|
HC MENENCEPH CMPT17
|
Facility
|
OP
|
$13.87
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
30200358
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$28.63 |
| Rate for Payer: Aetna Commercial |
$11.79
|
| Rate for Payer: Aetna Medicare |
$17.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.06
|
| Rate for Payer: BCBS Complete |
$9.68
|
| Rate for Payer: BCBS MAPPO |
$16.85
|
| Rate for Payer: BCBS Trust/PPO |
$13.20
|
| Rate for Payer: BCN Medicare Advantage |
$16.85
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$11.93
|
| Rate for Payer: Cofinity Commercial |
$9.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.85
|
| Rate for Payer: Healthscope Commercial |
$12.48
|
| Rate for Payer: Mclaren Medicaid |
$9.22
|
| Rate for Payer: Mclaren Medicare |
$16.85
|
| Rate for Payer: Meridian Medicaid |
$9.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
| Rate for Payer: PACE Medicare |
$16.01
|
| Rate for Payer: PACE SWMI |
$16.85
|
| Rate for Payer: PHP Commercial |
$11.79
|
| Rate for Payer: PHP Medicare Advantage |
$16.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: Priority Health Medicare |
$16.85
|
| Rate for Payer: Priority Health SBD |
$8.74
|
| Rate for Payer: Railroad Medicare Medicare |
$16.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.22
|
| Rate for Payer: UHC Core |
$28.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.85
|
| Rate for Payer: UHC Exchange |
$16.85
|
| Rate for Payer: UHC Medicare Advantage |
$17.36
|
| Rate for Payer: VA VA |
$16.85
|
|
|
HC MENENCEPH CMPT17
|
Facility
|
IP
|
$13.87
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
30200358
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Aetna Commercial |
$11.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$11.93
|
| Rate for Payer: Cofinity Commercial |
$9.71
|
| Rate for Payer: Healthscope Commercial |
$12.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
| Rate for Payer: PHP Commercial |
$11.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: Priority Health SBD |
$8.74
|
|
|
HC MENENCEPH CMPT 18
|
Facility
|
IP
|
$16.65
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
30200359
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.49 |
| Max. Negotiated Rate |
$14.98 |
| Rate for Payer: Aetna Commercial |
$14.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.82
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cofinity Commercial |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$14.32
|
| Rate for Payer: Healthscope Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.15
|
| Rate for Payer: PHP Commercial |
$14.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.66
|
| Rate for Payer: Priority Health SBD |
$10.49
|
|
|
HC MENENCEPH CMPT 18
|
Facility
|
OP
|
$16.65
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
30200359
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$24.47 |
| Rate for Payer: Aetna Commercial |
$14.15
|
| Rate for Payer: Aetna Medicare |
$14.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.99
|
| Rate for Payer: BCBS Complete |
$8.27
|
| Rate for Payer: BCBS MAPPO |
$14.39
|
| Rate for Payer: BCBS Trust/PPO |
$11.27
|
| Rate for Payer: BCN Medicare Advantage |
$14.39
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cofinity Commercial |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$14.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.39
|
| Rate for Payer: Healthscope Commercial |
$14.98
|
| Rate for Payer: Mclaren Medicaid |
$7.87
|
| Rate for Payer: Mclaren Medicare |
$14.39
|
| Rate for Payer: Meridian Medicaid |
$8.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.15
|
| Rate for Payer: PACE Medicare |
$13.67
|
| Rate for Payer: PACE SWMI |
$14.39
|
| Rate for Payer: PHP Commercial |
$14.15
|
| Rate for Payer: PHP Medicare Advantage |
$14.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.66
|
| Rate for Payer: Priority Health Medicare |
$14.39
|
| Rate for Payer: Priority Health SBD |
$10.49
|
| Rate for Payer: Railroad Medicare Medicare |
$14.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.27
|
| Rate for Payer: UHC Core |
$24.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.39
|
| Rate for Payer: UHC Exchange |
$14.39
|
| Rate for Payer: UHC Medicare Advantage |
$14.82
|
| Rate for Payer: VA VA |
$14.39
|
|
|
HC MENENCEPH CMPT 19
|
Facility
|
OP
|
$13.87
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200360
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$21.88 |
| Rate for Payer: Aetna Commercial |
$11.79
|
| Rate for Payer: Aetna Medicare |
$13.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: BCBS Complete |
$7.39
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$10.08
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$9.71
|
| Rate for Payer: Cofinity Commercial |
