|
HC CARDIOVERSION
|
Facility
|
OP
|
$1,232.88
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
48000002
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$344.43 |
| Max. Negotiated Rate |
$2,129.73 |
| Rate for Payer: Aetna Commercial |
$1,047.95
|
| Rate for Payer: Aetna Medicare |
$684.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$801.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$823.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$823.21
|
| Rate for Payer: BCBS Complete |
$361.69
|
| Rate for Payer: BCBS MAPPO |
$658.57
|
| Rate for Payer: BCBS Trust/PPO |
$460.81
|
| Rate for Payer: BCN Commercial |
$460.81
|
| Rate for Payer: BCN Medicare Advantage |
$658.57
|
| Rate for Payer: Cash Price |
$986.30
|
| Rate for Payer: Cash Price |
$986.30
|
| Rate for Payer: Cash Price |
$986.30
|
| Rate for Payer: Cofinity Advantage |
$863.02
|
| Rate for Payer: Cofinity Commercial |
$1,060.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$986.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.57
|
| Rate for Payer: Healthscope Commercial |
$1,109.59
|
| Rate for Payer: Mclaren Medicaid |
$344.43
|
| Rate for Payer: Mclaren Medicare |
$658.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$691.50
|
| Rate for Payer: Meridian Medicaid |
$691.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$757.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$724.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,047.95
|
| Rate for Payer: Nomi Health Commercial |
$1,975.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$924.66
|
| Rate for Payer: PACE Medicare |
$625.64
|
| Rate for Payer: PACE SWMI |
$658.57
|
| Rate for Payer: PHP Commercial |
$1,047.95
|
| Rate for Payer: PHP Medicare Advantage |
$658.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$344.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,129.73
|
| Rate for Payer: Priority Health Medicare |
$658.57
|
| Rate for Payer: Priority Health SBD |
$776.71
|
| Rate for Payer: Priority Health Tiered Network |
$1,703.78
|
| Rate for Payer: Railroad Medicare Medicare |
$658.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$801.37
|
| Rate for Payer: UHC Core |
$642.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$658.57
|
| Rate for Payer: UHC Exchange |
$484.52
|
| Rate for Payer: UHC Medicaid |
$344.43
|
| Rate for Payer: UHCCP Medicaid |
$344.43
|
| Rate for Payer: VA VA |
$658.57
|
|
|
HC CARDIOVERSION
|
Facility
|
IP
|
$1,232.88
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
48000002
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$776.71 |
| Max. Negotiated Rate |
$1,109.59 |
| Rate for Payer: Aetna Commercial |
$1,047.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$801.37
|
| Rate for Payer: Cash Price |
$986.30
|
| Rate for Payer: Cofinity Advantage |
$863.02
|
| Rate for Payer: Cofinity Commercial |
$1,060.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$986.30
|
| Rate for Payer: Healthscope Commercial |
$1,109.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,047.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$924.66
|
| Rate for Payer: PHP Commercial |
$1,047.95
|
| Rate for Payer: Priority Health SBD |
$776.71
|
|
|
HC CARDIOVERSION EXT
|
Facility
|
IP
|
$1,018.16
|
|
| Hospital Charge Code |
45000034
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$641.44 |
| Max. Negotiated Rate |
$916.34 |
| Rate for Payer: Aetna Commercial |
$865.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$661.80
|
| Rate for Payer: Cash Price |
$814.53
|
| Rate for Payer: Cofinity Advantage |
$712.71
|
| Rate for Payer: Cofinity Commercial |
$875.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$814.53
|
| Rate for Payer: Healthscope Commercial |
$916.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$865.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$763.62
|
| Rate for Payer: PHP Commercial |
$865.44
|
| Rate for Payer: Priority Health SBD |
$641.44
|
|
|
HC CARDIOVERSION EXT
|
Facility
|
OP
|
$1,018.16
|
|
| Hospital Charge Code |
45000034
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$916.34 |
| Rate for Payer: Aetna Commercial |
$865.44
|
| Rate for Payer: Aetna Medicare |
$509.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$661.80
|
| Rate for Payer: BCBS Complete |
$407.26
|
| Rate for Payer: Cash Price |
$814.53
|
| Rate for Payer: Cash Price |
$814.53
|
| Rate for Payer: Cofinity Advantage |
$712.71
|
| Rate for Payer: Cofinity Commercial |
$875.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$814.53
|
| Rate for Payer: Healthscope Commercial |
$916.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$814.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$865.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$763.62
|
| Rate for Payer: PHP Commercial |
