|
HC ER CRITICAL CARE EA ADDL 30 MIN
|
Facility
|
IP
|
$958.04
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
45000081
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$603.57 |
| Max. Negotiated Rate |
$862.24 |
| Rate for Payer: Aetna Commercial |
$814.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$622.73
|
| Rate for Payer: Cash Price |
$766.43
|
| Rate for Payer: Cofinity Advantage |
$670.63
|
| Rate for Payer: Cofinity Commercial |
$823.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$766.43
|
| Rate for Payer: Healthscope Commercial |
$862.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$814.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$718.53
|
| Rate for Payer: PHP Commercial |
$814.33
|
| Rate for Payer: Priority Health SBD |
$603.57
|
|
|
HC ER CRITICAL CARE INITIAL 30-74 MIN
|
Facility
|
OP
|
$3,673.91
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
45000026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$3,306.52 |
| Rate for Payer: Aetna Commercial |
$3,122.82
|
| Rate for Payer: Aetna Medicare |
$855.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,388.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,028.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,028.83
|
| Rate for Payer: BCBS Complete |
$452.02
|
| Rate for Payer: BCBS MAPPO |
$823.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,445.80
|
| Rate for Payer: BCN Commercial |
$1,445.80
|
| Rate for Payer: BCN Medicare Advantage |
$823.06
|
| Rate for Payer: Cash Price |
$2,939.13
|
| Rate for Payer: Cash Price |
$2,939.13
|
| Rate for Payer: Cash Price |
$2,939.13
|
| Rate for Payer: Cofinity Advantage |
$2,571.74
|
| Rate for Payer: Cofinity Commercial |
$3,159.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,939.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$823.06
|
| Rate for Payer: Healthscope Commercial |
$3,306.52
|
| Rate for Payer: Mclaren Medicaid |
$430.46
|
| Rate for Payer: Mclaren Medicare |
$823.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$864.21
|
| Rate for Payer: Meridian Medicaid |
$864.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$946.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$905.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,122.82
|
| Rate for Payer: Nomi Health Commercial |
$2,469.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,755.43
|
| Rate for Payer: PACE Medicare |
$781.91
|
| Rate for Payer: PACE SWMI |
$823.06
|
| Rate for Payer: PHP Commercial |
$3,122.82
|
| Rate for Payer: PHP Medicare Advantage |
$823.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$430.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,661.71
|
| Rate for Payer: Priority Health Medicare |
$823.06
|
| Rate for Payer: Priority Health SBD |
$2,314.56
|
| Rate for Payer: Priority Health Tiered Network |
$2,129.37
|
| Rate for Payer: Railroad Medicare Medicare |
$823.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$823.06
|
| Rate for Payer: UHC Medicaid |
$430.46
|
| Rate for Payer: UHCCP Medicaid |
$144.00
|
| Rate for Payer: VA VA |
$823.06
|
|
|
HC ER CRITICAL CARE INITIAL 30-74 MIN
|
Facility
|
IP
|
$3,673.91
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
45000026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,314.56 |
| Max. Negotiated Rate |
$3,306.52 |
| Rate for Payer: Aetna Commercial |
$3,122.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,388.04
|
| Rate for Payer: Cash Price |
$2,939.13
|
| Rate for Payer: Cofinity Advantage |
$2,571.74
|
| Rate for Payer: Cofinity Commercial |
$3,159.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,939.13
|
| Rate for Payer: Healthscope Commercial |
$3,306.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,122.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,755.43
|
| Rate for Payer: PHP Commercial |
$3,122.82
|
| Rate for Payer: Priority Health SBD |
$2,314.56
|
|
|
HC ER LEVEL FIVE 99285
|
Facility
|
IP
|
$2,191.00
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
45000025
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,380.33 |
| Max. Negotiated Rate |
$1,971.90 |
| Rate for Payer: Aetna Commercial |
$1,862.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,424.15
|
| Rate for Payer: Cash Price |
$1,752.80
|
| Rate for Payer: Cofinity Advantage |
$1,533.70
|
| Rate for Payer: Cofinity Commercial |
$1,884.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,752.80
|
| Rate for Payer: Healthscope Commercial |
$1,971.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,862.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,643.25
