|
HC ERCP
|
Facility
|
IP
|
$3,396.96
|
|
| Hospital Charge Code |
36000039
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,140.08 |
| Max. Negotiated Rate |
$3,057.26 |
| Rate for Payer: Aetna Commercial |
$2,887.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,208.02
|
| Rate for Payer: Cash Price |
$2,717.57
|
| Rate for Payer: Cofinity Commercial |
$2,377.87
|
| Rate for Payer: Cofinity Commercial |
$2,921.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,377.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,717.57
|
| Rate for Payer: Healthscope Commercial |
$3,057.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,887.42
|
| Rate for Payer: PHP Commercial |
$2,887.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,208.02
|
| Rate for Payer: Priority Health SBD |
$2,140.08
|
|
|
HC ERCP SPHINCTEROTOMY
|
Facility
|
IP
|
$4,045.90
|
|
| Hospital Charge Code |
36000040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,548.92 |
| Max. Negotiated Rate |
$3,641.31 |
| Rate for Payer: Aetna Commercial |
$3,439.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,629.84
|
| Rate for Payer: Cash Price |
$3,236.72
|
| Rate for Payer: Cofinity Commercial |
$2,832.13
|
| Rate for Payer: Cofinity Commercial |
$3,479.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,832.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,236.72
|
| Rate for Payer: Healthscope Commercial |
$3,641.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,439.01
|
| Rate for Payer: PHP Commercial |
$3,439.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,629.84
|
| Rate for Payer: Priority Health SBD |
$2,548.92
|
|
|
HC ERCP SPHINCTEROTOMY
|
Facility
|
OP
|
$4,045.90
|
|
| Hospital Charge Code |
36000040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,618.36 |
| Max. Negotiated Rate |
$3,641.31 |
| Rate for Payer: Aetna Commercial |
$3,439.01
|
| Rate for Payer: Aetna Medicare |
$2,022.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,629.84
|
| Rate for Payer: BCBS Complete |
$1,618.36
|
| Rate for Payer: Cash Price |
$3,236.72
|
| Rate for Payer: Cofinity Commercial |
$2,832.13
|
| Rate for Payer: Cofinity Commercial |
$3,479.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,832.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,236.72
|
| Rate for Payer: Healthscope Commercial |
$3,641.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,439.01
|
| Rate for Payer: PHP Commercial |
$3,439.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,629.84
|
| Rate for Payer: Priority Health SBD |
$2,548.92
|
|
|
HC ER CRITICAL CARE EA ADDL 30 MIN
|
Facility
|
OP
|
$895.36
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
45000081
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$358.14 |
| Max. Negotiated Rate |
$805.82 |
| Rate for Payer: Aetna Commercial |
$761.06
|
| Rate for Payer: Aetna Medicare |
$447.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.98
|
| Rate for Payer: BCBS Complete |
$358.14
|
| Rate for Payer: Cash Price |
$716.29
|
| Rate for Payer: Cofinity Commercial |
$626.75
|
| Rate for Payer: Cofinity Commercial |
$770.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$626.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.29
|
| Rate for Payer: Healthscope Commercial |
$805.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$761.06
|
| Rate for Payer: PHP Commercial |
$761.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$581.98
|
| Rate for Payer: Priority Health SBD |
$564.08
|
|
|
HC ER CRITICAL CARE EA ADDL 30 MIN
|
Facility
|
IP
|
$895.36
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
45000081
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$564.08 |
| Max. Negotiated Rate |
$805.82 |
| Rate for Payer: Aetna Commercial |
$761.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.98
|
| Rate for Payer: Cash Price |
$716.29
|
| Rate for Payer: Cofinity Commercial |
$626.75
|
| Rate for Payer: Cofinity Commercial |
$770.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$626.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.29
|
| Rate for Payer: Healthscope Commercial |
$805.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$761.06
|
| Rate for Payer: PHP Commercial |
$761.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$581.98
|
| Rate for Payer: Priority Health SBD |
$564.08
|
|
|
HC ER CRITICAL CARE INITIAL 30-74 MIN
|
Facility
|
OP
|
$3,433.56
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
