|
HC LARYNGOSCOPY
|
Facility
|
OP
|
$2,514.51
|
|
| Hospital Charge Code |
36000113
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,005.80 |
| Max. Negotiated Rate |
$2,263.06 |
| Rate for Payer: Aetna Commercial |
$2,137.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,634.43
|
| Rate for Payer: BCBS Complete |
$1,005.80
|
| Rate for Payer: Cash Price |
$2,011.61
|
| Rate for Payer: Cofinity Commercial |
$1,760.16
|
| Rate for Payer: Cofinity Commercial |
$2,162.48
|
| Rate for Payer: Healthscope Commercial |
$2,263.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,137.33
|
| Rate for Payer: PHP Commercial |
$2,137.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,760.16
|
| Rate for Payer: Priority Health SBD |
$1,584.14
|
|
|
HC LARYNGOSCOPY FIBEROPTIC
|
Facility
|
OP
|
$311.92
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
36100443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.45 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: Aetna Commercial |
$265.13
|
| Rate for Payer: Aetna Medicare |
$183.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$220.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$220.31
|
| Rate for Payer: BCBS Complete |
$101.24
|
| Rate for Payer: BCBS MAPPO |
$176.25
|
| Rate for Payer: BCBS Trust/PPO |
$112.61
|
| Rate for Payer: BCN Medicare Advantage |
$176.25
|
| Rate for Payer: Cash Price |
$249.54
|
| Rate for Payer: Cash Price |
$249.54
|
| Rate for Payer: Cofinity Commercial |
$218.34
|
| Rate for Payer: Cofinity Commercial |
$268.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.25
|
| Rate for Payer: Healthscope Commercial |
$280.73
|
| Rate for Payer: Mclaren Medicaid |
$96.41
|
| Rate for Payer: Mclaren Medicare |
$176.25
|
| Rate for Payer: Meridian Medicaid |
$101.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$185.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$202.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$265.13
|
| Rate for Payer: PACE Medicare |
$167.44
|
| Rate for Payer: PACE SWMI |
$176.25
|
| Rate for Payer: PHP Commercial |
$265.13
|
| Rate for Payer: PHP Medicare Advantage |
$176.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$536.00
|
| Rate for Payer: Priority Health Medicare |
$176.25
|
| Rate for Payer: Priority Health Narrow Network |
$428.80
|
| Rate for Payer: Priority Health SBD |
$196.51
|
| Rate for Payer: Railroad Medicare Medicare |
$176.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.25
|
| Rate for Payer: UHC Exchange |
$67.45
|
| Rate for Payer: UHC Medicare Advantage |
$181.54
|
| Rate for Payer: VA VA |
$176.25
|
|
|
HC LARYNGOSCOPY FIBEROPTIC
|
Facility
|
IP
|
$311.92
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
36100443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$196.51 |
| Max. Negotiated Rate |
$280.73 |
| Rate for Payer: Aetna Commercial |
$265.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.75
|
| Rate for Payer: Cash Price |
$249.54
|
| Rate for Payer: Cofinity Commercial |
$218.34
|
| Rate for Payer: Cofinity Commercial |
$268.25
|
| Rate for Payer: Healthscope Commercial |
$280.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$265.13
|
| Rate for Payer: PHP Commercial |
$265.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.34
|
| Rate for Payer: Priority Health SBD |
$196.51
|
|
|
HC LARYNGOSCOPY FLX/RGD TELESCOP W/STROBOSCOP
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
CPT 31579
|
| Hospital Charge Code |
76100455
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.22 |
| Max. Negotiated Rate |
$1,130.87 |
| Rate for Payer: Aetna Commercial |
$935.00
|
| Rate for Payer: Aetna Medicare |
$377.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$715.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$454.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$454.16
|
| Rate for Payer: BCBS Complete |
$208.70
|
| Rate for Payer: BCBS MAPPO |
$363.33
|
| Rate for Payer: BCBS Trust/PPO |
$170.58
|
| Rate for Payer: BCN Medicare Advantage |
$363.33
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cofinity Commercial |
$946.00
|
| Rate for Payer: Cofinity Commercial |
$770.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$363.33
|
