|
HC BRONCHOSCOPY W EBUS EXAM
|
Facility
|
IP
|
$3,178.02
|
|
| Hospital Charge Code |
36000015
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,002.15 |
| Max. Negotiated Rate |
$2,860.22 |
| Rate for Payer: Aetna Commercial |
$2,701.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,065.71
|
| Rate for Payer: Cash Price |
$2,542.42
|
| Rate for Payer: Cofinity Commercial |
$2,224.61
|
| Rate for Payer: Cofinity Commercial |
$2,733.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,224.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,542.42
|
| Rate for Payer: Healthscope Commercial |
$2,860.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,701.32
|
| Rate for Payer: PHP Commercial |
$2,701.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,065.71
|
| Rate for Payer: Priority Health SBD |
$2,002.15
|
|
|
HC BRONCHOSCOPY W EBUS EXAM
|
Facility
|
OP
|
$3,178.02
|
|
| Hospital Charge Code |
36000015
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,271.21 |
| Max. Negotiated Rate |
$2,860.22 |
| Rate for Payer: Aetna Commercial |
$2,701.32
|
| Rate for Payer: Aetna Medicare |
$1,589.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,065.71
|
| Rate for Payer: BCBS Complete |
$1,271.21
|
| Rate for Payer: Cash Price |
$2,542.42
|
| Rate for Payer: Cofinity Commercial |
$2,224.61
|
| Rate for Payer: Cofinity Commercial |
$2,733.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,224.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,542.42
|
| Rate for Payer: Healthscope Commercial |
$2,860.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,701.32
|
| Rate for Payer: PHP Commercial |
$2,701.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,065.71
|
| Rate for Payer: Priority Health SBD |
$2,002.15
|
|
|
HC BRONCHOSPASM PROVOCATION (METHACHOLINE CHALLENGE)
|
Facility
|
IP
|
$708.68
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
46000003
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$446.47 |
| Max. Negotiated Rate |
$637.81 |
| Rate for Payer: Aetna Commercial |
$602.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$460.64
|
| Rate for Payer: Cash Price |
$566.94
|
| Rate for Payer: Cofinity Commercial |
$496.08
|
| Rate for Payer: Cofinity Commercial |
$609.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$496.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$566.94
|
| Rate for Payer: Healthscope Commercial |
$637.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$602.38
|
| Rate for Payer: PHP Commercial |
$602.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$460.64
|
| Rate for Payer: Priority Health SBD |
$446.47
|
|
|
HC BRONCHOSPASM PROVOCATION (METHACHOLINE CHALLENGE)
|
Facility
|
OP
|
$708.68
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
46000003
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$854.89 |
| Rate for Payer: Aetna Commercial |
$602.38
|
| Rate for Payer: Aetna Medicare |
$315.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$460.64
|
| 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 |
$566.94
|
| Rate for Payer: Cash Price |
$566.94
|
| Rate for Payer: Cofinity Commercial |
$609.46
|
| Rate for Payer: Cofinity Commercial |
$496.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$496.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$566.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$637.81
|
| 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 |
$602.38
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$602.38
|
| 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 |
$460.64
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health SBD |
$446.47
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.89
|
| Rate for Payer: UHC Core |
$524.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$524.42
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$170.98
|
| Rate for Payer: VA VA |
$303.70
|
|
|
HC BRUCELLA ANTIBODY
|
Facility
|
OP
|
$73.44
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
30200236
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna Medicare |
$9.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.16
|
| Rate for Payer: BCBS Complete |
$5.03
|
| Rate for Payer: BCBS MAPPO |
$8.93
|
| Rate for Payer: BCN Medicare Advantage |
$8.93
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Cofinity Commercial |
$51.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.93
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Mclaren Medicaid |
$4.79
|
| Rate for Payer: Mclaren Medicare |
$8.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.38
|
