|
HC ADMIN RSV MONOC ANTB IM INJ
|
Facility
|
OP
|
$84.70
|
|
|
Service Code
|
CPT 96381
|
| Hospital Charge Code |
77100066
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$76.23 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Medicare |
$42.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.05
|
| Rate for Payer: BCBS Complete |
$33.88
|
| Rate for Payer: Cash Price |
$67.76
|
| Rate for Payer: Cofinity Commercial |
$59.29
|
| Rate for Payer: Cofinity Commercial |
$72.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.76
|
| Rate for Payer: Healthscope Commercial |
$76.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.00
|
| Rate for Payer: PHP Commercial |
$72.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.05
|
| Rate for Payer: Priority Health SBD |
$53.36
|
|
|
HC ADMIN RSV MONOC ANTB IM INJ
|
Facility
|
IP
|
$84.70
|
|
|
Service Code
|
CPT 96381
|
| Hospital Charge Code |
77100066
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$53.36 |
| Max. Negotiated Rate |
$76.23 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.05
|
| Rate for Payer: Cash Price |
$67.76
|
| Rate for Payer: Cofinity Commercial |
$59.29
|
| Rate for Payer: Cofinity Commercial |
$72.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.76
|
| Rate for Payer: Healthscope Commercial |
$76.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.00
|
| Rate for Payer: PHP Commercial |
$72.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.05
|
| Rate for Payer: Priority Health SBD |
$53.36
|
|
|
HC ADMIN RSV MONOC ANTB IM W/COUNSELING
|
Facility
|
IP
|
$84.70
|
|
|
Service Code
|
CPT 96380
|
| Hospital Charge Code |
77100065
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$53.36 |
| Max. Negotiated Rate |
$76.23 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.05
|
| Rate for Payer: Cash Price |
$67.76
|
| Rate for Payer: Cofinity Commercial |
$59.29
|
| Rate for Payer: Cofinity Commercial |
$72.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.76
|
| Rate for Payer: Healthscope Commercial |
$76.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.00
|
| Rate for Payer: PHP Commercial |
$72.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.05
|
| Rate for Payer: Priority Health SBD |
$53.36
|
|
|
HC ADMIN RSV MONOC ANTB IM W/COUNSELING
|
Facility
|
OP
|
$84.70
|
|
|
Service Code
|
CPT 96380
|
| Hospital Charge Code |
77100065
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$76.23 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Medicare |
$42.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.05
|
| Rate for Payer: BCBS Complete |
$33.88
|
| Rate for Payer: Cash Price |
$67.76
|
| Rate for Payer: Cofinity Commercial |
$59.29
|
| Rate for Payer: Cofinity Commercial |
$72.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.76
|
| Rate for Payer: Healthscope Commercial |
$76.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.00
|
| Rate for Payer: PHP Commercial |
$72.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.05
|
| Rate for Payer: Priority Health SBD |
$53.36
|
|
|
HC ADMIN TOCILIZUMAB COVID 19 1ST DOSE
|
Facility
|
IP
|
$534.77
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
77100044
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$336.91 |
| Max. Negotiated Rate |
$481.29 |
| Rate for Payer: Aetna Commercial |
$454.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.60
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cofinity Commercial |
$374.34
|
| Rate for Payer: Cofinity Commercial |
$459.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$374.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.82
|
| Rate for Payer: Healthscope Commercial |
$481.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.55
|
| Rate for Payer: PHP Commercial |
$454.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.60
|
| Rate for Payer: Priority Health SBD |
$336.91
|
|
|
HC ADMIN TOCILIZUMAB COVID 19 1ST DOSE
|
Facility
|
OP
|
$534.77
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
77100044
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$1,236.75 |
| Rate for Payer: Aetna Commercial |
$454.55
|
| Rate for Payer: Aetna Medicare |
$456.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.60
|
| 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 |
$247.27
|
| Rate for Payer: BCBS MAPPO |
$439.36
|
| Rate for Payer: BCN Medicare Advantage |
$439.36
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cofinity Commercial |
$459.90
|
| Rate for Payer: Cofinity Commercial |
$374.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$374.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$439.36
|
| Rate for Payer: Healthscope Commercial |
$481.29
|
| Rate for Payer: Mclaren Medicaid |
$235.50
|
| 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 |
$247.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$505.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.55