| Rate for Payer: Healthscope Commercial |
$990.00
|
| Rate for Payer: Mclaren Medicaid |
$198.74
|
| Rate for Payer: Mclaren Medicare |
$363.33
|
| Rate for Payer: Meridian Medicaid |
$208.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$381.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$417.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$935.00
|
| Rate for Payer: PACE Medicare |
$345.16
|
| Rate for Payer: PACE SWMI |
$363.33
|
| Rate for Payer: PHP Commercial |
$935.00
|
| Rate for Payer: PHP Medicare Advantage |
$363.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$198.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,130.87
|
| Rate for Payer: Priority Health Medicare |
$363.33
|
| Rate for Payer: Priority Health Narrow Network |
$904.70
|
| Rate for Payer: Priority Health SBD |
$693.00
|
| Rate for Payer: Railroad Medicare Medicare |
$363.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$363.33
|
| Rate for Payer: UHC Exchange |
$117.22
|
| Rate for Payer: UHC Medicare Advantage |
$374.23
|
| Rate for Payer: VA VA |
$363.33
|
|
|
HC LARYNGOSCOPY FLX/RGD TELESCOP W/STROBOSCOP
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
CPT 31579
|
| Hospital Charge Code |
76100455
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$693.00 |
| Max. Negotiated Rate |
$990.00 |
| Rate for Payer: Aetna Commercial |
$935.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$715.00
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cofinity Commercial |
$770.00
|
| Rate for Payer: Cofinity Commercial |
$946.00
|
| Rate for Payer: Healthscope Commercial |
$990.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$935.00
|
| Rate for Payer: PHP Commercial |
$935.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.00
|
| Rate for Payer: Priority Health SBD |
$693.00
|
|
|
HC LASER CATHETER
|
Facility
|
IP
|
$4,842.47
|
|
|
Service Code
|
HCPCS C1885
|
| Hospital Charge Code |
27200054
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,050.76 |
| Max. Negotiated Rate |
$4,358.22 |
| Rate for Payer: Aetna Commercial |
$4,116.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,147.61
|
| Rate for Payer: Cash Price |
$3,873.98
|
| Rate for Payer: Cofinity Commercial |
$3,389.73
|
| Rate for Payer: Cofinity Commercial |
$4,164.52
|
| Rate for Payer: Healthscope Commercial |
$4,358.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,116.10
|
| Rate for Payer: PHP Commercial |
$4,116.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,389.73
|
| Rate for Payer: Priority Health SBD |
$3,050.76
|
|
|
HC LASER CATHETER
|
Facility
|
OP
|
$4,842.47
|
|
|
Service Code
|
HCPCS C1885
|
| Hospital Charge Code |
27200054
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,936.99 |
| Max. Negotiated Rate |
$4,358.22 |
| Rate for Payer: Aetna Commercial |
$4,116.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,147.61
|
| Rate for Payer: BCBS Complete |
$1,936.99
|
| Rate for Payer: Cash Price |
$3,873.98
|
| Rate for Payer: Cofinity Commercial |
$3,389.73
|
| Rate for Payer: Cofinity Commercial |
$4,164.52
|
| Rate for Payer: Healthscope Commercial |
$4,358.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,116.10
|
| Rate for Payer: PHP Commercial |
$4,116.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,389.73
|
| Rate for Payer: Priority Health SBD |
$3,050.76
|
|
|
HC LATEX IGE
|
Facility
|
OP
|
$35.09
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200044
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$31.58 |
| Rate for Payer: Aetna Commercial |
$29.83
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.09
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$28.07
|
| Rate for Payer: Cash Price |
$28.07
|
| Rate for Payer: Cofinity Commercial |
$24.56
|
| Rate for Payer: Cofinity Commercial |
$30.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$31.58
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.83
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$29.83
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.56
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$22.11
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC LATEX IGE
|
Facility
|
IP
|
$35.09