45000026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$440.47 |
| Max. Negotiated Rate |
$3,917.00 |
| Rate for Payer: Aetna Commercial |
$2,918.53
|
| Rate for Payer: Aetna Medicare |
$854.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,231.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,027.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,027.22
|
| Rate for Payer: BCBS Complete |
$462.50
|
| Rate for Payer: BCBS MAPPO |
$821.78
|
| Rate for Payer: BCN Medicare Advantage |
$821.78
|
| Rate for Payer: Cash Price |
$2,746.85
|
| Rate for Payer: Cash Price |
$2,746.85
|
| Rate for Payer: Cash Price |
$2,746.85
|
| Rate for Payer: Cofinity Commercial |
$2,403.49
|
| Rate for Payer: Cofinity Commercial |
$2,952.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,403.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,746.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$821.78
|
| Rate for Payer: Healthscope Commercial |
$3,090.20
|
| Rate for Payer: Mclaren Medicaid |
$440.47
|
| Rate for Payer: Mclaren Medicare |
$821.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$862.87
|
| Rate for Payer: Meridian Medicaid |
$462.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$945.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,918.53
|
| Rate for Payer: PACE Medicare |
$780.69
|
| Rate for Payer: PACE SWMI |
$821.78
|
| Rate for Payer: PHP Commercial |
$2,918.53
|
| Rate for Payer: PHP Medicare Advantage |
$821.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,231.81
|
| Rate for Payer: Priority Health Medicare |
$821.78
|
| Rate for Payer: Priority Health SBD |
$2,163.14
|
| Rate for Payer: Railroad Medicare Medicare |
$821.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,313.23
|
| Rate for Payer: UHC Core |
$3,657.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$821.78
|
| Rate for Payer: UHC Exchange |
$3,917.00
|
| Rate for Payer: UHC Medicare Advantage |
$821.78
|
| Rate for Payer: UHCCP Medicaid |
$462.66
|
| Rate for Payer: VA VA |
$821.78
|
|
|
HC ER CRITICAL CARE INITIAL 30-74 MIN
|
Facility
|
IP
|
$3,433.56
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
45000026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,163.14 |
| Max. Negotiated Rate |
$3,090.20 |
| Rate for Payer: Aetna Commercial |
$2,918.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,231.81
|
| Rate for Payer: Cash Price |
$2,746.85
|
| Rate for Payer: Cofinity Commercial |
$2,403.49
|
| Rate for Payer: Cofinity Commercial |
$2,952.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,403.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,746.85
|
| Rate for Payer: Healthscope Commercial |
$3,090.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,918.53
|
| Rate for Payer: PHP Commercial |
$2,918.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,231.81
|
| Rate for Payer: Priority Health SBD |
$2,163.14
|
|
|
HC ER LEVEL FIVE 99285
|
Facility
|
IP
|
$2,047.66
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
45000025
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,290.03 |
| Max. Negotiated Rate |
$1,842.89 |
| Rate for Payer: Aetna Commercial |
$1,740.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,330.98
|
| Rate for Payer: Cash Price |
$1,638.13
|
| Rate for Payer: Cofinity Commercial |
$1,433.36
|
| Rate for Payer: Cofinity Commercial |
$1,760.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,433.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,638.13
|
| Rate for Payer: Healthscope Commercial |
$1,842.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,740.51
|
| Rate for Payer: PHP Commercial |
$1,740.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,330.98
|
| Rate for Payer: Priority Health SBD |
$1,290.03
|
|
|
HC ER LEVEL FIVE 99285
|
Facility
|
OP
|
$2,047.66
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
45000025
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$320.50 |
| Max. Negotiated Rate |
$3,263.00 |
| Rate for Payer: Aetna Commercial |
$1,740.51
|
| Rate for Payer: Aetna Medicare |
$621.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,330.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$747.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$747.42
|
| Rate for Payer: BCBS Complete |
$336.52
|
| Rate for Payer: BCBS MAPPO |
$597.94
|
| Rate for Payer: BCN Medicare Advantage |
$597.94
|
| Rate for Payer: Cash Price |
$1,638.13
|
| Rate for Payer: Cash Price |
$1,638.13
|
| Rate for Payer: Cash Price |