|
| Rate for Payer: PACE Medicare |
$417.39
|
| Rate for Payer: PACE SWMI |
$439.36
|
| Rate for Payer: PHP Commercial |
$454.55
|
| Rate for Payer: PHP Medicare Advantage |
$439.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$235.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.60
|
| Rate for Payer: Priority Health Medicare |
$439.36
|
| Rate for Payer: Priority Health SBD |
$336.91
|
| Rate for Payer: Railroad Medicare Medicare |
$439.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,236.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$439.36
|
| Rate for Payer: UHC Medicare Advantage |
$439.36
|
| Rate for Payer: UHCCP Medicaid |
$247.36
|
| Rate for Payer: VA VA |
$439.36
|
|
|
HC ADMIN TOCILIZUMAB COVID 19 2ND DOSE
|
Facility
|
IP
|
$534.77
|
|
|
Service Code
|
HCPCS M0250
|
| Hospital Charge Code |
77100045
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$336.91 |
| Max. Negotiated Rate |
$481.29 |
| Rate for Payer: Aetna Commercial |
$454.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.60
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cofinity Commercial |
$374.34
|
| Rate for Payer: Cofinity Commercial |
$459.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$374.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.82
|
| Rate for Payer: Healthscope Commercial |
$481.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.55
|
| Rate for Payer: PHP Commercial |
$454.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.60
|
| Rate for Payer: Priority Health SBD |
$336.91
|
|
|
HC ADMIN TOCILIZUMAB COVID 19 2ND DOSE
|
Facility
|
OP
|
$534.77
|
|
|
Service Code
|
HCPCS M0250
|
| Hospital Charge Code |
77100045
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$1,236.75 |
| Rate for Payer: Aetna Commercial |
$454.55
|
| Rate for Payer: Aetna Medicare |
$456.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.60
|
| 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 |
$247.27
|
| Rate for Payer: BCBS MAPPO |
$439.36
|
| Rate for Payer: BCN Medicare Advantage |
$439.36
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cofinity Commercial |
$459.90
|
| Rate for Payer: Cofinity Commercial |
$374.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$374.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$439.36
|
| Rate for Payer: Healthscope Commercial |
$481.29
|
| Rate for Payer: Mclaren Medicaid |
$235.50
|
| 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 |
$247.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$505.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.55
|
| Rate for Payer: PACE Medicare |
$417.39
|
| Rate for Payer: PACE SWMI |
$439.36
|
| Rate for Payer: PHP Commercial |
$454.55
|
| Rate for Payer: PHP Medicare Advantage |
$439.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$235.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.60
|
| Rate for Payer: Priority Health Medicare |
$439.36
|
| Rate for Payer: Priority Health SBD |
$336.91
|
| Rate for Payer: Railroad Medicare Medicare |
$439.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,236.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$439.36
|
| Rate for Payer: UHC Medicare Advantage |
$439.36
|
| Rate for Payer: UHCCP Medicaid |
$247.36
|
| Rate for Payer: VA VA |
$439.36
|
|
|
HC ADMN SARSCOV2 VACC 1 DOSE
|
Facility
|
OP
|
$84.70
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
77100064
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$21.70 |
| Max. Negotiated Rate |
$113.98 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Medicare |
$42.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.05
|
| 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 |
$22.79
|
| Rate for Payer: BCBS MAPPO |
$40.49
|
| Rate for Payer: BCN Medicare Advantage |
$40.49
|
| Rate for Payer: Cash Price |
$67.76
|
| Rate for Payer: Cash Price |
$67.76
|
| Rate for Payer: Cofinity Commercial |
$72.84
|
| Rate for Payer: Cofinity Commercial |
$59.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.49
|
| Rate for Payer: Healthscope Commercial |
$76.23
|
| Rate for Payer: Mclaren Medicaid |
$21.70
|
| 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 |
$22.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.00
|
| Rate for Payer: PACE Medicare |
$38.47
|
| Rate for Payer: PACE SWMI |
$40.49
|
| Rate for Payer: PHP Commercial |
$72.00
|
| Rate for Payer: PHP Medicare Advantage |
$40.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.05
|
| Rate for Payer: Priority Health Medicare |
$40.49
|
| Rate for Payer: Priority Health SBD |
$53.36
|
| Rate for Payer: Railroad Medicare Medicare |
$40.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.49
|
| Rate for Payer: UHC Medicare Advantage |
$40.49
|
| Rate for Payer: UHCCP Medicaid |
$22.80
|
| Rate for Payer: VA VA |
$40.49
|
|
|
HC ADMN SARSCOV2 VACC 1 DOSE
|
Facility
|
IP
|
$84.70