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200044
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$31.58 |
| Rate for Payer: Aetna Commercial |
$29.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.81
|
| Rate for Payer: Cash Price |
$28.07
|
| Rate for Payer: Cofinity Commercial |
$24.56
|
| Rate for Payer: Cofinity Commercial |
$30.18
|
| Rate for Payer: Healthscope Commercial |
$31.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.83
|
| Rate for Payer: PHP Commercial |
$29.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.56
|
| Rate for Payer: Priority Health SBD |
$22.11
|
|
|
HC LAYR CLOS WND REST BODY <2.5 CM
|
Facility
|
OP
|
$488.86
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
76100228
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$142.44 |
| Max. Negotiated Rate |
$443.50 |
| Rate for Payer: Aetna Commercial |
$415.53
|
| Rate for Payer: Aetna Medicare |
$368.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.50
|
| Rate for Payer: BCBS Complete |
$203.80
|
| Rate for Payer: BCBS MAPPO |
$354.80
|
| Rate for Payer: BCBS Trust/PPO |
$254.30
|
| Rate for Payer: BCN Medicare Advantage |
$354.80
|
| Rate for Payer: Cash Price |
$391.09
|
| Rate for Payer: Cash Price |
$391.09
|
| Rate for Payer: Cofinity Commercial |
$420.42
|
| Rate for Payer: Cofinity Commercial |
$342.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.80
|
| Rate for Payer: Healthscope Commercial |
$439.97
|
| Rate for Payer: Mclaren Medicaid |
$194.08
|
| Rate for Payer: Mclaren Medicare |
$354.80
|
| Rate for Payer: Meridian Medicaid |
$203.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$408.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$415.53
|
| Rate for Payer: PACE Medicare |
$337.06
|
| Rate for Payer: PACE SWMI |
$354.80
|
| Rate for Payer: PHP Commercial |
$415.53
|
| Rate for Payer: PHP Medicare Advantage |
$354.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.20
|
| Rate for Payer: Priority Health Medicare |
$354.80
|
| Rate for Payer: Priority Health SBD |
$307.98
|
| Rate for Payer: Railroad Medicare Medicare |
$354.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.80
|
| Rate for Payer: UHC Exchange |
$142.44
|
| Rate for Payer: UHC Medicare Advantage |
$365.44
|
| Rate for Payer: VA VA |
$354.80
|
|
|
HC LAYR CLOS WND REST BODY <2.5 CM
|
Facility
|
IP
|
$488.86
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
76100228
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$307.98 |
| Max. Negotiated Rate |
$439.97 |
| Rate for Payer: Aetna Commercial |
$415.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.76
|
| Rate for Payer: Cash Price |
$391.09
|
| Rate for Payer: Cofinity Commercial |
$342.20
|
| Rate for Payer: Cofinity Commercial |
$420.42
|
| Rate for Payer: Healthscope Commercial |
$439.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$415.53
|
| Rate for Payer: PHP Commercial |
$415.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.20
|
| Rate for Payer: Priority Health SBD |
$307.98
|
|
|
HC LC/CABG'S W INTERVENTION
|
Facility
|
OP
|
$10,797.39
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
48100050
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,083.51 |
| Max. Negotiated Rate |
$9,717.65 |
| Rate for Payer: Aetna Commercial |
$9,177.78
|
| Rate for Payer: Aetna Medicare |
$3,015.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,018.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,624.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,624.31
|
| Rate for Payer: BCBS Complete |
$1,665.44
|
| Rate for Payer: BCBS MAPPO |
$2,899.45
|
| Rate for Payer: BCBS Trust/PPO |
$3,655.02
|
| Rate for Payer: BCN Medicare Advantage |
$2,899.45
|
| Rate for Payer: Cash Price |
$8,637.91
|
| Rate for Payer: Cash Price |
$8,637.91
|
| Rate for Payer: Cofinity Commercial |
$7,558.17
|
| Rate for Payer: Cofinity Commercial |
$9,285.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,899.45
|
| Rate for Payer: Healthscope Commercial |
$9,717.65
|
| Rate for Payer: Mclaren Medicaid |
$1,586.00
|
| Rate for Payer: Mclaren Medicare |
$2,899.45
|
| Rate for Payer: Meridian Medicaid |