$1,638.13
|
| Rate for Payer: Cofinity Commercial |
$1,433.36
|
| Rate for Payer: Cofinity Commercial |
$1,760.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,433.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,638.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$597.94
|
| Rate for Payer: Healthscope Commercial |
$1,842.89
|
| Rate for Payer: Mclaren Medicaid |
$320.50
|
| Rate for Payer: Mclaren Medicare |
$597.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$627.84
|
| Rate for Payer: Meridian Medicaid |
$336.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$687.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,740.51
|
| Rate for Payer: PACE Medicare |
$568.04
|
| Rate for Payer: PACE SWMI |
$597.94
|
| Rate for Payer: PHP Commercial |
$1,740.51
|
| Rate for Payer: PHP Medicare Advantage |
$597.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$320.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,330.98
|
| Rate for Payer: Priority Health Medicare |
$597.94
|
| Rate for Payer: Priority Health SBD |
$1,290.03
|
| Rate for Payer: Railroad Medicare Medicare |
$597.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,683.14
|
| Rate for Payer: UHC Core |
$3,048.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.94
|
| Rate for Payer: UHC Exchange |
$3,263.00
|
| Rate for Payer: UHC Medicare Advantage |
$597.94
|
| Rate for Payer: UHCCP Medicaid |
$336.64
|
| Rate for Payer: VA VA |
$597.94
|
|
|
HC ER LEVEL FOUR 99284
|
Facility
|
OP
|
$1,419.01
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
45000024
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$222.60 |
| Max. Negotiated Rate |
$3,546.00 |
| Rate for Payer: Aetna Commercial |
$1,206.16
|
| Rate for Payer: Aetna Medicare |
$431.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$922.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$519.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$519.11
|
| Rate for Payer: BCBS Complete |
$233.73
|
| Rate for Payer: BCBS MAPPO |
$415.29
|
| Rate for Payer: BCN Medicare Advantage |
$415.29
|
| Rate for Payer: Cash Price |
$1,135.21
|
| Rate for Payer: Cash Price |
$1,135.21
|
| Rate for Payer: Cash Price |
$1,135.21
|
| Rate for Payer: Cofinity Commercial |
$1,220.35
|
| Rate for Payer: Cofinity Commercial |
$993.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$993.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,135.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$415.29
|
| Rate for Payer: Healthscope Commercial |
$1,277.11
|
| Rate for Payer: Mclaren Medicaid |
$222.60
|
| Rate for Payer: Mclaren Medicare |
$415.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$436.05
|
| Rate for Payer: Meridian Medicaid |
$233.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$477.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,206.16
|
| Rate for Payer: PACE Medicare |
$394.53
|
| Rate for Payer: PACE SWMI |
$415.29
|
| Rate for Payer: PHP Commercial |
$1,206.16
|
| Rate for Payer: PHP Medicare Advantage |
$415.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$222.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$922.36
|
| Rate for Payer: Priority Health Medicare |
$415.29
|
| Rate for Payer: Priority Health SBD |
$893.98
|
| Rate for Payer: Railroad Medicare Medicare |
$415.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,169.00
|
| Rate for Payer: UHC Core |
$2,377.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$415.29
|
| Rate for Payer: UHC Exchange |
$3,546.00
|
| Rate for Payer: UHC Medicare Advantage |
$415.29
|
| Rate for Payer: UHCCP Medicaid |
$233.81
|
| Rate for Payer: VA VA |
$415.29
|
|
|
HC ER LEVEL FOUR 99284
|
Facility
|
IP
|
$1,419.01
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
45000024
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$893.98 |
| Max. Negotiated Rate |
$1,277.11 |
| Rate for Payer: Aetna Commercial |
$1,206.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$922.36
|
| Rate for Payer: Cash Price |
$1,135.21
|
| Rate for Payer: Cofinity Commercial |
$1,220.35
|
| Rate for Payer: Cofinity Commercial |
$993.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$993.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,135.21
|
| Rate for Payer: Healthscope Commercial |
$1,277.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,206.16
|
| Rate for Payer: PHP Commercial |
$1,206.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$922.36
|
| Rate for Payer: Priority Health SBD |