| Rate for Payer: Meridian Medicaid |
$5.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: PACE Medicare |
$8.48
|
| Rate for Payer: PACE SWMI |
$8.93
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: PHP Medicare Advantage |
$8.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: Priority Health Medicare |
$8.93
|
| Rate for Payer: Priority Health SBD |
$46.27
|
| Rate for Payer: Railroad Medicare Medicare |
$8.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.93
|
| Rate for Payer: UHC Medicare Advantage |
$8.93
|
| Rate for Payer: UHCCP Medicaid |
$5.03
|
| Rate for Payer: VA VA |
$8.93
|
|
|
HC BRUCELLA ANTIBODY
|
Facility
|
IP
|
$73.44
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
30200236
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.27 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.74
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$51.41
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: Priority Health SBD |
$46.27
|
|
|
HC BRUCELLA ANTIBODY CMPT
|
Facility
|
OP
|
$73.44
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
30200238
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna Medicare |
$9.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.16
|
| Rate for Payer: BCBS Complete |
$5.03
|
| Rate for Payer: BCBS MAPPO |
$8.93
|
| Rate for Payer: BCN Medicare Advantage |
$8.93
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Cofinity Commercial |
$51.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.93
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Mclaren Medicaid |
$4.79
|
| Rate for Payer: Mclaren Medicare |
$8.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.38
|
| Rate for Payer: Meridian Medicaid |
$5.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: PACE Medicare |
$8.48
|
| Rate for Payer: PACE SWMI |
$8.93
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: PHP Medicare Advantage |
$8.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: Priority Health Medicare |
$8.93
|
| Rate for Payer: Priority Health SBD |
$46.27
|
| Rate for Payer: Railroad Medicare Medicare |
$8.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.93
|
| Rate for Payer: UHC Medicare Advantage |
$8.93
|
| Rate for Payer: UHCCP Medicaid |
$5.03
|
| Rate for Payer: VA VA |
$8.93
|
|
|
HC BRUCELLA ANTIBODY CMPT
|
Facility
|
IP
|
$73.44
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
30200238
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.27 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.74
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$51.41
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: Priority Health SBD |
$46.27
|
|
|
HC BRUCELLA ANTIBODY CONFIRMATION
|
Facility
|
IP
|
$53.04
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
30200237
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.42 |
| Max. Negotiated Rate |
$47.74 |
| Rate for Payer: Aetna Commercial |
$45.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.48
|
| Rate for Payer: Cash Price |
$42.43
|
| Rate for Payer: Cofinity Commercial |
$37.13
|
| Rate for Payer: Cofinity Commercial |
$45.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.43
|
| Rate for Payer: Healthscope Commercial |
$47.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.08
|
| Rate for Payer: PHP Commercial |
$45.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.48
|
| Rate for Payer: Priority Health SBD |
$33.42
|
|
|
HC BRUCELLA ANTIBODY CONFIRMATION
|
Facility
|
OP
|
$53.04
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
30200237
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$47.74 |
| Rate for Payer: Aetna Commercial |
$45.08
|
| Rate for Payer: Aetna Medicare |
$9.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.16
|
| Rate for Payer: BCBS Complete |
$5.03
|
| Rate for Payer: BCBS MAPPO |
$8.93
|
| Rate for Payer: BCN Medicare Advantage |
$8.93
|
| Rate for Payer: Cash Price |
$42.43
|
| Rate for Payer: Cash Price |
$42.43
|
| Rate for Payer: Cofinity Commercial |
$45.61
|
| Rate for Payer: Cofinity Commercial |
$37.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.93
|
| Rate for Payer: Healthscope Commercial |
$47.74
|
| Rate for Payer: Mclaren Medicaid |
$4.79
|
| Rate for Payer: Mclaren Medicare |
$8.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.38
|
| Rate for Payer: Meridian Medicaid |
$5.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.08
|
| Rate for Payer: PACE Medicare |
$8.48
|
| Rate for Payer: PACE SWMI |
$8.93
|
| Rate for Payer: PHP Commercial |
$45.08
|
| Rate for Payer: PHP Medicare Advantage |