$1,665.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,044.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,334.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,177.78
|
| Rate for Payer: PACE Medicare |
$2,754.48
|
| Rate for Payer: PACE SWMI |
$2,899.45
|
| Rate for Payer: PHP Commercial |
$9,177.78
|
| Rate for Payer: PHP Medicare Advantage |
$2,899.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,586.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,558.17
|
| Rate for Payer: Priority Health Medicare |
$2,899.45
|
| Rate for Payer: Priority Health SBD |
$6,802.36
|
| Rate for Payer: Railroad Medicare Medicare |
$2,899.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,191.86
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,899.45
|
| Rate for Payer: UHC Exchange |
$1,083.51
|
| Rate for Payer: UHC Medicare Advantage |
$2,986.43
|
| Rate for Payer: VA VA |
$2,899.45
|
|
|
HC LC/CABG'S W INTERVENTION
|
Facility
|
IP
|
$10,797.39
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
48100050
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,802.36 |
| Max. Negotiated Rate |
$9,717.65 |
| Rate for Payer: Aetna Commercial |
$9,177.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,018.30
|
| Rate for Payer: Cash Price |
$8,637.91
|
| Rate for Payer: Cofinity Commercial |
$7,558.17
|
| Rate for Payer: Cofinity Commercial |
$9,285.76
|
| Rate for Payer: Healthscope Commercial |
$9,717.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,177.78
|
| Rate for Payer: PHP Commercial |
$9,177.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,558.17
|
| Rate for Payer: Priority Health SBD |
$6,802.36
|
|
|
HC LDL DIRECT MEASURE
|
Facility
|
IP
|
$58.60
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
30100283
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.92 |
| Max. Negotiated Rate |
$52.74 |
| Rate for Payer: Aetna Commercial |
$49.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.09
|
| Rate for Payer: Cash Price |
$46.88
|
| Rate for Payer: Cofinity Commercial |
$41.02
|
| Rate for Payer: Cofinity Commercial |
$50.40
|
| Rate for Payer: Healthscope Commercial |
$52.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.81
|
| Rate for Payer: PHP Commercial |
$49.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.02
|
| Rate for Payer: Priority Health SBD |
$36.92
|
|
|
HC LDL DIRECT MEASURE
|
Facility
|
OP
|
$58.60
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
30100283
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$52.74 |
| Rate for Payer: Aetna Commercial |
$49.81
|
| Rate for Payer: Aetna Medicare |
$10.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.12
|
| Rate for Payer: BCBS Complete |
$6.03
|
| Rate for Payer: BCBS MAPPO |
$10.50
|
| Rate for Payer: BCBS Trust/PPO |
$8.23
|
| Rate for Payer: BCN Medicare Advantage |
$10.50
|
| Rate for Payer: Cash Price |
$46.88
|
| Rate for Payer: Cash Price |
$46.88
|
| Rate for Payer: Cofinity Commercial |
$41.02
|
| Rate for Payer: Cofinity Commercial |
$50.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.50
|
| Rate for Payer: Healthscope Commercial |
$52.74
|
| Rate for Payer: Mclaren Medicaid |
$5.74
|
| Rate for Payer: Mclaren Medicare |
$10.50
|
| Rate for Payer: Meridian Medicaid |
$6.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.81
|
| Rate for Payer: PACE Medicare |
$9.98
|
| Rate for Payer: PACE SWMI |
$10.50
|
| Rate for Payer: PHP Commercial |
$49.81
|
| Rate for Payer: PHP Medicare Advantage |
$10.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.02
|
| Rate for Payer: Priority Health Medicare |
$10.50
|
| Rate for Payer: Priority Health SBD |
$36.92
|
| Rate for Payer: Railroad Medicare Medicare |
$10.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.60
|
| Rate for Payer: UHC Core |
$16.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.50
|
| Rate for Payer: UHC Exchange |
$10.50
|
| Rate for Payer: UHC Medicare Advantage |
$10.82
|
| Rate for Payer: VA VA |
$10.50
|
|
|
HC L&D MEDICAL EMERGENCY VISIT
|
Facility
|
IP
|
$860.74
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
45000023
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$542.27 |
| Max. Negotiated Rate |
$774.67 |
| Rate for Payer: Aetna Commercial |
$731.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$559.48