$865.44
|
| Rate for Payer: Priority Health SBD |
$641.44
|
| Rate for Payer: UHCCP Medicaid |
$144.00
|
|
|
HC CAREGIVER HEALTH RISK ASSMT
|
Facility
|
IP
|
$54.12
|
|
|
Service Code
|
CPT 96161
|
| Hospital Charge Code |
51000095
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.10 |
| Max. Negotiated Rate |
$48.71 |
| Rate for Payer: Aetna Commercial |
$46.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.18
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cofinity Advantage |
$37.88
|
| Rate for Payer: Cofinity Commercial |
$46.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.30
|
| Rate for Payer: Healthscope Commercial |
$48.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.59
|
| Rate for Payer: PHP Commercial |
$46.00
|
| Rate for Payer: Priority Health SBD |
$34.10
|
|
|
HC CAREGIVER HEALTH RISK ASSMT
|
Facility
|
OP
|
$54.12
|
|
|
Service Code
|
CPT 96161
|
| Hospital Charge Code |
51000095
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.31 |
| Max. Negotiated Rate |
$120.72 |
| Rate for Payer: Aetna Commercial |
$46.00
|
| Rate for Payer: Aetna Medicare |
$38.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.66
|
| Rate for Payer: BCBS Complete |
$20.50
|
| Rate for Payer: BCBS MAPPO |
$37.33
|
| Rate for Payer: BCBS Trust/PPO |
$13.31
|
| Rate for Payer: BCN Commercial |
$13.31
|
| Rate for Payer: BCN Medicare Advantage |
$37.33
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cofinity Advantage |
$37.88
|
| Rate for Payer: Cofinity Commercial |
$46.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.33
|
| Rate for Payer: Healthscope Commercial |
$48.71
|
| Rate for Payer: Mclaren Medicaid |
$19.52
|
| Rate for Payer: Mclaren Medicare |
$37.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.20
|
| Rate for Payer: Meridian Medicaid |
$39.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$41.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.00
|
| Rate for Payer: Nomi Health Commercial |
$111.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.59
|
| Rate for Payer: PACE Medicare |
$35.46
|
| Rate for Payer: PACE SWMI |
$37.33
|
| Rate for Payer: PHP Commercial |
$46.00
|
| Rate for Payer: PHP Medicare Advantage |
$37.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$120.72
|
| Rate for Payer: Priority Health Medicare |
$37.33
|
| Rate for Payer: Priority Health SBD |
$34.10
|
| Rate for Payer: Priority Health Tiered Network |
$96.58
|
| Rate for Payer: Railroad Medicare Medicare |
$37.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.18
|
| Rate for Payer: UHC Core |
$28.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.33
|
| Rate for Payer: UHC Exchange |
$21.27
|
| Rate for Payer: UHC Medicaid |
$19.52
|
| Rate for Payer: UHCCP Medicaid |
$19.52
|
| Rate for Payer: VA VA |
$37.33
|
|
|
HC CARE MGMT SERVICES BEHAVIORAL HLTH COND 20 MINS
|
Facility
|
IP
|
$83.83
|
|
|
Service Code
|
CPT 99484
|
| Hospital Charge Code |
51000107
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.81 |
| Max. Negotiated Rate |
$75.45 |
| Rate for Payer: Aetna Commercial |
$71.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.49
|
| Rate for Payer: Cash Price |
$67.06
|
| Rate for Payer: Cofinity Advantage |
$58.68
|
| Rate for Payer: Cofinity Commercial |
$72.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.06
|
| Rate for Payer: Healthscope Commercial |
$75.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.87
|
| Rate for Payer: PHP Commercial |
$71.26
|
| Rate for Payer: Priority Health SBD |
$52.81
|
|
|
HC CARE MGMT SERVICES BEHAVIORAL HLTH COND 20 MINS
|
Facility
|
OP
|
$83.83
|
|
|
Service Code
|
CPT 99484
|
| Hospital Charge Code |
51000107
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.52 |
| Max. Negotiated Rate |
$120.72 |
| Rate for Payer: Aetna Commercial |
$71.26
|
| Rate for Payer: Aetna Medicare |
$38.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.66
|
| Rate for Payer: BCBS Complete |
$20.50
|
| Rate for Payer: BCBS MAPPO |
$37.33
|
| Rate for Payer: BCBS Trust/PPO |
$90.42
|
| Rate for Payer: BCN Commercial |
$90.42
|
| Rate for Payer: BCN Medicare Advantage |
$37.33
|
| Rate for Payer: Cash Price |
$67.06
|
| Rate for Payer: Cash Price |
$67.06
|
| Rate for Payer: Cofinity Advantage |
$58.68
|
| Rate for Payer: Cofinity Commercial |
$72.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.33
|
| Rate for Payer: Healthscope Commercial |
$75.45
|
| Rate for Payer: Mclaren Medicaid |
$19.52
|
| Rate for Payer: Mclaren Medicare |
$37.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.20
|
| Rate for Payer: Meridian Medicaid |
$39.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$41.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.26
|
| Rate for Payer: Nomi Health Commercial |
