|
HC DILATOR SIZE 12
|
Facility
|
OP
|
$35.26
|
|
| Hospital Charge Code |
27000055
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.86 |
| Max. Negotiated Rate |
$31.73 |
| Rate for Payer: Aetna Commercial |
$29.97
|
| Rate for Payer: Aetna Medicare |
$17.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.92
|
| Rate for Payer: BCBS Complete |
$14.10
|
| Rate for Payer: Cash Price |
$28.21
|
| Rate for Payer: Cofinity Advantage |
$24.68
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.21
|
| Rate for Payer: Healthscope Commercial |
$31.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.45
|
| Rate for Payer: PHP Commercial |
$29.97
|
| Rate for Payer: Priority Health SBD |
$22.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.92
|
| Rate for Payer: UHC Core |
$18.37
|
| Rate for Payer: UHC Exchange |
$13.86
|
|
|
HC DILATOR SIZE 7
|
Facility
|
IP
|
$25.81
|
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.26 |
| Max. Negotiated Rate |
$23.23 |
| Rate for Payer: Aetna Commercial |
$21.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.78
|
| Rate for Payer: Cash Price |
$20.65
|
| Rate for Payer: Cofinity Advantage |
$18.07
|
| Rate for Payer: Cofinity Commercial |
$22.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.65
|
| Rate for Payer: Healthscope Commercial |
$23.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.36
|
| Rate for Payer: PHP Commercial |
$21.94
|
| Rate for Payer: Priority Health SBD |
$16.26
|
|
|
HC DILATOR SIZE 7
|
Facility
|
OP
|
$25.81
|
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$23.23 |
| Rate for Payer: Aetna Commercial |
$21.94
|
| Rate for Payer: Aetna Medicare |
$12.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.78
|
| Rate for Payer: BCBS Complete |
$10.32
|
| Rate for Payer: Cash Price |
$20.65
|
| Rate for Payer: Cofinity Advantage |
$18.07
|
| Rate for Payer: Cofinity Commercial |
$22.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.65
|
| Rate for Payer: Healthscope Commercial |
$23.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.36
|
| Rate for Payer: PHP Commercial |
$21.94
|
| Rate for Payer: Priority Health SBD |
$16.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.78
|
| Rate for Payer: UHC Core |
$13.45
|
| Rate for Payer: UHC Exchange |
$10.14
|
|
|
HC DILATOR SIZE 9
|
Facility
|
OP
|
$25.81
|
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$23.23 |
| Rate for Payer: Aetna Commercial |
$21.94
|
| Rate for Payer: Aetna Medicare |
$12.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.78
|
| Rate for Payer: BCBS Complete |
$10.32
|
| Rate for Payer: Cash Price |
$20.65
|
| Rate for Payer: Cofinity Advantage |
$18.07
|
| Rate for Payer: Cofinity Commercial |
$22.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.65
|
| Rate for Payer: Healthscope Commercial |
$23.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.36
|
| Rate for Payer: PHP Commercial |
$21.94
|
| Rate for Payer: Priority Health SBD |
$16.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.78
|
| Rate for Payer: UHC Core |
$13.45
|
| Rate for Payer: UHC Exchange |
$10.14
|
|
|
HC DILATOR SIZE 9
|
Facility
|
IP
|
$25.81
|
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.26 |
| Max. Negotiated Rate |
$23.23 |
| Rate for Payer: Aetna Commercial |
$21.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.78
|
| Rate for Payer: Cash Price |
$20.65
|
| Rate for Payer: Cofinity Advantage |
$18.07
|
| Rate for Payer: Cofinity Commercial |
$22.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.65
|
| Rate for Payer: Healthscope Commercial |
$23.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.36
|
| Rate for Payer: PHP Commercial |
$21.94
|
| Rate for Payer: Priority Health SBD |
$16.26
|
|
|
HC DIL PERC EXISTING TRACT INCLUDE NEW ACCESS
|
Facility
|
IP
|
$4,658.71
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
32000329
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,934.99 |
| Max. Negotiated Rate |
$4,192.84 |
| Rate for Payer: Aetna Commercial |
$3,959.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,028.16
|
| Rate for Payer: Cash Price |
$3,726.97
|
| Rate for Payer: Cofinity Advantage |
$3,261.10
|
| Rate for Payer: Cofinity Commercial |
$4,006.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,726.97
|
| Rate for Payer: Healthscope Commercial |