|
| Rate for Payer: Cash Price |
$688.59
|
| Rate for Payer: Cofinity Commercial |
$602.52
|
| Rate for Payer: Cofinity Commercial |
$740.24
|
| Rate for Payer: Healthscope Commercial |
$774.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$731.63
|
| Rate for Payer: PHP Commercial |
$731.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.52
|
| Rate for Payer: Priority Health SBD |
$542.27
|
|
|
HC L&D MEDICAL EMERGENCY VISIT
|
Facility
|
OP
|
$860.74
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
45000023
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$69.09 |
| Max. Negotiated Rate |
$1,378.00 |
| Rate for Payer: Aetna Commercial |
$731.63
|
| Rate for Payer: Aetna Medicare |
$264.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$559.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$317.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$317.35
|
| Rate for Payer: BCBS Complete |
$145.83
|
| Rate for Payer: BCBS MAPPO |
$253.88
|
| Rate for Payer: BCBS Trust/PPO |
$269.34
|
| Rate for Payer: BCN Medicare Advantage |
$253.88
|
| Rate for Payer: Cash Price |
$688.59
|
| Rate for Payer: Cash Price |
$688.59
|
| Rate for Payer: Cash Price |
$688.59
|
| Rate for Payer: Cofinity Commercial |
$602.52
|
| Rate for Payer: Cofinity Commercial |
$740.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$253.88
|
| Rate for Payer: Healthscope Commercial |
$774.67
|
| Rate for Payer: Mclaren Medicaid |
$138.87
|
| Rate for Payer: Mclaren Medicare |
$253.88
|
| Rate for Payer: Meridian Medicaid |
$145.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$266.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$291.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$731.63
|
| Rate for Payer: PACE Medicare |
$241.19
|
| Rate for Payer: PACE SWMI |
$253.88
|
| Rate for Payer: PHP Commercial |
$731.63
|
| Rate for Payer: PHP Medicare Advantage |
$253.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$720.57
|
| Rate for Payer: Priority Health Medicare |
$253.88
|
| Rate for Payer: Priority Health Narrow Network |
$576.46
|
| Rate for Payer: Priority Health SBD |
$542.27
|
| Rate for Payer: Railroad Medicare Medicare |
$253.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.00
|
| Rate for Payer: UHC Core |
$1,378.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$253.88
|
| Rate for Payer: UHC Exchange |
$69.09
|
| Rate for Payer: UHC Medicare Advantage |
$261.50
|
| Rate for Payer: VA VA |
$253.88
|
|
|
HC LD RECOVERY 0-2 HRS
|
Facility
|
OP
|
$1,441.05
|
|
| Hospital Charge Code |
71000012
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$576.42 |
| Max. Negotiated Rate |
$1,296.94 |
| Rate for Payer: Aetna Commercial |
$1,224.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$936.68
|
| Rate for Payer: BCBS Complete |
$576.42
|
| Rate for Payer: Cash Price |
$1,152.84
|
| Rate for Payer: Cofinity Commercial |
$1,008.74
|
| Rate for Payer: Cofinity Commercial |
$1,239.30
|
| Rate for Payer: Healthscope Commercial |
$1,296.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,224.89
|
| Rate for Payer: PHP Commercial |
$1,224.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.74
|
| Rate for Payer: Priority Health SBD |
$907.86
|
|
|
HC LD RECOVERY 0-2 HRS
|
Facility
|
IP
|
$1,441.05
|
|
| Hospital Charge Code |
71000012
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$907.86 |
| Max. Negotiated Rate |
$1,296.94 |
| Rate for Payer: Aetna Commercial |
$1,224.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$936.68
|
| Rate for Payer: Cash Price |
$1,152.84
|
| Rate for Payer: Cofinity Commercial |
$1,008.74
|
| Rate for Payer: Cofinity Commercial |
$1,239.30
|
| Rate for Payer: Healthscope Commercial |
$1,296.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,224.89
|
| Rate for Payer: PHP Commercial |
$1,224.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.74
|
| Rate for Payer: Priority Health SBD |
$907.86
|
|
|
HC LD RECOVERY 10 OR MORE HOURS
|
Facility
|
OP
|
$3,602.41
|
|
| Hospital Charge Code |
71000013
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,440.96 |
| Max. Negotiated Rate |
$3,242.17 |
| Rate for Payer: Aetna Commercial |