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
77100064
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$53.36 |
| Max. Negotiated Rate |
$76.23 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.05
|
| Rate for Payer: Cash Price |
$67.76
|
| Rate for Payer: Cofinity Commercial |
$59.29
|
| Rate for Payer: Cofinity Commercial |
$72.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.76
|
| Rate for Payer: Healthscope Commercial |
$76.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.00
|
| Rate for Payer: PHP Commercial |
$72.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.05
|
| Rate for Payer: Priority Health SBD |
$53.36
|
|
|
HC ADMU OBSERVATION PER HOUR
|
Facility
|
OP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200020
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$58.03 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: Aetna Medicare |
$72.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.30
|
| Rate for Payer: BCBS Complete |
$58.03
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$101.56
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$130.57
|
| Rate for Payer: Meridian Medicaid |
$1,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: PHP Commercial |
$123.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health SBD |
$91.40
|
| Rate for Payer: UHC Core |
$107.36
|
| Rate for Payer: UHC Exchange |
$107.36
|
|
|
HC ADMU OBSERVATION PER HOUR
|
Facility
|
IP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200020
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$130.57 |
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.30
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$101.56
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$130.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: PHP Commercial |
$123.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health SBD |
$91.40
|
|
|
HC ADRENOCORTICOTROPIC HORMONE
|
Facility
|
OP
|
$63.18
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
30100071
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$108.71 |
| Rate for Payer: Aetna Commercial |
$53.70
|
| Rate for Payer: Aetna Medicare |
$40.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.07
|
| 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 |
$21.74
|
| Rate for Payer: BCBS MAPPO |
$38.62
|
| Rate for Payer: BCN Medicare Advantage |
$38.62
|
| Rate for Payer: Cash Price |
$50.54
|
| Rate for Payer: Cash Price |
$50.54
|
| Rate for Payer: Cofinity Commercial |
$54.33
|
| Rate for Payer: Cofinity Commercial |
$44.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.62
|
| Rate for Payer: Healthscope Commercial |
$56.86
|
| Rate for Payer: Mclaren Medicaid |
$20.70
|
| 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 |
$21.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.70
|
| Rate for Payer: PACE Medicare |
$36.69
|
| Rate for Payer: PACE SWMI |
$38.62
|
| Rate for Payer: PHP Commercial |
$53.70
|
| Rate for Payer: PHP Medicare Advantage |
$38.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.07
|
| Rate for Payer: Priority Health Medicare |
$38.62
|
| Rate for Payer: Priority Health SBD |
$39.80
|
| Rate for Payer: Railroad Medicare Medicare |
$38.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.62
|
| Rate for Payer: UHC Medicare Advantage |
$38.62
|
| Rate for Payer: UHCCP Medicaid |
$21.74
|
| Rate for Payer: VA VA |
$38.62
|
|
|
HC ADRENOCORTICOTROPIC HORMONE
|
Facility
|
IP
|
$63.18
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
30100071
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.80 |
| Max. Negotiated Rate |
$56.86 |
| Rate for Payer: Aetna Commercial |
$53.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.07
|
| Rate for Payer: Cash Price |
$50.54
|
| Rate for Payer: Cofinity Commercial |
$44.23
|
| Rate for Payer: Cofinity Commercial |
$54.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.54
|
| Rate for Payer: Healthscope Commercial |
$56.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.70
|
| Rate for Payer: PHP Commercial |
$53.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.07
|
| Rate for Payer: Priority Health SBD |
$39.80
|
|
|
HC ADULTERANT SURVEY URINE
|
Facility
|
IP
|
$15.30
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30700010
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Aetna Commercial |
$13.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.95
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$10.71
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.01
|
| Rate for Payer: PHP Commercial |
$13.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.95
|
| Rate for Payer: Priority Health SBD |
$9.64
|
|
|
HC ADULTERANT SURVEY URINE
|
Facility
|
OP
|
$15.30
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30700010
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Aetna Commercial |
$13.01
|
| Rate for Payer: Aetna Medicare |