|
| Rate for Payer: PHP Commercial |
$1,862.35
|
| Rate for Payer: Priority Health SBD |
$1,380.33
|
|
|
HC ER LEVEL FIVE 99285
|
Facility
|
OP
|
$2,191.00
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
45000025
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$1,971.90 |
| Rate for Payer: Aetna Commercial |
$1,862.35
|
| Rate for Payer: Aetna Medicare |
$617.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,424.15
|
| 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 |
$862.23
|
| Rate for Payer: BCN Commercial |
$862.23
|
| Rate for Payer: BCN Medicare Advantage |
$593.39
|
| Rate for Payer: Cash Price |
$1,752.80
|
| Rate for Payer: Cash Price |
$1,752.80
|
| Rate for Payer: Cash Price |
$1,752.80
|
| Rate for Payer: Cofinity Advantage |
$1,533.70
|
| Rate for Payer: Cofinity Commercial |
$1,884.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,752.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$593.39
|
| Rate for Payer: Healthscope Commercial |
$1,971.90
|
| 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 |
$1,862.35
|
| Rate for Payer: Nomi Health Commercial |
$1,780.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,643.25
|
| Rate for Payer: PACE Medicare |
$563.72
|
| Rate for Payer: PACE SWMI |
$593.39
|
| Rate for Payer: PHP Commercial |
$1,862.35
|
| 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 |
$1,380.33
|
| 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 |
$310.34
|
| Rate for Payer: UHCCP Medicaid |
$144.00
|
| Rate for Payer: VA VA |
$593.39
|
|
|
HC ER LEVEL FOUR 99284
|
Facility
|
IP
|
$1,518.34
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
45000024
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$956.55 |
| Max. Negotiated Rate |
$1,366.51 |
| Rate for Payer: Aetna Commercial |
$1,290.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$986.92
|
| Rate for Payer: Cash Price |
$1,214.67
|
| Rate for Payer: Cofinity Advantage |
$1,062.84
|
| Rate for Payer: Cofinity Commercial |
$1,305.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,214.67
|
| Rate for Payer: Healthscope Commercial |
$1,366.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,290.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,138.76
|
| Rate for Payer: PHP Commercial |
$1,290.59
|
| Rate for Payer: Priority Health SBD |
$956.55
|
|
|
HC ER LEVEL FOUR 99284
|
Facility
|
OP
|
$1,518.34
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
45000024
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$1,366.51 |
| Rate for Payer: Aetna Commercial |
$1,290.59
|
| Rate for Payer: Aetna Medicare |
$432.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$986.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$519.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$519.70
|
| Rate for Payer: BCBS Complete |
$228.34
|
| Rate for Payer: BCBS MAPPO |
$415.76
|
| Rate for Payer: BCBS Trust/PPO |
$597.52
|
| Rate for Payer: BCN Commercial |
$597.52
|
| Rate for Payer: BCN Medicare Advantage |
$415.76
|
| Rate for Payer: Cash Price |
$1,214.67
|
| Rate for Payer: Cash Price |
$1,214.67
|
| Rate for Payer: Cash Price |
$1,214.67
|
| Rate for Payer: Cofinity Advantage |
$1,062.84
|
| Rate for Payer: Cofinity Commercial |
$1,305.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,214.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$415.76
|
| Rate for Payer: Healthscope Commercial |
$1,366.51
|
| Rate for Payer: Mclaren Medicaid |
$217.44
|
| Rate for Payer: Mclaren Medicare |
$415.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$436.55
|
| Rate for Payer: Meridian Medicaid |
$436.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$478.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$457.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,290.59
|
| Rate for Payer: Nomi Health Commercial |
$1,247.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,138.76
|
| Rate for Payer: PACE Medicare |
$394.97
|
| Rate for Payer: PACE SWMI |
$415.76
|
| Rate for Payer: PHP Commercial |
$1,290.59
|
| Rate for Payer: PHP Medicare Advantage |
$415.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$217.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,344.55
|
| Rate for Payer: Priority Health Medicare |
$415.76
|
| Rate for Payer: Priority Health SBD |
$956.55
|
| Rate for Payer: Priority Health Tiered Network |
$1,075.64
|
| Rate for Payer: Railroad Medicare Medicare |
$415.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$415.76
|
| Rate for Payer: UHC Medicaid |
$217.44
|