$893.98
|
|
|
HC ER LEVEL ONE 99281
|
Facility
|
IP
|
$257.36
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
45000020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$162.14 |
| Max. Negotiated Rate |
$231.62 |
| Rate for Payer: Aetna Commercial |
$218.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.28
|
| Rate for Payer: Cash Price |
$205.89
|
| Rate for Payer: Cofinity Commercial |
$180.15
|
| Rate for Payer: Cofinity Commercial |
$221.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.89
|
| Rate for Payer: Healthscope Commercial |
$231.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.76
|
| Rate for Payer: PHP Commercial |
$218.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.28
|
| Rate for Payer: Priority Health SBD |
$162.14
|
|
|
HC ER LEVEL ONE 99281
|
Facility
|
OP
|
$257.36
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
45000020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$511.00 |
| Rate for Payer: Aetna Commercial |
$218.76
|
| Rate for Payer: Aetna Medicare |
$89.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$205.89
|
| Rate for Payer: Cash Price |
$205.89
|
| Rate for Payer: Cash Price |
$205.89
|
| Rate for Payer: Cofinity Commercial |
$180.15
|
| Rate for Payer: Cofinity Commercial |
$221.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$231.62
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.76
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$218.76
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.28
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health SBD |
$162.14
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.72
|
| Rate for Payer: UHC Core |
$477.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$511.00
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$48.34
|
| Rate for Payer: VA VA |
$85.87
|
|
|
HC ER LEVEL THREE 99283
|
Facility
|
OP
|
$903.62
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
45000022
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.75 |
| Max. Negotiated Rate |
$1,475.00 |
| Rate for Payer: Aetna Commercial |
$768.08
|
| Rate for Payer: Aetna Medicare |
$280.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$587.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$337.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$337.56
|
| Rate for Payer: BCBS Complete |
$151.98
|
| Rate for Payer: BCBS MAPPO |
$270.05
|
| Rate for Payer: BCN Medicare Advantage |
$270.05
|
| Rate for Payer: Cash Price |
$722.90
|
| Rate for Payer: Cash Price |
$722.90
|
| Rate for Payer: Cash Price |
$722.90
|
| Rate for Payer: Cofinity Commercial |
$632.53
|
| Rate for Payer: Cofinity Commercial |
$777.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$632.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$722.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$270.05
|
| Rate for Payer: Healthscope Commercial |
$813.26
|
| Rate for Payer: Mclaren Medicaid |
$144.75
|
| Rate for Payer: Mclaren Medicare |
$270.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$283.55
|
| Rate for Payer: Meridian Medicaid |
$151.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$310.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$768.08
|
| Rate for Payer: PACE Medicare |
$256.55
|
| Rate for Payer: PACE SWMI |
$270.05
|
| Rate for Payer: PHP Commercial |
$768.08
|
| Rate for Payer: PHP Medicare Advantage |
$270.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$587.35
|
| Rate for Payer: Priority Health Medicare |
$270.05
|
| Rate for Payer: Priority Health SBD |
$569.28
|
| Rate for Payer: Railroad Medicare Medicare |
$270.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$760.16
|
| Rate for Payer: UHC Core |
$1,378.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$270.05
|
| Rate for Payer: UHC Exchange |
$1,475.00
|
| Rate for Payer: UHC Medicare Advantage |
$270.05
|
| Rate for Payer: UHCCP Medicaid |
$152.04
|
| Rate for Payer: VA VA |
$270.05
|
|
|
HC ER LEVEL THREE 99283
|
Facility
|
IP
|
$903.62
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
45000022
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$569.28 |
| Max. Negotiated Rate |
$813.26 |
| Rate for Payer: Aetna Commercial |
$768.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$587.35
|
| Rate for Payer: Cash Price |
$722.90
|
| Rate for Payer: Cofinity Commercial |
$632.53
|
| Rate for Payer: Cofinity Commercial |
$777.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$632.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$722.90