$2.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.95
|
| 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 |
$1.22
|
| Rate for Payer: BCBS MAPPO |
$2.17
|
| Rate for Payer: BCN Medicare Advantage |
$2.17
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Cofinity Commercial |
$10.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.17
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Mclaren Medicaid |
$1.16
|
| 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 |
$1.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.01
|
| Rate for Payer: PACE Medicare |
$2.06
|
| Rate for Payer: PACE SWMI |
$2.17
|
| Rate for Payer: PHP Commercial |
$13.01
|
| Rate for Payer: PHP Medicare Advantage |
$2.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.95
|
| Rate for Payer: Priority Health Medicare |
$2.17
|
| Rate for Payer: Priority Health SBD |
$9.64
|
| Rate for Payer: Railroad Medicare Medicare |
$2.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.17
|
| Rate for Payer: UHC Medicare Advantage |
$2.17
|
| Rate for Payer: UHCCP Medicaid |
$1.22
|
| Rate for Payer: VA VA |
$2.17
|
|
|
HC ADVANCE CARE PLANNING EA ADDL 30 MIN
|
Facility
|
OP
|
$33.29
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
51000091
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$29.96 |
| Rate for Payer: Aetna Commercial |
$28.30
|
| Rate for Payer: Aetna Medicare |
$16.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.64
|
| Rate for Payer: BCBS Complete |
$13.32
|
| Rate for Payer: Cash Price |
$26.63
|
| Rate for Payer: Cofinity Commercial |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$28.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.63
|
| Rate for Payer: Healthscope Commercial |
$29.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.30
|
| Rate for Payer: PHP Commercial |
$28.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.64
|
| Rate for Payer: Priority Health SBD |
$20.97
|
|
|
HC ADVANCE CARE PLANNING EA ADDL 30 MIN
|
Facility
|
IP
|
$33.29
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
51000091
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.97 |
| Max. Negotiated Rate |
$29.96 |
| Rate for Payer: Aetna Commercial |
$28.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.64
|
| Rate for Payer: Cash Price |
$26.63
|
| Rate for Payer: Cofinity Commercial |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$28.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.63
|
| Rate for Payer: Healthscope Commercial |
$29.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.30
|
| Rate for Payer: PHP Commercial |
$28.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.64
|
| Rate for Payer: Priority Health SBD |
$20.97
|
|
|
HC ADVANCE CARE PLANNING FIRST 30 MIN
|
Facility
|
IP
|
$33.29
|
|
|
Service Code
|
CPT 99497
|
| Hospital Charge Code |
51000090
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.97 |
| Max. Negotiated Rate |
$29.96 |
| Rate for Payer: Aetna Commercial |
$28.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.64
|
| Rate for Payer: Cash Price |
$26.63
|
| Rate for Payer: Cofinity Commercial |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$28.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.63
|
| Rate for Payer: Healthscope Commercial |
$29.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.30
|
| Rate for Payer: PHP Commercial |
$28.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.64
|
| Rate for Payer: Priority Health SBD |
$20.97
|
|
|
HC ADVANCE CARE PLANNING FIRST 30 MIN
|
Facility
|
OP
|
$33.29
|
|
|
Service Code
|
CPT 99497
|
| Hospital Charge Code |
51000090
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.97 |
| Max. Negotiated Rate |
$253.93 |
| Rate for Payer: Aetna Commercial |
$28.30
|
| Rate for Payer: Aetna Medicare |
$93.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$112.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$112.76
|
| Rate for Payer: BCBS Complete |
$50.77
|
| Rate for Payer: BCBS MAPPO |
$90.21
|
| Rate for Payer: BCN Medicare Advantage |
$90.21
|
| Rate for Payer: Cash Price |
$26.63
|
| Rate for Payer: Cash Price |
$26.63
|
| Rate for Payer: Cofinity Commercial |
$28.63
|
| Rate for Payer: Cofinity Commercial |
$23.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.21
|
| Rate for Payer: Healthscope Commercial |
$29.96
|
| Rate for Payer: Mclaren Medicaid |
$48.35
|
| Rate for Payer: Mclaren Medicare |
$90.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.72
|
| Rate for Payer: Meridian Medicaid |
$50.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.30
|
| Rate for Payer: PACE Medicare |
$85.70
|
| Rate for Payer: PACE SWMI |
$90.21
|
| Rate for Payer: PHP Commercial |
$28.30
|
| Rate for Payer: PHP Medicare Advantage |
$90.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.64
|
| Rate for Payer: Priority Health Medicare |
$90.21
|
| Rate for Payer: Priority Health SBD |
