS Complete |
$241.30
|
| Rate for Payer: BCBS MAPPO |
$439.36
|
| Rate for Payer: BCN Medicare Advantage |
$439.36
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cofinity Advantage |
$381.83
|
| Rate for Payer: Cofinity Commercial |
$469.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$439.36
|
| Rate for Payer: Healthscope Commercial |
$490.92
|
| Rate for Payer: Mclaren Medicaid |
$229.79
|
| Rate for Payer: Mclaren Medicare |
$439.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$461.33
|
| Rate for Payer: Meridian Medicaid |
$461.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$505.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$483.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.65
|
| Rate for Payer: Nomi Health Commercial |
$1,318.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.10
|
| Rate for Payer: PACE Medicare |
$417.39
|
| Rate for Payer: PACE SWMI |
$439.36
|
| Rate for Payer: PHP Commercial |
$463.65
|
| Rate for Payer: PHP Medicare Advantage |
$439.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$229.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$450.50
|
| Rate for Payer: Priority Health Medicare |
$439.36
|
| Rate for Payer: Priority Health SBD |
$343.65
|
| Rate for Payer: Priority Health Tiered Network |
$360.40
|
| Rate for Payer: Railroad Medicare Medicare |
$439.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$354.56
|
| Rate for Payer: UHC Core |
$284.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$439.36
|
| Rate for Payer: UHC Exchange |
$214.37
|
| Rate for Payer: UHC Medicaid |
$229.79
|
| Rate for Payer: UHCCP Medicaid |
$229.79
|
| Rate for Payer: VA VA |
$439.36
|
|
|
HC ADMN SARSCOV2 VACC FIRST OR ONLY COMPONENT
|
Facility
|
OP
|
$101.64
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
77100064
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$21.18 |
| Max. Negotiated Rate |
$130.95 |
| Rate for Payer: Aetna Commercial |
$86.39
|
| Rate for Payer: Aetna Medicare |
$42.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.61
|
| Rate for Payer: BCBS Complete |
$22.24
|
| Rate for Payer: BCBS MAPPO |
$40.49
|
| Rate for Payer: BCBS Trust/PPO |
$71.29
|
| Rate for Payer: BCN Commercial |
$71.29
|
| Rate for Payer: BCN Medicare Advantage |
$40.49
|
| 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: Health Alliance Plan Medicare Advantage |
$40.49
|
| Rate for Payer: Healthscope Commercial |
$91.48
|
| Rate for Payer: Mclaren Medicaid |
$21.18
|
| Rate for Payer: Mclaren Medicare |
$40.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.51
|
| Rate for Payer: Meridian Medicaid |
$42.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$44.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.39
|
| Rate for Payer: Nomi Health Commercial |
$121.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.23
|
| Rate for Payer: PACE Medicare |
$38.47
|
| Rate for Payer: PACE SWMI |
$40.49
|
| Rate for Payer: PHP Commercial |
$86.39
|
| Rate for Payer: PHP Medicare Advantage |
$40.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$130.95
|
| Rate for Payer: Priority Health Medicare |
$40.49
|
| Rate for Payer: Priority Health SBD |
$64.03
|
| Rate for Payer: Priority Health Tiered Network |
$104.76
|
| Rate for Payer: Railroad Medicare Medicare |
$40.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.07
|
| Rate for Payer: UHC Core |
$52.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$40.49
|
| Rate for Payer: UHC Exchange |
$39.94
|
| Rate for Payer: UHC Medicaid |
$21.18
|
| Rate for Payer: UHCCP Medicaid |
$21.18
|
| Rate for Payer: VA VA |
$40.49
|
|
|
HC ADMN SARSCOV2 VACC FIRST OR ONLY COMPONENT
|
Facility
|
IP
|
$101.64
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
77100064
|
|
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 ADMU OBSERVATION PER HOUR
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200020
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Advantage |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health SBD |
$100.80
|
|
|
HC ADMU OBSERVATION PER HOUR
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200020