$11.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$12.48
|
| Rate for Payer: Mclaren Medicaid |
$7.04
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Medicaid |
$7.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$11.79
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health SBD |
$8.74
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.44
|
| Rate for Payer: UHC Core |
$21.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.87
|
| Rate for Payer: UHC Exchange |
$12.87
|
| Rate for Payer: UHC Medicare Advantage |
$13.26
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC MENENCEPH CMPT 19
|
Facility
|
IP
|
$13.87
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200360
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Aetna Commercial |
$11.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$11.93
|
| Rate for Payer: Cofinity Commercial |
$9.71
|
| Rate for Payer: Healthscope Commercial |
$12.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
| Rate for Payer: PHP Commercial |
$11.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: Priority Health SBD |
$8.74
|
|
|
HC MENENCEPH CMPT 2
|
Facility
|
IP
|
$13.87
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
30200256
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Aetna Commercial |
$11.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$11.93
|
| Rate for Payer: Cofinity Commercial |
$9.71
|
| Rate for Payer: Healthscope Commercial |
$12.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
| Rate for Payer: PHP Commercial |
$11.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: Priority Health SBD |
$8.74
|
|
|
HC MENENCEPH CMPT 2
|
Facility
|
OP
|
$13.87
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
30200256
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$22.42 |
| Rate for Payer: Aetna Commercial |
$11.79
|
| Rate for Payer: Aetna Medicare |
$13.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.49
|
| Rate for Payer: BCBS Complete |
$7.58
|
| Rate for Payer: BCBS MAPPO |
$13.19
|
| Rate for Payer: BCBS Trust/PPO |
$10.33
|
| Rate for Payer: BCN Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$9.71
|
| Rate for Payer: Cofinity Commercial |
$11.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.19
|
| Rate for Payer: Healthscope Commercial |
$12.48
|
| Rate for Payer: Mclaren Medicaid |
$7.21
|
| Rate for Payer: Mclaren Medicare |
$13.19
|
| Rate for Payer: Meridian Medicaid |
$7.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
| Rate for Payer: PACE Medicare |
$12.53
|
| Rate for Payer: PACE SWMI |
$13.19
|
| Rate for Payer: PHP Commercial |
$11.79
|
| Rate for Payer: PHP Medicare Advantage |
$13.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: Priority Health Medicare |
$13.19
|
| Rate for Payer: Priority Health SBD |
$8.74
|
| Rate for Payer: Railroad Medicare Medicare |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.83
|
| Rate for Payer: UHC Core |
$22.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.19
|
| Rate for Payer: UHC Exchange |
$13.19
|
| Rate for Payer: UHC Medicare Advantage |
$13.59
|
| Rate for Payer: VA VA |
$13.19
|
|
|
HC MENENCEPH CMPT 3
|
Facility
|
OP
|
$13.87
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
30200264
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.13 |
| Max. Negotiated Rate |
$22.15 |
| Rate for Payer: Aetna Commercial |
$11.79
|
| Rate for Payer: Aetna Medicare |
$13.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.29
|
| Rate for Payer: BCBS Complete |
$7.48
|
| Rate for Payer: BCBS MAPPO |
$13.03
|
| Rate for Payer: BCBS Trust/PPO |
$10.20
|
| Rate for Payer: BCN Medicare Advantage |
$13.03
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$9.71
|
| Rate for Payer: Cofinity Commercial |
$11.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.03
|
| Rate for Payer: Healthscope Commercial |
$12.48
|
| Rate for Payer: Mclaren Medicaid |
$7.13
|
| Rate for Payer: Mclaren Medicare |
$13.03
|
| Rate for Payer: Meridian Medicaid |
$7.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
| Rate for Payer: PACE Medicare |
$12.38
|
| Rate for Payer: PACE SWMI |
$13.03
|
| Rate for Payer: PHP Commercial |
$11.79
|
| Rate for Payer: PHP Medicare Advantage |
$13.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: Priority Health Medicare |
$13.03
|
| Rate for Payer: Priority Health SBD |
$8.74
|
| Rate for Payer: Railroad Medicare Medicare |
$13.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.64
|
| Rate for Payer: UHC Core |
$22.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.03
|
| Rate for Payer: UHC Exchange |
$13.03
|
| Rate for Payer: UHC Medicare Advantage |
$13.42
|
| Rate for Payer: VA VA |
$13.03
|
|
|
HC MENENCEPH CMPT 3
|
Facility
|
IP
|
$13.87
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
30200264
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Aetna Commercial |