$111.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.87
|
| Rate for Payer: PACE Medicare |
$35.46
|
| Rate for Payer: PACE SWMI |
$37.33
|
| Rate for Payer: PHP Commercial |
$71.26
|
| Rate for Payer: PHP Medicare Advantage |
$37.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$120.72
|
| Rate for Payer: Priority Health Medicare |
$37.33
|
| Rate for Payer: Priority Health SBD |
$52.81
|
| Rate for Payer: Priority Health Tiered Network |
$96.58
|
| Rate for Payer: Railroad Medicare Medicare |
$37.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.49
|
| Rate for Payer: UHC Core |
$43.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.33
|
| Rate for Payer: UHC Exchange |
$32.95
|
| Rate for Payer: UHC Medicaid |
$19.52
|
| Rate for Payer: UHCCP Medicaid |
$19.52
|
| Rate for Payer: VA VA |
$37.33
|
|
|
HC CARNITINE
|
Facility
|
IP
|
$60.34
|
|
|
Service Code
|
CPT 82379
|
| Hospital Charge Code |
30100136
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.01 |
| Max. Negotiated Rate |
$54.31 |
| Rate for Payer: Aetna Commercial |
$51.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.22
|
| Rate for Payer: Cash Price |
$48.27
|
| Rate for Payer: Cofinity Advantage |
$42.24
|
| Rate for Payer: Cofinity Commercial |
$51.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.27
|
| Rate for Payer: Healthscope Commercial |
$54.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.26
|
| Rate for Payer: PHP Commercial |
$51.29
|
| Rate for Payer: Priority Health SBD |
$38.01
|
|
|
HC CARNITINE
|
Facility
|
OP
|
$60.34
|
|
|
Service Code
|
CPT 82379
|
| Hospital Charge Code |
30100136
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$54.31 |
| Rate for Payer: Aetna Commercial |
$51.29
|
| Rate for Payer: Aetna Medicare |
$17.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.09
|
| Rate for Payer: BCBS Complete |
$9.27
|
| Rate for Payer: BCBS MAPPO |
$16.87
|
| Rate for Payer: BCBS Trust/PPO |
$17.98
|
| Rate for Payer: BCN Commercial |
$17.98
|
| Rate for Payer: BCN Medicare Advantage |
$16.87
|
| Rate for Payer: Cash Price |
$48.27
|
| Rate for Payer: Cash Price |
$48.27
|
| Rate for Payer: Cofinity Advantage |
$42.24
|
| Rate for Payer: Cofinity Commercial |
$51.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.87
|
| Rate for Payer: Healthscope Commercial |
$54.31
|
| Rate for Payer: Mclaren Medicaid |
$8.82
|
| Rate for Payer: Mclaren Medicare |
$16.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.71
|
| Rate for Payer: Meridian Medicaid |
$17.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.29
|
| Rate for Payer: Nomi Health Commercial |
$25.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.26
|
| Rate for Payer: PACE Medicare |
$16.03
|
| Rate for Payer: PACE SWMI |
$16.87
|
| Rate for Payer: PHP Commercial |
$51.29
|
| Rate for Payer: PHP Medicare Advantage |
$16.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16.87
|
| Rate for Payer: Priority Health Medicare |
$16.87
|
| Rate for Payer: Priority Health SBD |
$38.01
|
| Rate for Payer: Priority Health Tiered Network |
$13.50
|
| Rate for Payer: Railroad Medicare Medicare |
$16.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.31
|
| Rate for Payer: UHC Core |
$25.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.87
|
| Rate for Payer: UHC Exchange |
$25.31
|
| Rate for Payer: UHC Medicaid |
$8.82
|
| Rate for Payer: UHCCP Medicaid |
$8.82
|
| Rate for Payer: VA VA |
$16.87
|
|
|
HC CAR OBSERVATION PER HOUR
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200010
|
|
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 CAR OBSERVATION PER HOUR
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200010
|
|
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 CAROTENE
|
Facility
|
IP
|
$153.98
|
|
|
Service Code
|
CPT 82380
|
| Hospital Charge Code |
30100137
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.01 |
| Max. Negotiated Rate |
$138.58 |
| Rate for Payer: Aetna Commercial |
$130.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.09
|
| Rate for Payer: Cash Price |
$123.18
|
| Rate for Payer: Cofinity Advantage |
$107.79
|
| Rate for Payer: Cofinity Commercial |
$132.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.18
|
| Rate for Payer: Healthscope Commercial |
$138.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.48
|
| Rate for Payer: PHP Commercial |
$130.88
|
| Rate for Payer: Priority Health SBD |
$97.01
|
|
|
HC CAROTENE
|
Facility
|
OP
|
$153.98
|
|
|
Service Code
|
CPT 82380
|
| Hospital Charge Code |
30100137
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$138.58 |
| Rate for Payer: Aetna Commercial |
$130.88
|
| Rate for Payer: Aetna Medicare |
$9.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.53
|
| Rate for Payer: BCBS Complete |
$5.06
|
| Rate for Payer: BCBS MAPPO |
$9.22
|