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna Medicare |
$80.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.00
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: BCBS Trust/PPO |
$112.58
|
| Rate for Payer: BCN Commercial |
$112.58
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Advantage |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health SBD |
$100.80
|
| Rate for Payer: UHC Medicaid |
$1,608.00
|
| Rate for Payer: UHCCP Medicaid |
$810.00
|
|
|
HC ADRENOCORTICOTROPIC HORMONE
|
Facility
|
IP
|
$69.15
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
30100071
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.56 |
| Max. Negotiated Rate |
$62.23 |
| Rate for Payer: Aetna Commercial |
$58.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.95
|
| Rate for Payer: Cash Price |
$55.32
|
| Rate for Payer: Cofinity Advantage |
$48.41
|
| Rate for Payer: Cofinity Commercial |
$59.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.32
|
| Rate for Payer: Healthscope Commercial |
$62.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.86
|
| Rate for Payer: PHP Commercial |
$58.78
|
| Rate for Payer: Priority Health SBD |
$43.56
|
|
|
HC ADRENOCORTICOTROPIC HORMONE
|
Facility
|
OP
|
$69.15
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
30100071
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.20 |
| Max. Negotiated Rate |
$62.23 |
| Rate for Payer: Aetna Commercial |
$58.78
|
| Rate for Payer: Aetna Medicare |
$40.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.27
|
| Rate for Payer: BCBS Complete |
$21.21
|
| Rate for Payer: BCBS MAPPO |
$38.62
|
| Rate for Payer: BCBS Trust/PPO |
$41.18
|
| Rate for Payer: BCN Commercial |
$41.18
|
| Rate for Payer: BCN Medicare Advantage |
$38.62
|
| Rate for Payer: Cash Price |
$55.32
|
| Rate for Payer: Cash Price |
$55.32
|
| Rate for Payer: Cofinity Advantage |
$48.41
|
| Rate for Payer: Cofinity Commercial |
$59.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.62
|
| Rate for Payer: Healthscope Commercial |
$62.23
|
| Rate for Payer: Mclaren Medicaid |
$20.20
|
| Rate for Payer: Mclaren Medicare |
$38.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.55
|
| Rate for Payer: Meridian Medicaid |
$40.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.78
|
| Rate for Payer: Nomi Health Commercial |
$57.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.86
|
| Rate for Payer: PACE Medicare |
$36.69
|
| Rate for Payer: PACE SWMI |
$38.62
|
| Rate for Payer: PHP Commercial |
$58.78
|
| Rate for Payer: PHP Medicare Advantage |
$38.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$38.62
|
| Rate for Payer: Priority Health Medicare |
$38.62
|
| Rate for Payer: Priority Health SBD |
$43.56
|
| Rate for Payer: Priority Health Tiered Network |
$30.90
|
| Rate for Payer: Railroad Medicare Medicare |
$38.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.93
|
| Rate for Payer: UHC Core |
$57.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$38.62
|
| Rate for Payer: UHC Exchange |
$57.93
|
| Rate for Payer: UHC Medicaid |
$20.20
|
| Rate for Payer: UHCCP Medicaid |
$20.20
|
| Rate for Payer: VA VA |
$38.62
|
|
|
HC ADULTERANT SURVEY URINE
|
Facility
|
IP
|
$15.61
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30700010
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Aetna Commercial |
$13.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.15
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Advantage |
$10.93
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$14.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.71
|
| Rate for Payer: PHP Commercial |
$13.27
|
| Rate for Payer: Priority Health SBD |
$9.83
|
|
|
HC ADULTERANT SURVEY URINE
|
Facility
|
OP
|
$15.61
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30700010
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Aetna Commercial |
$13.27
|
| Rate for Payer: Aetna Medicare |
$2.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.71
|
| Rate for Payer: BCBS Complete |
$1.19
|
| Rate for Payer: BCBS MAPPO |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$2.32
|
| Rate for Payer: BCN Commercial |