$11.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$11.93
|
| Rate for Payer: Cofinity Commercial |
$9.71
|
| Rate for Payer: Healthscope Commercial |
$12.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
| Rate for Payer: PHP Commercial |
$11.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: Priority Health SBD |
$8.74
|
|
|
HC MENENCEPH CMPT 4
|
Facility
|
OP
|
$13.87
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
30200250
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$24.47 |
| Rate for Payer: Aetna Commercial |
$11.79
|
| Rate for Payer: Aetna Medicare |
$14.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.99
|
| Rate for Payer: BCBS Complete |
$8.27
|
| Rate for Payer: BCBS MAPPO |
$14.39
|
| Rate for Payer: BCBS Trust/PPO |
$11.27
|
| Rate for Payer: BCN Medicare Advantage |
$14.39
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$9.71
|
| Rate for Payer: Cofinity Commercial |
$11.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.39
|
| Rate for Payer: Healthscope Commercial |
$12.48
|
| Rate for Payer: Mclaren Medicaid |
$7.87
|
| Rate for Payer: Mclaren Medicare |
$14.39
|
| Rate for Payer: Meridian Medicaid |
$8.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
| Rate for Payer: PACE Medicare |
$13.67
|
| Rate for Payer: PACE SWMI |
$14.39
|
| Rate for Payer: PHP Commercial |
$11.79
|
| Rate for Payer: PHP Medicare Advantage |
$14.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: Priority Health Medicare |
$14.39
|
| Rate for Payer: Priority Health SBD |
$8.74
|
| Rate for Payer: Railroad Medicare Medicare |
$14.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.27
|
| Rate for Payer: UHC Core |
$24.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.39
|
| Rate for Payer: UHC Exchange |
$14.39
|
| Rate for Payer: UHC Medicare Advantage |
$14.82
|
| Rate for Payer: VA VA |
$14.39
|
|
|
HC MENENCEPH CMPT 4
|
Facility
|
IP
|
$13.87
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
30200250
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Aetna Commercial |
$11.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$11.93
|
| Rate for Payer: Cofinity Commercial |
$9.71
|
| Rate for Payer: Healthscope Commercial |
$12.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
| Rate for Payer: PHP Commercial |
$11.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: Priority Health SBD |
$8.74
|
|
|
HC MENENCEPH CMPT 5
|
Facility
|
IP
|
$13.87
|
|
|
Service Code
|
CPT 86645
|
| Hospital Charge Code |
30200253
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Aetna Commercial |
$11.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$11.93
|
| Rate for Payer: Cofinity Commercial |
$9.71
|
| Rate for Payer: Healthscope Commercial |
$12.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
| Rate for Payer: PHP Commercial |
$11.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: Priority Health SBD |
$8.74
|
|
|
HC MENENCEPH CMPT 5
|
Facility
|
OP
|
$13.87
|
|
|
Service Code
|
CPT 86645
|
| Hospital Charge Code |
30200253
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$28.63 |
| Rate for Payer: Aetna Commercial |
$11.79
|
| Rate for Payer: Aetna Medicare |
$17.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.06
|
| Rate for Payer: BCBS Complete |
$9.68
|
| Rate for Payer: BCBS MAPPO |
$16.85
|
| Rate for Payer: BCBS Trust/PPO |
$13.20
|
| Rate for Payer: BCN Medicare Advantage |
$16.85
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$11.93
|
| Rate for Payer: Cofinity Commercial |
$9.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.85
|
| Rate for Payer: Healthscope Commercial |
$12.48
|
| Rate for Payer: Mclaren Medicaid |
$9.22
|
| Rate for Payer: Mclaren Medicare |
$16.85
|
| Rate for Payer: Meridian Medicaid |
$9.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
| Rate for Payer: PACE Medicare |
$16.01
|
| Rate for Payer: PACE SWMI |
$16.85
|
| Rate for Payer: PHP Commercial |
$11.79
|
| Rate for Payer: PHP Medicare Advantage |
$16.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: Priority Health Medicare |
$16.85
|
| Rate for Payer: Priority Health SBD |
$8.74
|
| Rate for Payer: Railroad Medicare Medicare |
$16.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.22
|
| Rate for Payer: UHC Core |
$28.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.85
|
| Rate for Payer: UHC Exchange |
$16.85
|
| Rate for Payer: UHC Medicare Advantage |
$17.36
|
| Rate for Payer: VA VA |
$16.85
|
|
|
HC MENENCEPH CMPT 6
|
Facility
|
OP
|
$13.87
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
30200257
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$22.42 |
| Rate for Payer: Aetna Commercial |
$11.79
|
| Rate for Payer: Aetna Medicare |
$13.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.49
|
| Rate for Payer: BCBS Complete |
$7.58