$4,192.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,959.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,494.03
|
| Rate for Payer: PHP Commercial |
$3,959.90
|
| Rate for Payer: Priority Health SBD |
$2,934.99
|
|
|
HC DIL PERC EXISTING TRACT INCLUDE NEW ACCESS
|
Facility
|
OP
|
$4,658.71
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
32000329
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,789.76 |
| Max. Negotiated Rate |
$11,358.48 |
| Rate for Payer: Aetna Commercial |
$3,959.90
|
| Rate for Payer: Aetna Medicare |
$3,652.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,028.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,390.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,390.39
|
| Rate for Payer: BCBS Complete |
$1,928.96
|
| Rate for Payer: BCBS MAPPO |
$3,512.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,789.76
|
| Rate for Payer: BCN Commercial |
$1,789.76
|
| Rate for Payer: BCN Medicare Advantage |
$3,512.31
|
| Rate for Payer: Cash Price |
$3,726.97
|
| Rate for Payer: Cash Price |
$3,726.97
|
| Rate for Payer: Cash Price |
$3,726.97
|
| Rate for Payer: Cofinity Advantage |
$3,261.10
|
| Rate for Payer: Cofinity Commercial |
$4,006.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,726.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,512.31
|
| Rate for Payer: Healthscope Commercial |
$4,192.84
|
| Rate for Payer: Mclaren Medicaid |
$1,836.94
|
| Rate for Payer: Mclaren Medicare |
$3,512.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,687.93
|
| Rate for Payer: Meridian Medicaid |
$3,687.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,039.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,863.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,959.90
|
| Rate for Payer: Nomi Health Commercial |
$10,536.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,494.03
|
| Rate for Payer: PACE Medicare |
$3,336.69
|
| Rate for Payer: PACE SWMI |
$3,512.31
|
| Rate for Payer: PHP Commercial |
$3,959.90
|
| Rate for Payer: PHP Medicare Advantage |
$3,512.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,836.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,358.48
|
| Rate for Payer: Priority Health Medicare |
$3,512.31
|
| Rate for Payer: Priority Health SBD |
$2,934.99
|
| Rate for Payer: Priority Health Tiered Network |
$9,086.78
|
| Rate for Payer: Railroad Medicare Medicare |
$3,512.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,028.16
|
| Rate for Payer: UHC Core |
$2,427.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,512.31
|
| Rate for Payer: UHC Exchange |
$1,830.87
|
| Rate for Payer: UHC Medicaid |
$1,836.94
|
| Rate for Payer: UHCCP Medicaid |
$1,836.94
|
| Rate for Payer: VA VA |
$3,512.31
|
|
|
HC DIPHTHERIA/TETANUS AB PANEL, S
|
Facility
|
OP
|
$46.30
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200506
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$41.67 |
| Rate for Payer: Aetna Commercial |
$39.35
|
| Rate for Payer: Aetna Medicare |
$15.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.74
|
| Rate for Payer: BCBS Complete |
$8.23
|
| Rate for Payer: BCBS MAPPO |
$14.99
|
| Rate for Payer: BCBS Trust/PPO |
$15.98
|
| Rate for Payer: BCN Commercial |
$15.98
|
| Rate for Payer: BCN Medicare Advantage |
$14.99
|
| Rate for Payer: Cash Price |
$37.04
|
| Rate for Payer: Cash Price |
$37.04
|
| Rate for Payer: Cofinity Advantage |
$32.41
|
| Rate for Payer: Cofinity Commercial |
$39.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.99
|
| Rate for Payer: Healthscope Commercial |
$41.67
|
| Rate for Payer: Mclaren Medicaid |
$7.84
|
| Rate for Payer: Mclaren Medicare |
$14.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.74
|
| Rate for Payer: Meridian Medicaid |
$15.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.35
|
| Rate for Payer: Nomi Health Commercial |
$22.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.73
|
| Rate for Payer: PACE Medicare |
$14.24
|
| Rate for Payer: PACE SWMI |
$14.99
|
| Rate for Payer: PHP Commercial |
$39.35
|
| Rate for Payer: PHP Medicare Advantage |
$14.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.99
|
| Rate for Payer: Priority Health Medicare |
$14.99
|
| Rate for Payer: Priority Health SBD |
$29.17
|
| Rate for Payer: Priority Health Tiered Network |
$11.99
|
| Rate for Payer: Railroad Medicare Medicare |
$14.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.49
|