|
| Rate for Payer: Healthscope Commercial |
$813.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$768.08
|
| Rate for Payer: PHP Commercial |
$768.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$587.35
|
| Rate for Payer: Priority Health SBD |
$569.28
|
|
|
HC ER LEVEL TWO 99282
|
Facility
|
OP
|
$512.06
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
45000021
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$82.79 |
| Max. Negotiated Rate |
$1,022.00 |
| Rate for Payer: Aetna Commercial |
$435.25
|
| Rate for Payer: Aetna Medicare |
$160.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$332.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$193.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$193.06
|
| Rate for Payer: BCBS Complete |
$86.92
|
| Rate for Payer: BCBS MAPPO |
$154.45
|
| Rate for Payer: BCN Medicare Advantage |
$154.45
|
| Rate for Payer: Cash Price |
$409.65
|
| Rate for Payer: Cash Price |
$409.65
|
| Rate for Payer: Cash Price |
$409.65
|
| Rate for Payer: Cofinity Commercial |
$358.44
|
| Rate for Payer: Cofinity Commercial |
$440.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$358.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$409.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.45
|
| Rate for Payer: Healthscope Commercial |
$460.85
|
| Rate for Payer: Mclaren Medicaid |
$82.79
|
| Rate for Payer: Mclaren Medicare |
$154.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.17
|
| Rate for Payer: Meridian Medicaid |
$86.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$435.25
|
| Rate for Payer: PACE Medicare |
$146.73
|
| Rate for Payer: PACE SWMI |
$154.45
|
| Rate for Payer: PHP Commercial |
$435.25
|
| Rate for Payer: PHP Medicare Advantage |
$154.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.84
|
| Rate for Payer: Priority Health Medicare |
$154.45
|
| Rate for Payer: Priority Health SBD |
$322.60
|
| Rate for Payer: Railroad Medicare Medicare |
$154.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$434.76
|
| Rate for Payer: UHC Core |
$954.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$154.45
|
| Rate for Payer: UHC Exchange |
$1,022.00
|
| Rate for Payer: UHC Medicare Advantage |
$154.45
|
| Rate for Payer: UHCCP Medicaid |
$86.96
|
| Rate for Payer: VA VA |
$154.45
|
|
|
HC ER LEVEL TWO 99282
|
Facility
|
IP
|
$512.06
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
45000021
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$322.60 |
| Max. Negotiated Rate |
$460.85 |
| Rate for Payer: Aetna Commercial |
$435.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$332.84
|
| Rate for Payer: Cash Price |
$409.65
|
| Rate for Payer: Cofinity Commercial |
$358.44
|
| Rate for Payer: Cofinity Commercial |
$440.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$358.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$409.65
|
| Rate for Payer: Healthscope Commercial |
$460.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$435.25
|
| Rate for Payer: PHP Commercial |
$435.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.84
|
| Rate for Payer: Priority Health SBD |
$322.60
|
|
|
HC ER OBSERVATION PER HOUR
|
Facility
|
OP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200002
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$58.03 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: Aetna Medicare |
$72.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.30
|
| Rate for Payer: BCBS Complete |
$58.03
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$101.56
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$130.57
|
| Rate for Payer: Meridian Medicaid |
$1,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: PHP Commercial |
$123.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health SBD |
$91.40
|
| Rate for Payer: UHC Core |
$107.36
|
| Rate for Payer: UHC Exchange |
$107.36
|
|
|
HC ER OBSERVATION PER HOUR
|
Facility
|
IP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200002
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$130.57 |
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.30
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$101.56
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$130.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: PHP Commercial |
$123.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health SBD |
$91.40
|
|
|
HC ERO OR PACU R&B
|
Facility
|
IP
|
$3,356.84