$2.32
|
| Rate for Payer: BCN Medicare Advantage |
$2.17
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Advantage |
$10.93
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.17
|
| Rate for Payer: Healthscope Commercial |
$14.05
|
| Rate for Payer: Mclaren Medicaid |
$1.13
|
| Rate for Payer: Mclaren Medicare |
$2.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.28
|
| Rate for Payer: Meridian Medicaid |
$2.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$3.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.71
|
| Rate for Payer: PACE Medicare |
$2.06
|
| Rate for Payer: PACE SWMI |
$2.17
|
| Rate for Payer: PHP Commercial |
$13.27
|
| Rate for Payer: PHP Medicare Advantage |
$2.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2.17
|
| Rate for Payer: Priority Health Medicare |
$2.17
|
| Rate for Payer: Priority Health SBD |
$9.83
|
| Rate for Payer: Priority Health Tiered Network |
$1.74
|
| Rate for Payer: Railroad Medicare Medicare |
$2.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.26
|
| Rate for Payer: UHC Core |
$3.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.17
|
| Rate for Payer: UHC Exchange |
$3.26
|
| Rate for Payer: UHC Medicaid |
$1.13
|
| Rate for Payer: UHCCP Medicaid |
$1.13
|
| Rate for Payer: VA VA |
$2.17
|
|
|
HC ADVANCE CARE PLANNING EA ADDL 30 MIN
|
Facility
|
OP
|
$33.96
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
51000091
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.35 |
| Max. Negotiated Rate |
$30.56 |
| Rate for Payer: Aetna Commercial |
$28.87
|
| Rate for Payer: Aetna Medicare |
$16.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.07
|
| Rate for Payer: BCBS Complete |
$13.58
|
| Rate for Payer: Cash Price |
$27.17
|
| Rate for Payer: Cofinity Advantage |
$23.77
|
| Rate for Payer: Cofinity Commercial |
$29.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.17
|
| Rate for Payer: Healthscope Commercial |
$30.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.47
|
| Rate for Payer: PHP Commercial |
$28.87
|
| Rate for Payer: Priority Health SBD |
$21.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.07
|
| Rate for Payer: UHC Core |
$17.69
|
| Rate for Payer: UHC Exchange |
$13.35
|
|
|
HC ADVANCE CARE PLANNING EA ADDL 30 MIN
|
Facility
|
IP
|
$33.96
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
51000091
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.39 |
| Max. Negotiated Rate |
$30.56 |
| Rate for Payer: Aetna Commercial |
$28.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.07
|
| Rate for Payer: Cash Price |
$27.17
|
| Rate for Payer: Cofinity Advantage |
$23.77
|
| Rate for Payer: Cofinity Commercial |
$29.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.17
|
| Rate for Payer: Healthscope Commercial |
$30.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.47
|
| Rate for Payer: PHP Commercial |
$28.87
|
| Rate for Payer: Priority Health SBD |
$21.39
|
|
|
HC ADVANCE CARE PLANNING FIRST 30 MIN
|
Facility
|
IP
|
$33.96
|
|
|
Service Code
|
CPT 99497
|
| Hospital Charge Code |
51000090
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.39 |
| Max. Negotiated Rate |
$30.56 |
| Rate for Payer: Aetna Commercial |
$28.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.07
|
| Rate for Payer: Cash Price |
$27.17
|
| Rate for Payer: Cofinity Advantage |
$23.77
|
| Rate for Payer: Cofinity Commercial |
$29.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.17
|
| Rate for Payer: Healthscope Commercial |
$30.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.47
|
| Rate for Payer: PHP Commercial |
$28.87
|
| Rate for Payer: Priority Health SBD |
$21.39
|
|
|
HC ADVANCE CARE PLANNING FIRST 30 MIN
|
Facility
|
OP
|
$33.96
|
|
|
Service Code
|
CPT 99497
|
| Hospital Charge Code |
51000090
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.35 |
| Max. Negotiated Rate |
$327.36 |
| Rate for Payer: Aetna Commercial |
$28.87
|
| Rate for Payer: Aetna Medicare |
$105.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$126.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$126.53
|
| Rate for Payer: BCBS Complete |
$55.59
|
| Rate for Payer: BCBS MAPPO |