| Rate for Payer: UHCCP Medicaid |
$144.00
|
| Rate for Payer: VA VA |
$415.76
|
|
|
HC ER LEVEL ONE 99281
|
Facility
|
IP
|
$275.38
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
45000020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$173.49 |
| Max. Negotiated Rate |
$247.84 |
| Rate for Payer: Aetna Commercial |
$234.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.00
|
| Rate for Payer: Cash Price |
$220.30
|
| Rate for Payer: Cofinity Advantage |
$192.77
|
| Rate for Payer: Cofinity Commercial |
$236.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.30
|
| Rate for Payer: Healthscope Commercial |
$247.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.53
|
| Rate for Payer: PHP Commercial |
$234.07
|
| Rate for Payer: Priority Health SBD |
$173.49
|
|
|
HC ER LEVEL ONE 99281
|
Facility
|
OP
|
$275.38
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
45000020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$43.94 |
| Max. Negotiated Rate |
$271.71 |
| Rate for Payer: Aetna Commercial |
$234.07
|
| Rate for Payer: Aetna Medicare |
$87.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.03
|
| Rate for Payer: BCBS Complete |
$46.14
|
| Rate for Payer: BCBS MAPPO |
$84.02
|
| Rate for Payer: BCBS Trust/PPO |
$108.36
|
| Rate for Payer: BCN Commercial |
$108.36
|
| Rate for Payer: BCN Medicare Advantage |
$84.02
|
| Rate for Payer: Cash Price |
$220.30
|
| Rate for Payer: Cash Price |
$220.30
|
| Rate for Payer: Cash Price |
$220.30
|
| Rate for Payer: Cofinity Advantage |
$192.77
|
| Rate for Payer: Cofinity Commercial |
$236.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.02
|
| Rate for Payer: Healthscope Commercial |
$247.84
|
| Rate for Payer: Mclaren Medicaid |
$43.94
|
| Rate for Payer: Mclaren Medicare |
$84.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.22
|
| Rate for Payer: Meridian Medicaid |
$88.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.07
|
| Rate for Payer: Nomi Health Commercial |
$252.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.53
|
| Rate for Payer: PACE Medicare |
$79.82
|
| Rate for Payer: PACE SWMI |
$84.02
|
| Rate for Payer: PHP Commercial |
$234.07
|
| Rate for Payer: PHP Medicare Advantage |
$84.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$271.71
|
| Rate for Payer: Priority Health Medicare |
$84.02
|
| Rate for Payer: Priority Health SBD |
$173.49
|
| Rate for Payer: Priority Health Tiered Network |
$217.37
|
| Rate for Payer: Railroad Medicare Medicare |
$84.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$84.02
|
| Rate for Payer: UHC Medicaid |
$43.94
|
| Rate for Payer: UHCCP Medicaid |
$144.00
|
| Rate for Payer: VA VA |
$84.02
|
|
|
HC ER LEVEL THREE 99283
|
Facility
|
IP
|
$966.87
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
45000022
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$609.13 |
| Max. Negotiated Rate |
$870.18 |
| Rate for Payer: Aetna Commercial |
$821.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$628.47
|
| Rate for Payer: Cash Price |
$773.50
|
| Rate for Payer: Cofinity Advantage |
$676.81
|
| Rate for Payer: Cofinity Commercial |
$831.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$773.50
|
| Rate for Payer: Healthscope Commercial |
$870.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$821.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$725.15
|
| Rate for Payer: PHP Commercial |
$821.84
|
| Rate for Payer: Priority Health SBD |
$609.13
|
|
|
HC ER LEVEL THREE 99283
|
Facility
|
OP
|
$966.87
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
45000022
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$142.26 |
| Max. Negotiated Rate |
$879.61 |
| Rate for Payer: Aetna Commercial |
$821.84
|
| Rate for Payer: Aetna Medicare |
$282.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$628.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$340.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$340.00
|
| Rate for Payer: BCBS Complete |
$149.38
|
| Rate for Payer: BCBS MAPPO |
$272.00
|
| Rate for Payer: BCBS Trust/PPO |
$348.27
|
| Rate for Payer: BCN Commercial |
$348.27
|
| Rate for Payer: BCN Medicare Advantage |
$272.00
|
| Rate for Payer: Cash Price |
$773.50
|
| Rate for Payer: Cash Price |
$773.50
|
| Rate for Payer: Cash Price |
$773.50
|
| Rate for Payer: Cofinity Advantage |
$676.81
|
| Rate for Payer: Cofinity Commercial |
$831.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$773.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$272.00
|
| Rate for Payer: Healthscope Commercial |
$870.18
|
| Rate for Payer: Mclaren Medicaid |