| Rate for Payer: BCBS Trust/PPO |
$9.84
|
| Rate for Payer: BCN Commercial |
$9.84
|
| Rate for Payer: BCN Medicare Advantage |
$9.22
|
| Rate for Payer: Cash Price |
$123.18
|
| Rate for Payer: Cash Price |
$123.18
|
| Rate for Payer: Cofinity Advantage |
$107.79
|
| Rate for Payer: Cofinity Commercial |
$132.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.22
|
| Rate for Payer: Healthscope Commercial |
$138.58
|
| Rate for Payer: Mclaren Medicaid |
$4.82
|
| Rate for Payer: Mclaren Medicare |
$9.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.68
|
| Rate for Payer: Meridian Medicaid |
$9.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.88
|
| Rate for Payer: Nomi Health Commercial |
$13.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.48
|
| Rate for Payer: PACE Medicare |
$8.76
|
| Rate for Payer: PACE SWMI |
$9.22
|
| Rate for Payer: PHP Commercial |
$130.88
|
| Rate for Payer: PHP Medicare Advantage |
$9.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.22
|
| Rate for Payer: Priority Health Medicare |
$9.22
|
| Rate for Payer: Priority Health SBD |
$97.01
|
| Rate for Payer: Priority Health Tiered Network |
$7.38
|
| Rate for Payer: Railroad Medicare Medicare |
$9.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.83
|
| Rate for Payer: UHC Core |
$13.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9.22
|
| Rate for Payer: UHC Exchange |
$13.83
|
| Rate for Payer: UHC Medicaid |
$4.82
|
| Rate for Payer: UHCCP Medicaid |
$4.82
|
| Rate for Payer: VA VA |
$9.22
|
|
|
HC CAROTID/VERTEBRAL LIMITED
|
Facility
|
OP
|
$741.06
|
|
|
Service Code
|
CPT 93882
|
| Hospital Charge Code |
40200054
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$666.95 |
| Rate for Payer: Aetna Commercial |
$629.90
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$481.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$442.67
|
| Rate for Payer: BCN Commercial |
$442.67
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$592.85
|
| Rate for Payer: Cash Price |
$592.85
|
| Rate for Payer: Cofinity Advantage |
$518.74
|
| Rate for Payer: Cofinity Commercial |
$637.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$592.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$666.95
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$629.90
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$555.79
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$629.90
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$466.87
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$481.69
|
| Rate for Payer: UHC Core |
$386.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$291.24
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC CAROTID/VERTEBRAL LIMITED
|
Facility
|
IP
|
$741.06
|
|
|
Service Code
|
CPT 93882
|
| Hospital Charge Code |
40200054
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$466.87 |
| Max. Negotiated Rate |
$666.95 |
| Rate for Payer: Aetna Commercial |
$629.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$481.69
|
| Rate for Payer: Cash Price |
$592.85
|
| Rate for Payer: Cofinity Advantage |
$518.74
|
| Rate for Payer: Cofinity Commercial |
$637.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$592.85
|
| Rate for Payer: Healthscope Commercial |
$666.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$629.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$555.79
|
| Rate for Payer: PHP Commercial |
$629.90
|
| Rate for Payer: Priority Health SBD |
$466.87
|
|
|
HC CAROTID/VERTEBRAL ULTRASOUND
|
Facility
|
IP
|
$1,409.73
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
92100001
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$888.13 |
| Max. Negotiated Rate |
$1,268.76 |
| Rate for Payer: Aetna Commercial |
$1,198.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$916.32
|
| Rate for Payer: Cash Price |
$1,127.78
|
| Rate for Payer: Cofinity Advantage |
$986.81
|
| Rate for Payer: Cofinity Commercial |
$1,212.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,127.78
|
| Rate for Payer: Healthscope Commercial |
$1,268.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,198.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,057.30
|
| Rate for Payer: PHP Commercial |
$1,198.27
|
| Rate for Payer: Priority Health SBD |
$888.13
|
|
|
HC CAROTID/VERTEBRAL ULTRASOUND
|
Facility
|
OP
|
$1,409.73
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
92100001
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$1,268.76 |
| Rate for Payer: Aetna Commercial |
$1,198.27
|
| Rate for Payer: Aetna Medicare |
$247.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$916.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$666.21
|
| Rate for Payer: BCN Commercial |
$666.21
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$1,127.78
|
| Rate for Payer: Cash Price |