|
| Rate for Payer: BCBS MAPPO |
$13.19
|
| Rate for Payer: BCBS Trust/PPO |
$10.33
|
| Rate for Payer: BCN Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$9.71
|
| Rate for Payer: Cofinity Commercial |
$11.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.19
|
| Rate for Payer: Healthscope Commercial |
$12.48
|
| Rate for Payer: Mclaren Medicaid |
$7.21
|
| Rate for Payer: Mclaren Medicare |
$13.19
|
| Rate for Payer: Meridian Medicaid |
$7.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
| Rate for Payer: PACE Medicare |
$12.53
|
| Rate for Payer: PACE SWMI |
$13.19
|
| Rate for Payer: PHP Commercial |
$11.79
|
| Rate for Payer: PHP Medicare Advantage |
$13.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: Priority Health Medicare |
$13.19
|
| Rate for Payer: Priority Health SBD |
$8.74
|
| Rate for Payer: Railroad Medicare Medicare |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.83
|
| Rate for Payer: UHC Core |
$22.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.19
|
| Rate for Payer: UHC Exchange |
$13.19
|
| Rate for Payer: UHC Medicare Advantage |
$13.59
|
| Rate for Payer: VA VA |
$13.19
|
|
|
HC MENENCEPH CMPT 6
|
Facility
|
IP
|
$13.87
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
30200257
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Aetna Commercial |
$11.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$9.71
|
| Rate for Payer: Cofinity Commercial |
$11.93
|
| Rate for Payer: Healthscope Commercial |
$12.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
| Rate for Payer: PHP Commercial |
$11.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: Priority Health SBD |
$8.74
|
|
|
HC MENENCEPH CMPT 7
|
Facility
|
OP
|
$13.87
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
30200282
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$22.42 |
| Rate for Payer: Aetna Commercial |
$11.79
|
| Rate for Payer: Aetna Medicare |
$13.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.49
|
| Rate for Payer: BCBS Complete |
$7.58
|
| Rate for Payer: BCBS MAPPO |
$13.19
|
| Rate for Payer: BCBS Trust/PPO |
$10.33
|
| Rate for Payer: BCN Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$11.93
|
| Rate for Payer: Cofinity Commercial |
$9.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.19
|
| Rate for Payer: Healthscope Commercial |
$12.48
|
| Rate for Payer: Mclaren Medicaid |
$7.21
|
| Rate for Payer: Mclaren Medicare |
$13.19
|
| Rate for Payer: Meridian Medicaid |
$7.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
| Rate for Payer: PACE Medicare |
$12.53
|
| Rate for Payer: PACE SWMI |
$13.19
|
| Rate for Payer: PHP Commercial |
$11.79
|
| Rate for Payer: PHP Medicare Advantage |
$13.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: Priority Health Medicare |
$13.19
|
| Rate for Payer: Priority Health SBD |
$8.74
|
| Rate for Payer: Railroad Medicare Medicare |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.83
|
| Rate for Payer: UHC Core |
$22.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.19
|
| Rate for Payer: UHC Exchange |
$13.19
|
| Rate for Payer: UHC Medicare Advantage |
$13.59
|
| Rate for Payer: VA VA |
$13.19
|
|
|
HC MENENCEPH CMPT 7
|
Facility
|
IP
|
$13.87
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
30200282
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Aetna Commercial |
$11.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$11.93
|
| Rate for Payer: Cofinity Commercial |
$9.71
|
| Rate for Payer: Healthscope Commercial |
$12.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
| Rate for Payer: PHP Commercial |
$11.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: Priority Health SBD |
$8.74
|
|
|
HC MENENCEPH CMPT 8
|
Facility
|
IP
|
$13.87
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
30200284
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Aetna Commercial |
$11.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$11.93
|
| Rate for Payer: Cofinity Commercial |
$9.71
|
| Rate for Payer: Healthscope Commercial |
$12.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
| Rate for Payer: PHP Commercial |
$11.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: Priority Health SBD |
$8.74
|
|
|
HC MENENCEPH CMPT 8
|
Facility
|
OP
|
$13.87
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
30200284
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$32.89 |
| Rate for Payer: Aetna Commercial |
$11.79
|
| Rate for Payer: Aetna Medicare |
$20.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.19
|
| Rate for Payer: BCBS Complete |
$11.11
|
| Rate for Payer: BCBS MAPPO |
$19.35
|
| Rate for Payer: BCBS Trust/PPO |
$15.15
|
| Rate for Payer: BCN Medicare Advantage |
$19.35
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$9.71
|
| Rate for Payer: Cofinity Commercial |