| Rate for Payer: UHC Core |
$22.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.99
|
| Rate for Payer: UHC Exchange |
$22.49
|
| Rate for Payer: UHC Medicaid |
$7.84
|
| Rate for Payer: UHCCP Medicaid |
$7.84
|
| Rate for Payer: VA VA |
$14.99
|
|
|
HC DIPHTHERIA/TETANUS AB PANEL, S
|
Facility
|
IP
|
$46.30
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200506
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.17 |
| Max. Negotiated Rate |
$41.67 |
| Rate for Payer: Aetna Commercial |
$39.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.09
|
| Rate for Payer: Cash Price |
$37.04
|
| Rate for Payer: Cofinity Advantage |
$32.41
|
| Rate for Payer: Cofinity Commercial |
$39.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.04
|
| Rate for Payer: Healthscope Commercial |
$41.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.73
|
| Rate for Payer: PHP Commercial |
$39.35
|
| Rate for Payer: Priority Health SBD |
$29.17
|
|
|
HC DIP, TET TOX, HAEMO INFLU TYPE B, INACTIV POLIO VAC, (DTAP-IPV/HIB) IM
|
Facility
|
OP
|
$126.07
|
|
|
Service Code
|
CPT 90698
|
| Hospital Charge Code |
63600080
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.43 |
| Max. Negotiated Rate |
$321.42 |
| Rate for Payer: Aetna Commercial |
$107.16
|
| Rate for Payer: Aetna Medicare |
$63.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.95
|
| Rate for Payer: BCBS Complete |
$50.43
|
| Rate for Payer: BCBS Trust/PPO |
$321.42
|
| Rate for Payer: BCN Commercial |
$321.42
|
| Rate for Payer: Cash Price |
$100.86
|
| Rate for Payer: Cash Price |
$100.86
|
| Rate for Payer: Cofinity Advantage |
$88.25
|
| Rate for Payer: Cofinity Commercial |
$108.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.86
|
| Rate for Payer: Healthscope Commercial |
$113.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.55
|
| Rate for Payer: PHP Commercial |
$107.16
|
| Rate for Payer: Priority Health SBD |
$79.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.10
|
| Rate for Payer: UHC Core |
$233.10
|
| Rate for Payer: UHC Exchange |
$233.10
|
|
|
HC DIP, TET TOX, HAEMO INFLU TYPE B, INACTIV POLIO VAC, (DTAP-IPV/HIB) IM
|
Facility
|
IP
|
$126.07
|
|
|
Service Code
|
CPT 90698
|
| Hospital Charge Code |
63600080
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.42 |
| Max. Negotiated Rate |
$113.46 |
| Rate for Payer: Aetna Commercial |
$107.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.95
|
| Rate for Payer: Cash Price |
$100.86
|
| Rate for Payer: Cofinity Advantage |
$88.25
|
| Rate for Payer: Cofinity Commercial |
$108.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.86
|
| Rate for Payer: Healthscope Commercial |
$113.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.55
|
| Rate for Payer: PHP Commercial |
$107.16
|
| Rate for Payer: Priority Health SBD |
$79.42
|
|
|
HC DIPTH, TET TOX, AND ACELLUEAR PERTUSSIS VAC (DTAP), LESS THAN 7 YRS IM
|
Facility
|
OP
|
$54.86
|
|
|
Service Code
|
CPT 90700
|
| Hospital Charge Code |
63600081
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.94 |
| Max. Negotiated Rate |
$72.86 |
| Rate for Payer: Aetna Commercial |
$46.63
|
| Rate for Payer: Aetna Medicare |
$27.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.66
|
| Rate for Payer: BCBS Complete |
$21.94
|
| Rate for Payer: BCBS Trust/PPO |
$72.86
|
| Rate for Payer: BCN Commercial |
$72.86
|
| Rate for Payer: Cash Price |
$43.89
|
| Rate for Payer: Cash Price |
$43.89
|
| Rate for Payer: Cofinity Advantage |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$47.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.89
|
| Rate for Payer: Healthscope Commercial |
$49.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.15
|
| Rate for Payer: PHP Commercial |
$46.63
|
| Rate for Payer: Priority Health SBD |
$34.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.12
|
| Rate for Payer: UHC Core |
$61.12
|
| Rate for Payer: UHC Exchange |
$61.12
|
|
|
HC DIPTH, TET TOX, AND ACELLUEAR PERTUSSIS VAC (DTAP), LESS THAN 7 YRS IM
|
Facility
|
IP
|
$54.86
|
|
|
Service Code
|
CPT 90700
|
| Hospital Charge Code |
63600081
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.56 |
| Max. Negotiated Rate |
$49.37 |
| Rate for Payer: Aetna Commercial |
$46.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.66
|
| Rate for Payer: Cash Price |
$43.89
|