$8.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.48
|
| Rate for Payer: Priority Health Medicare |
$8.93
|
| Rate for Payer: Priority Health SBD |
$33.42
|
| Rate for Payer: Railroad Medicare Medicare |
$8.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.93
|
| Rate for Payer: UHC Medicare Advantage |
$8.93
|
| Rate for Payer: UHCCP Medicaid |
$5.03
|
| Rate for Payer: VA VA |
$8.93
|
|
|
HC BUDESONIDE INHALATION SOLUTION
|
Facility
|
OP
|
$29.35
|
|
| Hospital Charge Code |
63700005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.74 |
| Max. Negotiated Rate |
$26.41 |
| Rate for Payer: Aetna Commercial |
$24.95
|
| Rate for Payer: Aetna Medicare |
$14.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.08
|
| Rate for Payer: BCBS Complete |
$11.74
|
| Rate for Payer: Cash Price |
$23.48
|
| Rate for Payer: Cofinity Commercial |
$20.55
|
| Rate for Payer: Cofinity Commercial |
$25.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.48
|
| Rate for Payer: Healthscope Commercial |
$26.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.95
|
| Rate for Payer: PHP Commercial |
$24.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.08
|
| Rate for Payer: Priority Health SBD |
$18.49
|
|
|
HC BUDESONIDE INHALATION SOLUTION
|
Facility
|
IP
|
$29.35
|
|
| Hospital Charge Code |
63700005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.49 |
| Max. Negotiated Rate |
$26.41 |
| Rate for Payer: Aetna Commercial |
$24.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.08
|
| Rate for Payer: Cash Price |
$23.48
|
| Rate for Payer: Cofinity Commercial |
$20.55
|
| Rate for Payer: Cofinity Commercial |
$25.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.48
|
| Rate for Payer: Healthscope Commercial |
$26.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.95
|
| Rate for Payer: PHP Commercial |
$24.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.08
|
| Rate for Payer: Priority Health SBD |
$18.49
|
|
|
HC BUNDLE OF HIS RECORDING
|
Facility
|
IP
|
$4,021.38
|
|
|
Service Code
|
CPT 93600
|
| Hospital Charge Code |
48100029
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,533.47 |
| Max. Negotiated Rate |
$3,619.24 |
| Rate for Payer: Aetna Commercial |
$3,418.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,613.90
|
| Rate for Payer: Cash Price |
$3,217.10
|
| Rate for Payer: Cofinity Commercial |
$2,814.97
|
| Rate for Payer: Cofinity Commercial |
$3,458.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,814.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,217.10
|
| Rate for Payer: Healthscope Commercial |
$3,619.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,418.17
|
| Rate for Payer: PHP Commercial |
$3,418.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,613.90
|
| Rate for Payer: Priority Health SBD |
$2,533.47
|
|
|
HC BUNDLE OF HIS RECORDING
|
Facility
|
OP
|
$4,021.38
|
|
|
Service Code
|
CPT 93600
|
| Hospital Charge Code |
48100029
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,533.47 |
| Max. Negotiated Rate |
$20,831.72 |
| Rate for Payer: Aetna Commercial |
$3,418.17
|
| Rate for Payer: Aetna Medicare |
$7,696.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,613.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,250.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,250.65
|
| Rate for Payer: BCBS Complete |
$4,165.01
|
| Rate for Payer: BCBS MAPPO |
$7,400.52
|
| Rate for Payer: BCN Medicare Advantage |
$7,400.52
|
| Rate for Payer: Cash Price |
$3,217.10
|
| Rate for Payer: Cash Price |
$3,217.10
|
| Rate for Payer: Cofinity Commercial |
$3,458.39
|
| Rate for Payer: Cofinity Commercial |
$2,814.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,814.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,217.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,400.52
|
| Rate for Payer: Healthscope Commercial |
$3,619.24
|
| Rate for Payer: Mclaren Medicaid |
$3,966.68
|
| Rate for Payer: Mclaren Medicare |
$7,400.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,770.55
|
| Rate for Payer: Meridian Medicaid |
$4,165.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,510.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,418.17
|
| Rate for Payer: PACE Medicare |
$7,030.49
|
| Rate for Payer: PACE SWMI |
$7,400.52
|
| Rate for Payer: PHP Commercial |
$3,418.17
|
| Rate for Payer: PHP Medicare Advantage |
$7,400.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,966.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,613.90
|
| Rate for Payer: Priority Health Medicare |
$7,400.52
|
| Rate for Payer: Priority Health SBD |
$2,533.47
|