$142.26
|
| Rate for Payer: Mclaren Medicare |
$272.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$285.60
|
| Rate for Payer: Meridian Medicaid |
$285.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$312.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$299.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$821.84
|
| Rate for Payer: Nomi Health Commercial |
$816.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$725.15
|
| Rate for Payer: PACE Medicare |
$258.40
|
| Rate for Payer: PACE SWMI |
$272.00
|
| Rate for Payer: PHP Commercial |
$821.84
|
| Rate for Payer: PHP Medicare Advantage |
$272.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$142.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$879.61
|
| Rate for Payer: Priority Health Medicare |
$272.00
|
| Rate for Payer: Priority Health SBD |
$609.13
|
| Rate for Payer: Priority Health Tiered Network |
$703.69
|
| Rate for Payer: Railroad Medicare Medicare |
$272.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$272.00
|
| Rate for Payer: UHC Medicaid |
$142.26
|
| Rate for Payer: UHCCP Medicaid |
$144.00
|
| Rate for Payer: VA VA |
$272.00
|
|
|
HC ER LEVEL TWO 99282
|
Facility
|
OP
|
$547.90
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
45000021
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$80.01 |
| Max. Negotiated Rate |
$494.76 |
| Rate for Payer: Aetna Commercial |
$465.71
|
| Rate for Payer: Aetna Medicare |
$159.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.24
|
| Rate for Payer: BCBS Complete |
$84.02
|
| Rate for Payer: BCBS MAPPO |
$152.99
|
| Rate for Payer: BCBS Trust/PPO |
$207.46
|
| Rate for Payer: BCN Commercial |
$207.46
|
| Rate for Payer: BCN Medicare Advantage |
$152.99
|
| Rate for Payer: Cash Price |
$438.32
|
| Rate for Payer: Cash Price |
$438.32
|
| Rate for Payer: Cash Price |
$438.32
|
| Rate for Payer: Cofinity Advantage |
$383.53
|
| Rate for Payer: Cofinity Commercial |
$471.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$438.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.99
|
| Rate for Payer: Healthscope Commercial |
$493.11
|
| Rate for Payer: Mclaren Medicaid |
$80.01
|
| Rate for Payer: Mclaren Medicare |
$152.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.64
|
| Rate for Payer: Meridian Medicaid |
$160.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$168.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$465.71
|
| Rate for Payer: Nomi Health Commercial |
$458.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$410.93
|
| Rate for Payer: PACE Medicare |
$145.34
|
| Rate for Payer: PACE SWMI |
$152.99
|
| Rate for Payer: PHP Commercial |
$465.71
|
| Rate for Payer: PHP Medicare Advantage |
$152.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$80.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$494.76
|
| Rate for Payer: Priority Health Medicare |
$152.99
|
| Rate for Payer: Priority Health SBD |
$345.18
|
| Rate for Payer: Priority Health Tiered Network |
$395.81
|
| Rate for Payer: Railroad Medicare Medicare |
$152.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$152.99
|
| Rate for Payer: UHC Medicaid |
$80.01
|
| Rate for Payer: UHCCP Medicaid |
$144.00
|
| Rate for Payer: VA VA |
$152.99
|
|
|
HC ER LEVEL TWO 99282
|
Facility
|
IP
|
$547.90
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
45000021
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$345.18 |
| Max. Negotiated Rate |
$493.11 |
| Rate for Payer: Aetna Commercial |
$465.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.13
|
| Rate for Payer: Cash Price |
$438.32
|
| Rate for Payer: Cofinity Advantage |
$383.53
|
| Rate for Payer: Cofinity Commercial |
$471.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$438.32
|
| Rate for Payer: Healthscope Commercial |
$493.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$465.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$410.93
|
| Rate for Payer: PHP Commercial |
$465.71
|
| Rate for Payer: Priority Health SBD |
$345.18
|
|
|
HC ER OBSERVATION PER HOUR
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200002
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Advantage |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health SBD |
$100.80
|
|
|
HC ER OBSERVATION PER HOUR
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200002
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna Medicare |
$80.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.00
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: BCBS Trust/PPO |
$112.58
|