| Rate for Payer: Cofinity Advantage |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$47.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.89
|
| Rate for Payer: Healthscope Commercial |
$49.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.15
|
| Rate for Payer: PHP Commercial |
$46.63
|
| Rate for Payer: Priority Health SBD |
$34.56
|
|
|
HC DIRECT ADMIT TO OBS
|
Facility
|
OP
|
$157.93
|
|
|
Service Code
|
HCPCS G0379
|
| Hospital Charge Code |
76200001
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$99.50 |
| Max. Negotiated Rate |
$1,918.97 |
| Rate for Payer: Aetna Commercial |
$134.24
|
| Rate for Payer: Aetna Medicare |
$617.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$741.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$741.74
|
| Rate for Payer: BCBS Complete |
$325.89
|
| Rate for Payer: BCBS MAPPO |
$593.39
|
| Rate for Payer: BCBS Trust/PPO |
$112.58
|
| Rate for Payer: BCN Commercial |
$112.58
|
| Rate for Payer: BCN Medicare Advantage |
$593.39
|
| Rate for Payer: Cash Price |
$126.34
|
| Rate for Payer: Cash Price |
$126.34
|
| Rate for Payer: Cash Price |
$126.34
|
| Rate for Payer: Cash Price |
$126.34
|
| Rate for Payer: Cofinity Advantage |
$110.55
|
| Rate for Payer: Cofinity Commercial |
$135.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$593.39
|
| Rate for Payer: Healthscope Commercial |
$142.14
|
| Rate for Payer: Mclaren Medicaid |
$310.34
|
| Rate for Payer: Mclaren Medicare |
$593.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$623.06
|
| Rate for Payer: Meridian Medicaid |
$623.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$682.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$652.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.24
|
| Rate for Payer: Nomi Health Commercial |
$1,780.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.45
|
| Rate for Payer: PACE Medicare |
$563.72
|
| Rate for Payer: PACE SWMI |
$593.39
|
| Rate for Payer: PHP Commercial |
$134.24
|
| Rate for Payer: PHP Medicare Advantage |
$593.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$310.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,918.97
|
| Rate for Payer: Priority Health Medicare |
$593.39
|
| Rate for Payer: Priority Health SBD |
$99.50
|
| Rate for Payer: Priority Health Tiered Network |
$1,535.18
|
| Rate for Payer: Railroad Medicare Medicare |
$593.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$593.39
|
| Rate for Payer: UHC Medicaid |
$1,608.00
|
| Rate for Payer: UHCCP Medicaid |
$810.00
|
| Rate for Payer: VA VA |
$593.39
|
|
|
HC DIRECT ADMIT TO OBS
|
Facility
|
IP
|
$157.93
|
|
|
Service Code
|
HCPCS G0379
|
| Hospital Charge Code |
76200001
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$99.50 |
| Max. Negotiated Rate |
$142.14 |
| Rate for Payer: Aetna Commercial |
$134.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.65
|
| Rate for Payer: Cash Price |
$126.34
|
| Rate for Payer: Cofinity Advantage |
$110.55
|
| Rate for Payer: Cofinity Commercial |
$135.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.34
|
| Rate for Payer: Healthscope Commercial |
$142.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.45
|
| Rate for Payer: PHP Commercial |
$134.24
|
| Rate for Payer: Priority Health SBD |
$99.50
|
|
|
HC DIRECT COOMBS
|
Facility
|
IP
|
$66.96
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
30200343
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$42.18 |
| Max. Negotiated Rate |
$60.26 |
| Rate for Payer: Aetna Commercial |
$56.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.52
|
| Rate for Payer: Cash Price |
$53.57
|
| Rate for Payer: Cofinity Advantage |
$46.87
|
| Rate for Payer: Cofinity Commercial |
$57.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.57
|
| Rate for Payer: Healthscope Commercial |
$60.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.22
|
| Rate for Payer: PHP Commercial |
$56.92
|
| Rate for Payer: Priority Health SBD |
$42.18
|
|
|
HC DIRECT COOMBS
|
Facility
|
OP
|
$66.96
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
30200343
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$190.09 |
| Rate for Payer: Aetna Commercial |
$56.92
|
| Rate for Payer: Aetna Medicare |
$5.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.74
|
| Rate for Payer: BCBS Complete |
$2.96
|
| Rate for Payer: BCBS MAPPO |
$5.39
|
| Rate for Payer: BCBS Trust/PPO |
$5.74
|
| Rate for Payer: BCN Commercial |
$5.74
|