| Rate for Payer: Railroad Medicare Medicare |
$7,400.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,831.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,400.52
|
| Rate for Payer: UHC Medicare Advantage |
$7,400.52
|
| Rate for Payer: UHCCP Medicaid |
$4,166.49
|
| Rate for Payer: VA VA |
$7,400.52
|
|
|
HC BUPIVACAINE 0.5 MG
|
Facility
|
IP
|
$1.51
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25000016
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$1.36 |
| Rate for Payer: Aetna Commercial |
$1.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.98
|
| Rate for Payer: Cash Price |
$1.21
|
| Rate for Payer: Cofinity Commercial |
$1.06
|
| Rate for Payer: Cofinity Commercial |
$1.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.21
|
| Rate for Payer: Healthscope Commercial |
$1.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.28
|
| Rate for Payer: PHP Commercial |
$1.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.98
|
| Rate for Payer: Priority Health SBD |
$0.95
|
|
|
HC BUPIVACAINE 0.5 MG
|
Facility
|
OP
|
$1.51
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25000016
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1.36 |
| Rate for Payer: Aetna Commercial |
$1.28
|
| Rate for Payer: Aetna Medicare |
$0.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.98
|
| Rate for Payer: BCBS Complete |
$0.60
|
| Rate for Payer: Cash Price |
$1.21
|
| Rate for Payer: Cofinity Commercial |
$1.06
|
| Rate for Payer: Cofinity Commercial |
$1.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.21
|
| Rate for Payer: Healthscope Commercial |
$1.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.28
|
| Rate for Payer: PHP Commercial |
$1.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.98
|
| Rate for Payer: Priority Health SBD |
$0.95
|
|
|
HC BUPRENORPHINE & MET QUANT, UR
|
Facility
|
IP
|
$177.48
|
|
|
Service Code
|
CPT 80348
|
| Hospital Charge Code |
30100598
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$111.81 |
| Max. Negotiated Rate |
$159.73 |
| Rate for Payer: Aetna Commercial |
$150.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.36
|
| Rate for Payer: Cash Price |
$141.98
|
| Rate for Payer: Cofinity Commercial |
$124.24
|
| Rate for Payer: Cofinity Commercial |
$152.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.98
|
| Rate for Payer: Healthscope Commercial |
$159.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.86
|
| Rate for Payer: PHP Commercial |
$150.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.36
|
| Rate for Payer: Priority Health SBD |
$111.81
|
|
|
HC BUPRENORPHINE & MET QUANT, UR
|
Facility
|
OP
|
$177.48
|
|
|
Service Code
|
CPT 80348
|
| Hospital Charge Code |
30100598
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$70.99 |
| Max. Negotiated Rate |
$159.73 |
| Rate for Payer: Aetna Commercial |
$150.86
|
| Rate for Payer: Aetna Medicare |
$88.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.36
|
| Rate for Payer: BCBS Complete |
$70.99
|
| Rate for Payer: Cash Price |
$141.98
|
| Rate for Payer: Cofinity Commercial |
$124.24
|
| Rate for Payer: Cofinity Commercial |
$152.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.98
|
| Rate for Payer: Healthscope Commercial |
$159.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.86
|
| Rate for Payer: PHP Commercial |
$150.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.36
|
| Rate for Payer: Priority Health SBD |
$111.81
|
|
|
HC BUPRENORPHINE SCRN URN
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000116
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.22 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.05
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health SBD |
$26.22
|
|
|
HC BUPRENORPHINE SCRN URN
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000116
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna Medicare |
$13.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.75
|
| Rate for Payer: BCBS Complete |
$7.09
|
| Rate for Payer: BCBS MAPPO |
$12.60
|
| Rate for Payer: BCN Medicare Advantage |
$12.60
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Cofinity Commercial |
$29.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Mclaren Medicaid |
$6.75
|
| Rate for Payer: Mclaren Medicare |
$12.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.23
|
| Rate for Payer: Meridian Medicaid |
$7.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: PACE Medicare |
$11.97
|
| Rate for Payer: PACE SWMI |
$12.60
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: PHP Medicare Advantage |