$101.22
|
| Rate for Payer: BCN Medicare Advantage |
$101.22
|
| Rate for Payer: Cash Price |
$27.17
|
| Rate for Payer: Cash Price |
$27.17
|
| Rate for Payer: Cofinity Advantage |
$23.77
|
| Rate for Payer: Cofinity Commercial |
$29.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.22
|
| Rate for Payer: Healthscope Commercial |
$30.56
|
| Rate for Payer: Mclaren Medicaid |
$52.94
|
| Rate for Payer: Mclaren Medicare |
$101.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.28
|
| Rate for Payer: Meridian Medicaid |
$106.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.87
|
| Rate for Payer: Nomi Health Commercial |
$303.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.47
|
| Rate for Payer: PACE Medicare |
$96.16
|
| Rate for Payer: PACE SWMI |
$101.22
|
| Rate for Payer: PHP Commercial |
$28.87
|
| Rate for Payer: PHP Medicare Advantage |
$101.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$327.36
|
| Rate for Payer: Priority Health Medicare |
$101.22
|
| Rate for Payer: Priority Health SBD |
$21.39
|
| Rate for Payer: Priority Health Tiered Network |
$261.89
|
| Rate for Payer: Railroad Medicare Medicare |
$101.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.07
|
| Rate for Payer: UHC Core |
$17.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$101.22
|
| Rate for Payer: UHC Exchange |
$13.35
|
| Rate for Payer: UHC Medicaid |
$52.94
|
| Rate for Payer: UHCCP Medicaid |
$52.94
|
| Rate for Payer: VA VA |
$101.22
|
|
|
HC AEP HEARING STATUS DETER BROADBAND STIMULI I&R
|
Facility
|
IP
|
$164.38
|
|
|
Service Code
|
CPT 92651
|
| Hospital Charge Code |
76100497
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$103.56 |
| Max. Negotiated Rate |
$147.94 |
| Rate for Payer: Aetna Commercial |
$139.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.85
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cofinity Advantage |
$115.07
|
| Rate for Payer: Cofinity Commercial |
$141.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.50
|
| Rate for Payer: Healthscope Commercial |
$147.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.28
|
| Rate for Payer: PHP Commercial |
$139.72
|
| Rate for Payer: Priority Health SBD |
$103.56
|
|
|
HC AEP HEARING STATUS DETER BROADBAND STIMULI I&R
|
Facility
|
OP
|
$164.38
|
|
|
Service Code
|
CPT 92651
|
| Hospital Charge Code |
76100497
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$64.60 |
| Max. Negotiated Rate |
$695.77 |
| Rate for Payer: Aetna Commercial |
$139.72
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$196.91
|
| Rate for Payer: BCN Commercial |
$196.91
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cofinity Advantage |
$115.07
|
| Rate for Payer: Cofinity Commercial |
$141.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$147.94
|
| Rate for Payer: Mclaren Medicaid |
$112.52
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.72
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.28
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$139.72
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$103.56
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.85
|
| Rate for Payer: UHC Core |
$85.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$64.60
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R
|
Facility
|
IP
|
$292.35
|
|
|
Service Code
|
CPT 92652
|
| Hospital Charge Code |
47100401
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$184.18 |
| Max. Negotiated Rate |
$263.12 |
| Rate for Payer: Aetna Commercial |
$248.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.03
|
| Rate for Payer: Cash Price |
$233.88
|
| Rate for Payer: Cofinity Advantage |
$204.65
|
| Rate for Payer: Cofinity Commercial |
$251.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.88
|
| Rate for Payer: Healthscope Commercial |
$263.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$219.26
|
| Rate for Payer: PHP Commercial |
$248.50
|
| Rate for Payer: Priority Health SBD |
$184.18
|
|
|
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R
|
Facility
|
OP
|
$292.35
|
|
|
Service Code
|
CPT 92652
|
| Hospital Charge Code |
47100401