| Rate for Payer: BCN Medicare Advantage |
$5.39
|
| Rate for Payer: Cash Price |
$53.57
|
| Rate for Payer: Cash Price |
$53.57
|
| Rate for Payer: Cofinity Advantage |
$46.87
|
| Rate for Payer: Cofinity Commercial |
$57.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.39
|
| Rate for Payer: Healthscope Commercial |
$60.26
|
| Rate for Payer: Mclaren Medicaid |
$2.82
|
| Rate for Payer: Mclaren Medicare |
$5.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.66
|
| Rate for Payer: Meridian Medicaid |
$5.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.92
|
| Rate for Payer: Nomi Health Commercial |
$16.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.22
|
| Rate for Payer: PACE Medicare |
$5.12
|
| Rate for Payer: PACE SWMI |
$5.39
|
| Rate for Payer: PHP Commercial |
$56.92
|
| Rate for Payer: PHP Medicare Advantage |
$5.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$190.09
|
| Rate for Payer: Priority Health Medicare |
$5.39
|
| Rate for Payer: Priority Health SBD |
$42.18
|
| Rate for Payer: Priority Health Tiered Network |
$152.07
|
| Rate for Payer: Railroad Medicare Medicare |
$5.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.09
|
| Rate for Payer: UHC Core |
$8.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.39
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.82
|
| Rate for Payer: UHCCP Medicaid |
$2.82
|
| Rate for Payer: VA VA |
$5.39
|
|
|
HC DISACCHARIDASE ANALYSIS
|
Facility
|
IP
|
$156.06
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
30100755
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$98.32 |
| Max. Negotiated Rate |
$140.45 |
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.44
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Advantage |
$109.24
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$140.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.05
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: Priority Health SBD |
$98.32
|
|
|
HC DISACCHARIDASE ANALYSIS
|
Facility
|
OP
|
$156.06
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
30100755
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.59 |
| Max. Negotiated Rate |
$140.45 |
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: Aetna Medicare |
$23.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.71
|
| Rate for Payer: BCBS Complete |
$12.18
|
| Rate for Payer: BCBS MAPPO |
$22.17
|
| Rate for Payer: BCBS Trust/PPO |
$23.64
|
| Rate for Payer: BCN Commercial |
$23.64
|
| Rate for Payer: BCN Medicare Advantage |
$22.17
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Advantage |
$109.24
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.17
|
| Rate for Payer: Healthscope Commercial |
$140.45
|
| Rate for Payer: Mclaren Medicaid |
$11.59
|
| Rate for Payer: Mclaren Medicare |
$22.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.28
|
| Rate for Payer: Meridian Medicaid |
$23.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Nomi Health Commercial |
$33.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.05
|
| Rate for Payer: PACE Medicare |
$21.06
|
| Rate for Payer: PACE SWMI |
$22.17
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: PHP Medicare Advantage |
$22.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22.17
|
| Rate for Payer: Priority Health Medicare |
$22.17
|
| Rate for Payer: Priority Health SBD |
$98.32
|
| Rate for Payer: Priority Health Tiered Network |
$17.74
|
| Rate for Payer: Railroad Medicare Medicare |
$22.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.26
|
| Rate for Payer: UHC Core |
$33.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22.17
|
| Rate for Payer: UHC Exchange |
$33.26
|
| Rate for Payer: UHC Medicaid |
$11.59
|
| Rate for Payer: UHCCP Medicaid |
$11.59
|
| Rate for Payer: VA VA |
$22.17
|
|
|
HC DISASTER COVERAGE
|
Facility
|
IP
|
$147.74
|
|
| Hospital Charge Code |
27000704
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$93.08 |
| Max. Negotiated Rate |
$132.97 |
| Rate for Payer: Aetna Commercial |
$125.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.03
|
| Rate for Payer: Cash Price |
$118.19
|
| Rate for Payer: Cofinity Advantage |
$103.42
|
| Rate for Payer: Cofinity Commercial |
$127.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.19
|
| Rate for Payer: Healthscope Commercial |
$132.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.81
|
| Rate for Payer: PHP Commercial |