$20.97
|
| Rate for Payer: Railroad Medicare Medicare |
$90.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$253.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.21
|
| Rate for Payer: UHC Medicare Advantage |
$90.21
|
| Rate for Payer: UHCCP Medicaid |
$50.79
|
| Rate for Payer: VA VA |
$90.21
|
|
|
HC AEP HEARING STATUS DETER BROADBAND STIMULI I&R
|
Facility
|
IP
|
$161.16
|
|
|
Service Code
|
CPT 92651
|
| Hospital Charge Code |
76100497
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$101.53 |
| Max. Negotiated Rate |
$145.04 |
| Rate for Payer: Aetna Commercial |
$136.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.75
|
| Rate for Payer: Cash Price |
$128.93
|
| Rate for Payer: Cofinity Commercial |
$112.81
|
| Rate for Payer: Cofinity Commercial |
$138.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$112.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.93
|
| Rate for Payer: Healthscope Commercial |
$145.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.99
|
| Rate for Payer: PHP Commercial |
$136.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.75
|
| Rate for Payer: Priority Health SBD |
$101.53
|
|
|
HC AEP HEARING STATUS DETER BROADBAND STIMULI I&R
|
Facility
|
OP
|
$161.16
|
|
|
Service Code
|
CPT 92651
|
| Hospital Charge Code |
76100497
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$101.53 |
| Max. Negotiated Rate |
$854.89 |
| Rate for Payer: Aetna Commercial |
$136.99
|
| Rate for Payer: Aetna Medicare |
$315.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$128.93
|
| Rate for Payer: Cash Price |
$128.93
|
| Rate for Payer: Cofinity Commercial |
$112.81
|
| Rate for Payer: Cofinity Commercial |
$138.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$112.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$145.04
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.99
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$136.99
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.75
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health SBD |
$101.53
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.89
|
| Rate for Payer: UHC Core |
$119.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$119.26
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$170.98
|
| Rate for Payer: VA VA |
$303.70
|
|
|
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R
|
Facility
|
IP
|
$286.62
|
|
|
Service Code
|
CPT 92652
|
| Hospital Charge Code |
47100401
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$180.57 |
| Max. Negotiated Rate |
$257.96 |
| Rate for Payer: Aetna Commercial |
$243.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.30
|
| Rate for Payer: Cash Price |
$229.30
|
| Rate for Payer: Cofinity Commercial |
$200.63
|
| Rate for Payer: Cofinity Commercial |
$246.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.30
|
| Rate for Payer: Healthscope Commercial |
$257.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.63
|
| Rate for Payer: PHP Commercial |
$243.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.30
|
| Rate for Payer: Priority Health SBD |
$180.57
|
|
|
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R
|
Facility
|
OP
|
$286.62
|
|
|
Service Code
|
CPT 92652
|
| Hospital Charge Code |
47100401
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$854.89 |
| Rate for Payer: Aetna Commercial |
$243.63
|
| Rate for Payer: Aetna Medicare |
$315.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$229.30
|
| Rate for Payer: Cash Price |
$229.30
|
| Rate for Payer: Cofinity Commercial |
$246.49
|
| Rate for Payer: Cofinity Commercial |
$200.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$257.96
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.63
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$243.63
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.30
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health SBD |
$180.57
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.89
|
| Rate for Payer: UHC Core |
$212.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$212.10
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$170.98
|
| Rate for Payer: VA VA |
$303.70
|
|
|
HC AEROBIKA
|
Facility
|
IP
|
$150.27
|
|
| Hospital Charge Code |
27000612
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$94.67 |
| Max. Negotiated Rate |
$135.24 |
| Rate for Payer: Aetna Commercial |
$127.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.68
|
| Rate for Payer: Cash Price |
$120.22
|
| Rate for Payer: Cofinity Commercial |
$105.19
|
| Rate for Payer: Cofinity Commercial |
$129.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.22
|
| Rate for Payer: Healthscope Commercial |
$135.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.73
|
| Rate for Payer: PHP Commercial |
$127.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.68
|
| Rate for Payer: Priority Health SBD |
$94.67
|
|