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$695.77 |
| Rate for Payer: Aetna Commercial |
$248.50
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$248.73
|
| Rate for Payer: BCN Commercial |
$248.73
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$233.88
|
| Rate for Payer: Cash Price |
$233.88
|
| Rate for Payer: Cofinity Advantage |
$204.65
|
| Rate for Payer: Cofinity Commercial |
$251.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$263.12
|
| Rate for Payer: Mclaren Medicaid |
$112.52
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.50
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$219.26
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$248.50
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$184.18
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.03
|
| Rate for Payer: UHC Core |
$152.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$114.89
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC AEROBIKA
|
Facility
|
OP
|
$153.28
|
|
| Hospital Charge Code |
27000612
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$60.24 |
| Max. Negotiated Rate |
$137.95 |
| Rate for Payer: Aetna Commercial |
$130.29
|
| Rate for Payer: Aetna Medicare |
$76.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.63
|
| Rate for Payer: BCBS Complete |
$61.31
|
| Rate for Payer: Cash Price |
$122.62
|
| Rate for Payer: Cofinity Advantage |
$107.30
|
| Rate for Payer: Cofinity Commercial |
$131.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.62
|
| Rate for Payer: Healthscope Commercial |
$137.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.96
|
| Rate for Payer: PHP Commercial |
$130.29
|
| Rate for Payer: Priority Health SBD |
$96.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.63
|
| Rate for Payer: UHC Core |
$79.86
|
| Rate for Payer: UHC Exchange |
$60.24
|
|
|
HC AEROBIKA
|
Facility
|
IP
|
$153.28
|
|
| Hospital Charge Code |
27000612
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.57 |
| Max. Negotiated Rate |
$137.95 |
| Rate for Payer: Aetna Commercial |
$130.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.63
|
| Rate for Payer: Cash Price |
$122.62
|
| Rate for Payer: Cofinity Advantage |
$107.30
|
| Rate for Payer: Cofinity Commercial |
$131.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.62
|
| Rate for Payer: Healthscope Commercial |
$137.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.96
|
| Rate for Payer: PHP Commercial |
$130.29
|
| Rate for Payer: Priority Health SBD |
$96.57
|
|
|
HC AERONEB SUPPLY
|
Facility
|
IP
|
$170.55
|
|
| Hospital Charge Code |
27000465
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$107.45 |
| Max. Negotiated Rate |
$153.50 |
| Rate for Payer: Aetna Commercial |
$144.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.86
|
| Rate for Payer: Cash Price |
$136.44
|
| Rate for Payer: Cofinity Advantage |
$119.39
|
| Rate for Payer: Cofinity Commercial |
$146.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.44
|
| Rate for Payer: Healthscope Commercial |
$153.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.91
|
| Rate for Payer: PHP Commercial |
$144.97
|
| Rate for Payer: Priority Health SBD |
$107.45
|
|
|
HC AERONEB SUPPLY
|
Facility
|
OP
|
$170.55
|
|
| Hospital Charge Code |
27000465
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$67.03 |
| Max. Negotiated Rate |
$153.50 |
| Rate for Payer: Aetna Commercial |
$144.97
|
| Rate for Payer: Aetna Medicare |
$85.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.86
|
| Rate for Payer: BCBS Complete |
$68.22
|
| Rate for Payer: Cash Price |
$136.44
|
| Rate for Payer: Cofinity Advantage |
$119.39
|
| Rate for Payer: Cofinity Commercial |
$146.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.44
|
| Rate for Payer: Healthscope Commercial |
$153.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$136.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.91
|
| Rate for Payer: PHP Commercial |
$144.97
|
| Rate for Payer: Priority Health SBD |
$107.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.86
|
| Rate for Payer: UHC Core |
$88.86
|
| Rate for Payer: UHC Exchange |
$67.03
|
|