| Rate for Payer: BCN Commercial |
$112.58
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Advantage |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health SBD |
$100.80
|
| Rate for Payer: UHC Medicaid |
$1,608.00
|
| Rate for Payer: UHCCP Medicaid |
$810.00
|
|
|
HC ERO OR PACU R&B
|
Facility
|
IP
|
$3,423.98
|
|
| Hospital Charge Code |
12000001
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$2,157.11 |
| Max. Negotiated Rate |
$3,081.58 |
| Rate for Payer: Aetna Commercial |
$2,910.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,225.59
|
| Rate for Payer: Cash Price |
$2,739.18
|
| Rate for Payer: Cofinity Advantage |
$2,396.79
|
| Rate for Payer: Cofinity Commercial |
$2,944.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,739.18
|
| Rate for Payer: Healthscope Commercial |
$3,081.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,910.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,567.99
|
| Rate for Payer: PHP Commercial |
$2,910.38
|
| Rate for Payer: Priority Health SBD |
$2,157.11
|
|
|
HC ER REDUCTION/DISLOCATION LEVEL 1
|
Facility
|
IP
|
$704.42
|
|
| Hospital Charge Code |
45000039
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$443.78 |
| Max. Negotiated Rate |
$633.98 |
| Rate for Payer: Aetna Commercial |
$598.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$457.87
|
| Rate for Payer: Cash Price |
$563.54
|
| Rate for Payer: Cofinity Advantage |
$493.09
|
| Rate for Payer: Cofinity Commercial |
$605.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$563.54
|
| Rate for Payer: Healthscope Commercial |
$633.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$598.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$528.32
|
| Rate for Payer: PHP Commercial |
$598.76
|
| Rate for Payer: Priority Health SBD |
$443.78
|
|
|
HC ER REDUCTION/DISLOCATION LEVEL 1
|
Facility
|
OP
|
$704.42
|
|
| Hospital Charge Code |
45000039
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$633.98 |
| Rate for Payer: Aetna Commercial |
$598.76
|
| Rate for Payer: Aetna Medicare |
$352.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$457.87
|
| Rate for Payer: BCBS Complete |
$281.77
|
| Rate for Payer: Cash Price |
$563.54
|
| Rate for Payer: Cash Price |
$563.54
|
| Rate for Payer: Cofinity Advantage |
$493.09
|
| Rate for Payer: Cofinity Commercial |
$605.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$563.54
|
| Rate for Payer: Healthscope Commercial |
$633.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$563.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$598.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$528.32
|
| Rate for Payer: PHP Commercial |
$598.76
|
| Rate for Payer: Priority Health SBD |
$443.78
|
| Rate for Payer: UHCCP Medicaid |
$144.00
|
|
|
HC ER SURGICAL HAND/FOOT CARE
|
Facility
|
IP
|
$704.42
|
|
| Hospital Charge Code |
45000040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$443.78 |
| Max. Negotiated Rate |
$633.98 |
| Rate for Payer: Aetna Commercial |
$598.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$457.87
|
| Rate for Payer: Cash Price |
$563.54
|
| Rate for Payer: Cofinity Advantage |
$493.09
|
| Rate for Payer: Cofinity Commercial |
$605.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$563.54
|
| Rate for Payer: Healthscope Commercial |
$633.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$598.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$528.32
|
| Rate for Payer: PHP Commercial |
$598.76
|
| Rate for Payer: Priority Health SBD |
$443.78
|
|
|
HC ER SURGICAL HAND/FOOT CARE
|
Facility
|
OP
|
$704.42
|
|
| Hospital Charge Code |
45000040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$633.98 |
| Rate for Payer: Aetna Commercial |
$598.76
|
| Rate for Payer: Aetna Medicare |
$352.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$457.87
|
| Rate for Payer: BCBS Complete |
$281.77
|
| Rate for Payer: Cash Price |
$563.54
|
| Rate for Payer: Cash Price |
$563.54
|
| Rate for Payer: Cofinity Advantage |
$493.09
|
| Rate for Payer: Cofinity Commercial |
$605.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$563.54
|
| Rate for Payer: Healthscope Commercial |
$633.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$563.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$598.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$528.32
|
| Rate for Payer: PHP Commercial |
$598.76
|
| Rate for Payer: Priority Health SBD |
$443.78
|
| Rate for Payer: UHCCP Medicaid |
$144.00
|
|
|
HC ERYTHROPOIETIN
|
Facility
|
IP
|
$42.45
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