$125.58
|
| Rate for Payer: Priority Health SBD |
$93.08
|
|
|
HC DISASTER COVERAGE
|
Facility
|
OP
|
$147.74
|
|
| Hospital Charge Code |
27000704
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$58.06 |
| Max. Negotiated Rate |
$132.97 |
| Rate for Payer: Aetna Commercial |
$125.58
|
| Rate for Payer: Aetna Medicare |
$73.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.03
|
| Rate for Payer: BCBS Complete |
$59.10
|
| Rate for Payer: Cash Price |
$118.19
|
| Rate for Payer: Cofinity Advantage |
$103.42
|
| Rate for Payer: Cofinity Commercial |
$127.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.19
|
| Rate for Payer: Healthscope Commercial |
$132.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.81
|
| Rate for Payer: PHP Commercial |
$125.58
|
| Rate for Payer: Priority Health SBD |
$93.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.03
|
| Rate for Payer: UHC Core |
$76.97
|
| Rate for Payer: UHC Exchange |
$58.06
|
|
|
HC DISP FEE CONTRALATERAL BINAURAL
|
Facility
|
IP
|
$494.19
|
|
|
Service Code
|
CPT V5240
|
| Hospital Charge Code |
27100022
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$311.34 |
| Max. Negotiated Rate |
$444.77 |
| Rate for Payer: Aetna Commercial |
$420.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.22
|
| Rate for Payer: Cash Price |
$395.35
|
| Rate for Payer: Cofinity Advantage |
$345.93
|
| Rate for Payer: Cofinity Commercial |
$425.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.35
|
| Rate for Payer: Healthscope Commercial |
$444.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$370.64
|
| Rate for Payer: PHP Commercial |
$420.06
|
| Rate for Payer: Priority Health SBD |
$311.34
|
|
|
HC DISP FEE CONTRALATERAL BINAURAL
|
Facility
|
OP
|
$494.19
|
|
|
Service Code
|
CPT V5240
|
| Hospital Charge Code |
27100022
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$194.22 |
| Max. Negotiated Rate |
$444.77 |
| Rate for Payer: Aetna Commercial |
$420.06
|
| Rate for Payer: Aetna Medicare |
$247.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.22
|
| Rate for Payer: BCBS Complete |
$197.68
|
| Rate for Payer: Cash Price |
$395.35
|
| Rate for Payer: Cofinity Advantage |
$345.93
|
| Rate for Payer: Cofinity Commercial |
$425.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.35
|
| Rate for Payer: Healthscope Commercial |
$444.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$395.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$370.64
|
| Rate for Payer: PHP Commercial |
$420.06
|
| Rate for Payer: Priority Health SBD |
$311.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$321.22
|
| Rate for Payer: UHC Core |
$257.47
|
| Rate for Payer: UHC Exchange |
$194.22
|
|
|
HC DISP FEE CONTRALATERAL MONAURAL
|
Facility
|
IP
|
$286.11
|
|
|
Service Code
|
CPT V5200
|
| Hospital Charge Code |
27100021
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$180.25 |
| Max. Negotiated Rate |
$257.50 |
| Rate for Payer: Aetna Commercial |
$243.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.97
|
| Rate for Payer: Cash Price |
$228.89
|
| Rate for Payer: Cofinity Advantage |
$200.28
|
| Rate for Payer: Cofinity Commercial |
$246.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.89
|
| Rate for Payer: Healthscope Commercial |
$257.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.58
|
| Rate for Payer: PHP Commercial |
$243.19
|
| Rate for Payer: Priority Health SBD |
$180.25
|
|
|
HC DISP FEE CONTRALATERAL MONAURAL
|
Facility
|
OP
|
$286.11
|
|
|
Service Code
|
CPT V5200
|
| Hospital Charge Code |
27100021
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$112.44 |
| Max. Negotiated Rate |
$257.50 |
| Rate for Payer: Aetna Commercial |
$243.19
|
| Rate for Payer: Aetna Medicare |
$143.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.97
|
| Rate for Payer: BCBS Complete |
$114.44
|
| Rate for Payer: Cash Price |
$228.89
|
| Rate for Payer: Cofinity Advantage |
$200.28
|
| Rate for Payer: Cofinity Commercial |
$246.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.89
|
| Rate for Payer: Healthscope Commercial |
$257.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.58
|
| Rate for Payer: PHP Commercial |
$243.19
|
| Rate for Payer: Priority Health SBD |
$180.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.97
|
| Rate for Payer: UHC Core |
$149.06
|
| Rate for Payer: UHC Exchange |
$112.44
|
|