|
|
| Hospital Charge Code |
12000001
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$2,114.81 |
| Max. Negotiated Rate |
$3,021.16 |
| Rate for Payer: Aetna Commercial |
$2,853.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,181.95
|
| Rate for Payer: Cash Price |
$2,685.47
|
| Rate for Payer: Cofinity Commercial |
$2,349.79
|
| Rate for Payer: Cofinity Commercial |
$2,886.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,349.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,685.47
|
| Rate for Payer: Healthscope Commercial |
$3,021.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,853.31
|
| Rate for Payer: PHP Commercial |
$2,853.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,181.95
|
| Rate for Payer: Priority Health SBD |
$2,114.81
|
|
|
HC ER REDUCTION/DISLOCATION LEVEL 1
|
Facility
|
IP
|
$690.61
|
|
| Hospital Charge Code |
45000039
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$435.08 |
| Max. Negotiated Rate |
$621.55 |
| Rate for Payer: Aetna Commercial |
$587.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$448.90
|
| Rate for Payer: Cash Price |
$552.49
|
| Rate for Payer: Cofinity Commercial |
$483.43
|
| Rate for Payer: Cofinity Commercial |
$593.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$483.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.49
|
| Rate for Payer: Healthscope Commercial |
$621.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.02
|
| Rate for Payer: PHP Commercial |
$587.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.90
|
| Rate for Payer: Priority Health SBD |
$435.08
|
|
|
HC ER REDUCTION/DISLOCATION LEVEL 1
|
Facility
|
OP
|
$690.61
|
|
| Hospital Charge Code |
45000039
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$276.24 |
| Max. Negotiated Rate |
$621.55 |
| Rate for Payer: Aetna Commercial |
$587.02
|
| Rate for Payer: Aetna Medicare |
$345.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$448.90
|
| Rate for Payer: BCBS Complete |
$276.24
|
| Rate for Payer: Cash Price |
$552.49
|
| Rate for Payer: Cofinity Commercial |
$483.43
|
| Rate for Payer: Cofinity Commercial |
$593.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$483.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.49
|
| Rate for Payer: Healthscope Commercial |
$621.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.02
|
| Rate for Payer: PHP Commercial |
$587.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.90
|
| Rate for Payer: Priority Health SBD |
$435.08
|
|
|
HC ER SURGICAL HAND/FOOT CARE
|
Facility
|
IP
|
$690.61
|
|
| Hospital Charge Code |
45000040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$435.08 |
| Max. Negotiated Rate |
$621.55 |
| Rate for Payer: Aetna Commercial |
$587.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$448.90
|
| Rate for Payer: Cash Price |
$552.49
|
| Rate for Payer: Cofinity Commercial |
$483.43
|
| Rate for Payer: Cofinity Commercial |
$593.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$483.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.49
|
| Rate for Payer: Healthscope Commercial |
$621.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.02
|
| Rate for Payer: PHP Commercial |
$587.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.90
|
| Rate for Payer: Priority Health SBD |
$435.08
|
|
|
HC ER SURGICAL HAND/FOOT CARE
|
Facility
|
OP
|
$690.61
|
|
| Hospital Charge Code |
45000040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$276.24 |
| Max. Negotiated Rate |
$621.55 |
| Rate for Payer: Aetna Commercial |
$587.02
|
| Rate for Payer: Aetna Medicare |
$345.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$448.90
|
| Rate for Payer: BCBS Complete |
$276.24
|
| Rate for Payer: Cash Price |
$552.49
|
| Rate for Payer: Cofinity Commercial |
$483.43
|
| Rate for Payer: Cofinity Commercial |
$593.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$483.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.49
|
| Rate for Payer: Healthscope Commercial |
$621.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.02
|
| Rate for Payer: PHP Commercial |
$587.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.90
|
| Rate for Payer: Priority Health SBD |
$435.08
|
|
|
HC ERYTHROPOIETIN
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
30100191
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.22 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.05
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health SBD |
$26.22
|
|