$1,127.78
|
| Rate for Payer: Cofinity Advantage |
$986.81
|
| Rate for Payer: Cofinity Commercial |
$1,212.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,127.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$1,268.76
|
| Rate for Payer: Mclaren Medicaid |
$124.34
|
| Rate for Payer: Mclaren Medicare |
$237.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.63
|
| Rate for Payer: Meridian Medicaid |
$249.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,198.27
|
| Rate for Payer: Nomi Health Commercial |
$713.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,057.30
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$1,198.27
|
| Rate for Payer: PHP Medicare Advantage |
$237.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$768.83
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health SBD |
$888.13
|
| Rate for Payer: Priority Health Tiered Network |
$615.06
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$916.32
|
| Rate for Payer: UHC Core |
$734.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$554.02
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC CART TRACE 24 IN
|
Facility
|
IP
|
$114.00
|
|
| Hospital Charge Code |
27000714
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$71.82 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna Commercial |
$96.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.10
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Advantage |
$79.80
|
| Rate for Payer: Cofinity Commercial |
$98.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.20
|
| Rate for Payer: Healthscope Commercial |
$102.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.50
|
| Rate for Payer: PHP Commercial |
$96.90
|
| Rate for Payer: Priority Health SBD |
$71.82
|
|
|
HC CART TRACE 24 IN
|
Facility
|
OP
|
$114.00
|
|
| Hospital Charge Code |
27000714
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna Commercial |
$96.90
|
| Rate for Payer: Aetna Medicare |
$57.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.10
|
| Rate for Payer: BCBS Complete |
$45.60
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Advantage |
$79.80
|
| Rate for Payer: Cofinity Commercial |
$98.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.20
|
| Rate for Payer: Healthscope Commercial |
$102.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.50
|
| Rate for Payer: PHP Commercial |
$96.90
|
| Rate for Payer: Priority Health SBD |
$71.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.10
|
| Rate for Payer: UHC Core |
$59.39
|
| Rate for Payer: UHC Exchange |
$44.80
|
|
|
HC CASHEW IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200030
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC CASHEW IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200030
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
|
|
HC CASSETTE ADDITIVE
|
Facility
|
OP
|
$109.50
|
|
| Hospital Charge Code |
27000719
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$43.03 |
| Max. Negotiated Rate |
$98.55 |
| Rate for Payer: Aetna Commercial |
$93.08
|
| Rate for Payer: Aetna Medicare |
$54.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.17
|
| Rate for Payer: BCBS Complete |
$43.80
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cofinity Advantage |
$76.65
|
| Rate for Payer: Cofinity Commercial |
$94.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.60
|
| Rate for Payer: Healthscope Commercial |
$98.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.12
|
| Rate for Payer: PHP Commercial |
$93.08
|
| Rate for Payer: Priority Health SBD |
$68.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.17
|
| Rate for Payer: UHC Core |
$57.05
|
| Rate for Payer: UHC Exchange |
$43.03
|
|
|
HC CASSETTE ADDITIVE
|
Facility
|
IP
|
$109.50
|
|
| Hospital Charge Code |
27000719
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$68.98 |
| Max. Negotiated Rate |
$98.55 |
| Rate for Payer: Aetna Commercial |
$93.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.17
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cofinity Advantage |
$76.65
|
| Rate for Payer: Cofinity Commercial |
$94.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.60
|
| Rate for Payer: Healthscope Commercial |
$98.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.12
|
| Rate for Payer: PHP Commercial |
$93.08
|
| Rate for Payer: Priority Health SBD |
$68.98
|
|
|
HC CASSETTES QUEST
|
Facility
|
IP
|
$78.03
|
|
| Hospital Charge Code |
27000458
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$49.16 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.72
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Advantage |
$54.62
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.52
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: Priority Health SBD |
$49.16
|
|