$12.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health Medicare |
$12.60
|
| Rate for Payer: Priority Health SBD |
$26.22
|
| Rate for Payer: Railroad Medicare Medicare |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.60
|
| Rate for Payer: UHC Medicare Advantage |
$12.60
|
| Rate for Payer: UHCCP Medicaid |
$7.09
|
| Rate for Payer: VA VA |
$12.60
|
|
|
HC BURN CARE LARGE
|
Facility
|
IP
|
$691.65
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
36100007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$435.74 |
| Max. Negotiated Rate |
$622.49 |
| Rate for Payer: Aetna Commercial |
$587.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$449.57
|
| Rate for Payer: Cash Price |
$553.32
|
| Rate for Payer: Cofinity Commercial |
$484.15
|
| Rate for Payer: Cofinity Commercial |
$594.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$484.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.32
|
| Rate for Payer: Healthscope Commercial |
$622.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.90
|
| Rate for Payer: PHP Commercial |
$587.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.57
|
| Rate for Payer: Priority Health SBD |
$435.74
|
|
|
HC BURN CARE LARGE
|
Facility
|
OP
|
$691.65
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
36100007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna Commercial |
$587.90
|
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$449.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$553.32
|
| Rate for Payer: Cash Price |
$553.32
|
| Rate for Payer: Cofinity Commercial |
$594.82
|
| Rate for Payer: Cofinity Commercial |
$484.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$484.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$622.49
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.90
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$587.90
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.57
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health SBD |
$435.74
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$219.37
|
| Rate for Payer: VA VA |
$389.65
|
|
|
HC BURN CARE MEDIUM
|
Facility
|
OP
|
$531.94
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
36100006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna Commercial |
$452.15
|
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Cash Price |
$425.55
|
| Rate for Payer: Cash Price |
$425.55
|
| Rate for Payer: Cofinity Commercial |
$457.47
|
| Rate for Payer: Cofinity Commercial |
$372.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$372.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$478.75
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$452.15
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$452.15
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.76
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health SBD |
$335.12
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$109.10
|
| Rate for Payer: VA VA |
$193.79
|
|
|
HC BURN CARE MEDIUM
|
Facility
|
IP
|
$531.94
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
36100006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$335.12 |
| Max. Negotiated Rate |
$478.75 |
| Rate for Payer: Aetna Commercial |
$452.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.76
|
| Rate for Payer: Cash Price |
$425.55
|
| Rate for Payer: Cofinity Commercial |
$372.36
|
| Rate for Payer: Cofinity Commercial |
$457.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$372.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.55
|
| Rate for Payer: Healthscope Commercial |
$478.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$452.15
|
| Rate for Payer: PHP Commercial |
$452.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.76
|
| Rate for Payer: Priority Health SBD |
$335.12
|
|
|
HC BURN CARE SMALL
|
Facility
|
IP
|
$365.20
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
36100005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$230.08 |
| Max. Negotiated Rate |
$328.68 |
| Rate for Payer: Aetna Commercial |
$310.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.38
|
| Rate for Payer: Cash Price |
$292.16
|
| Rate for Payer: Cofinity Commercial |
$255.64
|
| Rate for Payer: Cofinity Commercial |
$314.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$255.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.16
|
| Rate for Payer: Healthscope Commercial |
$328.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.42
|
| Rate for Payer: PHP Commercial |
$310.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.38
|
| Rate for Payer: Priority Health SBD |
$230.08
|
|