$3,062.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,341.57
|
| Rate for Payer: BCBS Complete |
$1,440.96
|
| Rate for Payer: Cash Price |
$2,881.93
|
| Rate for Payer: Cofinity Commercial |
$2,521.69
|
| Rate for Payer: Cofinity Commercial |
$3,098.07
|
| Rate for Payer: Healthscope Commercial |
$3,242.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,062.05
|
| Rate for Payer: PHP Commercial |
$3,062.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,521.69
|
| Rate for Payer: Priority Health SBD |
$2,269.52
|
|
|
HC LD RECOVERY 10 OR MORE HOURS
|
Facility
|
IP
|
$3,602.41
|
|
| Hospital Charge Code |
71000013
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$2,269.52 |
| Max. Negotiated Rate |
$3,242.17 |
| Rate for Payer: Aetna Commercial |
$3,062.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,341.57
|
| Rate for Payer: Cash Price |
$2,881.93
|
| Rate for Payer: Cofinity Commercial |
$2,521.69
|
| Rate for Payer: Cofinity Commercial |
$3,098.07
|
| Rate for Payer: Healthscope Commercial |
$3,242.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,062.05
|
| Rate for Payer: PHP Commercial |
$3,062.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,521.69
|
| Rate for Payer: Priority Health SBD |
$2,269.52
|
|
|
HC LD RECOVERY 2-4 HRS
|
Facility
|
OP
|
$2,881.83
|
|
| Hospital Charge Code |
71000014
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,152.73 |
| Max. Negotiated Rate |
$2,593.65 |
| Rate for Payer: Aetna Commercial |
$2,449.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,873.19
|
| Rate for Payer: BCBS Complete |
$1,152.73
|
| Rate for Payer: Cash Price |
$2,305.46
|
| Rate for Payer: Cofinity Commercial |
$2,017.28
|
| Rate for Payer: Cofinity Commercial |
$2,478.37
|
| Rate for Payer: Healthscope Commercial |
$2,593.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,449.56
|
| Rate for Payer: PHP Commercial |
$2,449.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,017.28
|
| Rate for Payer: Priority Health SBD |
$1,815.55
|
|
|
HC LD RECOVERY 2-4 HRS
|
Facility
|
IP
|
$2,881.83
|
|
| Hospital Charge Code |
71000014
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,815.55 |
| Max. Negotiated Rate |
$2,593.65 |
| Rate for Payer: Aetna Commercial |
$2,449.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,873.19
|
| Rate for Payer: Cash Price |
$2,305.46
|
| Rate for Payer: Cofinity Commercial |
$2,017.28
|
| Rate for Payer: Cofinity Commercial |
$2,478.37
|
| Rate for Payer: Healthscope Commercial |
$2,593.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,449.56
|
| Rate for Payer: PHP Commercial |
$2,449.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,017.28
|
| Rate for Payer: Priority Health SBD |
$1,815.55
|
|
|
HC LD RECOVERY 4-6 HRS
|
Facility
|
OP
|
$3,202.09
|
|
| Hospital Charge Code |
71000015
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,280.84 |
| Max. Negotiated Rate |
$2,881.88 |
| Rate for Payer: Aetna Commercial |
$2,721.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,081.36
|
| Rate for Payer: BCBS Complete |
$1,280.84
|
| Rate for Payer: Cash Price |
$2,561.67
|
| Rate for Payer: Cofinity Commercial |
$2,241.46
|
| Rate for Payer: Cofinity Commercial |
$2,753.80
|
| Rate for Payer: Healthscope Commercial |
$2,881.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,721.78
|
| Rate for Payer: PHP Commercial |
$2,721.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,241.46
|
| Rate for Payer: Priority Health SBD |
$2,017.32
|
|
|
HC LD RECOVERY 4-6 HRS
|
Facility
|
IP
|
$3,202.09
|
|
| Hospital Charge Code |
71000015
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$2,017.32 |
| Max. Negotiated Rate |
$2,881.88 |
| Rate for Payer: Aetna Commercial |
$2,721.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,081.36
|
| Rate for Payer: Cash Price |
$2,561.67
|
| Rate for Payer: Cofinity Commercial |
$2,241.46
|
| Rate for Payer: Cofinity Commercial |
$2,753.80
|
| Rate for Payer: Healthscope Commercial |
$2,881.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,721.78
|
| Rate for Payer: PHP Commercial |
$2,721.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,241.46
|
| Rate for Payer: Priority Health SBD |
$2,017.32
|
|