$11.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$12.48
|
| Rate for Payer: Mclaren Medicaid |
$10.58
|
| Rate for Payer: Mclaren Medicare |
$19.35
|
| Rate for Payer: Meridian Medicaid |
$11.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
| Rate for Payer: PACE Medicare |
$18.38
|
| Rate for Payer: PACE SWMI |
$19.35
|
| Rate for Payer: PHP Commercial |
$11.79
|
| Rate for Payer: PHP Medicare Advantage |
$19.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: Priority Health Medicare |
$19.35
|
| Rate for Payer: Priority Health SBD |
$8.74
|
| Rate for Payer: Railroad Medicare Medicare |
$19.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.22
|
| Rate for Payer: UHC Core |
$32.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.35
|
| Rate for Payer: UHC Exchange |
$19.35
|
| Rate for Payer: UHC Medicare Advantage |
$19.93
|
| Rate for Payer: VA VA |
$19.35
|
|
|
HC MENENCEPH CMPT 9
|
Facility
|
OP
|
$13.87
|
|
|
Service Code
|
CPT 86727
|
| Hospital Charge Code |
30200304
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$21.88 |
| Rate for Payer: Aetna Commercial |
$11.79
|
| Rate for Payer: Aetna Medicare |
$13.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: BCBS Complete |
$7.39
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$10.08
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$9.71
|
| Rate for Payer: Cofinity Commercial |
$11.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$12.48
|
| Rate for Payer: Mclaren Medicaid |
$7.04
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Medicaid |
$7.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$11.79
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health SBD |
$8.74
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.44
|
| Rate for Payer: UHC Core |
$21.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.87
|
| Rate for Payer: UHC Exchange |
$12.87
|
| Rate for Payer: UHC Medicare Advantage |
$13.26
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC MENENCEPH CMPT 9
|
Facility
|
IP
|
$13.87
|
|
|
Service Code
|
CPT 86727
|
| Hospital Charge Code |
30200304
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Aetna Commercial |
$11.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$11.93
|
| Rate for Payer: Cofinity Commercial |
$9.71
|
| Rate for Payer: Healthscope Commercial |
$12.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.79
|
| Rate for Payer: PHP Commercial |
$11.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.71
|
| Rate for Payer: Priority Health SBD |
$8.74
|
|
|
HC MENIGOCOCCAL, QUADRIVALENT (MCV4 OR MENACWY) IM
|
Facility
|
IP
|
$157.08
|
|
|
Service Code
|
CPT 90734
|
| Hospital Charge Code |
63600085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$98.96 |
| Max. Negotiated Rate |
$141.37 |
| Rate for Payer: Aetna Commercial |
$133.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.10
|
| Rate for Payer: Cash Price |
$125.66
|
| Rate for Payer: Cofinity Commercial |
$109.96
|
| Rate for Payer: Cofinity Commercial |
$135.09
|
| Rate for Payer: Healthscope Commercial |
$141.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.52
|
| Rate for Payer: PHP Commercial |
$133.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.96
|
| Rate for Payer: Priority Health SBD |
$98.96
|
|
|
HC MENIGOCOCCAL, QUADRIVALENT (MCV4 OR MENACWY) IM
|
Facility
|
OP
|
$157.08
|
|
|
Service Code
|
CPT 90734
|
| Hospital Charge Code |
63600085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.83 |
| Max. Negotiated Rate |
$435.86 |
| Rate for Payer: Aetna Commercial |
$133.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.10
|
| Rate for Payer: BCBS Complete |
$62.83
|
| Rate for Payer: BCBS Trust/PPO |
$435.86
|
| Rate for Payer: Cash Price |
$125.66
|
| Rate for Payer: Cash Price |
$125.66
|
| Rate for Payer: Cofinity Commercial |
$109.96
|
| Rate for Payer: Cofinity Commercial |
$135.09
|
| Rate for Payer: Healthscope Commercial |
$141.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.52
|
| Rate for Payer: PHP Commercial |
$133.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.96
|
| Rate for Payer: Priority Health SBD |
$98.96
|
|
|
HC MENINGITIS/ENCEPHALITIS PANEL
|
Facility
|
IP
|
$714.00
|
|
|
Service Code
|
CPT 87483
|
| Hospital Charge Code |
30600287
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$449.82 |
| Max. Negotiated Rate |
$642.60 |
| Rate for Payer: Aetna Commercial |
$606.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.10
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cofinity Commercial |
$499.80
|
| Rate for Payer: Cofinity Commercial |
$614.04
|
| Rate for Payer: Healthscope Commercial |
$642.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$606.90
|
| Rate for Payer: PHP Commercial |
$606.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.80
|
| Rate for Payer: Priority Health SBD |
$449.82
|
|