30100191
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.74 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Aetna Commercial |
$36.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.59
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Advantage |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$36.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$38.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: PHP Commercial |
$36.08
|
| Rate for Payer: Priority Health SBD |
$26.74
|
|
|
HC ERYTHROPOIETIN
|
Facility
|
OP
|
$42.45
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
30100191
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Aetna Commercial |
$36.08
|
| Rate for Payer: Aetna Medicare |
$19.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.49
|
| Rate for Payer: BCBS Complete |
$10.32
|
| Rate for Payer: BCBS MAPPO |
$18.79
|
| Rate for Payer: BCBS Trust/PPO |
$20.03
|
| Rate for Payer: BCN Commercial |
$20.03
|
| Rate for Payer: BCN Medicare Advantage |
$18.79
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Advantage |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$36.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.79
|
| Rate for Payer: Healthscope Commercial |
$38.20
|
| Rate for Payer: Mclaren Medicaid |
$9.83
|
| Rate for Payer: Mclaren Medicare |
$18.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.73
|
| Rate for Payer: Meridian Medicaid |
$19.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$28.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: PACE Medicare |
$17.85
|
| Rate for Payer: PACE SWMI |
$18.79
|
| Rate for Payer: PHP Commercial |
$36.08
|
| Rate for Payer: PHP Medicare Advantage |
$18.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18.79
|
| Rate for Payer: Priority Health Medicare |
$18.79
|
| Rate for Payer: Priority Health SBD |
$26.74
|
| Rate for Payer: Priority Health Tiered Network |
$15.03
|
| Rate for Payer: Railroad Medicare Medicare |
$18.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.19
|
| Rate for Payer: UHC Core |
$28.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.79
|
| Rate for Payer: UHC Exchange |
$28.19
|
| Rate for Payer: UHC Medicaid |
$9.83
|
| Rate for Payer: UHCCP Medicaid |
$9.83
|
| Rate for Payer: VA VA |
$18.79
|
|
|
HC ESCHERICHIA COLI K1
|
Facility
|
OP
|
$53.06
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600268
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$52.64 |
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$19.27
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$37.42
|
| Rate for Payer: BCN Commercial |
$37.42
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Advantage |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Mclaren Medicaid |
$18.35
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$52.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.35
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$33.43
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.64
|
| Rate for Payer: UHC Core |
$52.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.09
|
| Rate for Payer: UHC Exchange |
$52.64
|
| Rate for Payer: UHC Medicaid |
$18.35
|
| Rate for Payer: UHCCP Medicaid |
$18.35
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC ESCHERICHIA COLI K1
|
Facility
|
IP
|
$53.06
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600268
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.43 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.49
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Advantage |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: Priority Health SBD |
$33.43
|
|
|
HC ESOPHAGOSCOPY
|
Facility
|
OP
|
$1,404.77
|
|
| Hospital Charge Code |
36000041
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$561.91 |
| Max. Negotiated Rate |
$1,264.29 |
| Rate for Payer: Aetna Commercial |
$1,194.05
|
| Rate for Payer: Aetna Medicare |
$702.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$913.10
|
| Rate for Payer: BCBS Complete |
$561.91
|
| Rate for Payer: Cash Price |
$1,123.82
|
| Rate for Payer: Cofinity Advantage |
$983.34
|
| Rate for Payer: Cofinity Commercial |
$1,208.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,123.82
|
| Rate for Payer: Healthscope Commercial |
$1,264.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,123.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,194.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,053.58
|
| Rate for Payer: PHP Commercial |
$1,194.05
|
| Rate for Payer: Priority Health SBD |
$885.01
|
|
