|
HC EPSTEIN BARR EA AG
|
Facility
|
IP
|
$37.45
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
30200365
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.59 |
| Max. Negotiated Rate |
$33.70 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.34
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$26.22
|
| Rate for Payer: Cofinity Commercial |
$32.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Healthscope Commercial |
$33.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: PHP Commercial |
$31.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: Priority Health SBD |
$23.59
|
|
|
HC EPSTEIN BARR VIRUS BY PCR FLUID
|
Facility
|
OP
|
$121.73
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600171
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$109.56 |
| Rate for Payer: Aetna Commercial |
$103.47
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.12
|
| 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 |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$31.07
|
| Rate for Payer: BCN Commercial |
$31.07
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cofinity Commercial |
$104.69
|
| Rate for Payer: Cofinity Commercial |
$85.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$109.56
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| 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 |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.47
|
| Rate for Payer: Nomi Health Commercial |
$52.64
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$103.47
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.12
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$76.69
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$19.76
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC EPSTEIN BARR VIRUS BY PCR FLUID
|
Facility
|
IP
|
$121.73
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600171
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$76.69 |
| Max. Negotiated Rate |
$109.56 |
| Rate for Payer: Aetna Commercial |
$103.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.12
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cofinity Commercial |
$104.69
|
| Rate for Payer: Cofinity Commercial |
$85.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.38
|
| Rate for Payer: Healthscope Commercial |
$109.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.47
|
| Rate for Payer: PHP Commercial |
$103.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.12
|
| Rate for Payer: Priority Health SBD |
$76.69
|
|
|
HC EPSTEIN BARR VIRUS PCR BLOOD
|
Facility
|
OP
|
$121.73
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
30600172
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.96 |
| Max. Negotiated Rate |
$109.56 |
| Rate for Payer: Aetna Commercial |
$103.47
|
| Rate for Payer: Aetna Medicare |
$44.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.55
|
| Rate for Payer: BCBS Complete |
$24.11
|
| Rate for Payer: BCBS MAPPO |
$42.84
|
| Rate for Payer: BCBS Trust/PPO |
$37.92
|
| Rate for Payer: BCN Commercial |
$37.92
|
| Rate for Payer: BCN Medicare Advantage |
$42.84
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cofinity Commercial |
$104.69
|
| Rate for Payer: Cofinity Commercial |
$85.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.84
|
| Rate for Payer: Healthscope Commercial |
$109.56
|
| Rate for Payer: Mclaren Medicaid |
$22.96
|
| Rate for Payer: Mclaren Medicare |
$42.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.98
|
| Rate for Payer: Meridian Medicaid |
$24.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.47
|
| Rate for Payer: Nomi Health Commercial |
$64.26
|
| Rate for Payer: PACE Medicare |
$40.70
|
| Rate for Payer: PACE SWMI |
$42.84
|
| Rate for Payer: PHP Commercial |
$103.47
|
| Rate for Payer: PHP Medicare Advantage |
$42.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.12
|
| Rate for Payer: Priority Health Medicare |
$42.84
|
| Rate for Payer: Priority Health SBD |
$76.69
|
| Rate for Payer: Railroad Medicare Medicare |
$42.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.84
|
| Rate for Payer: UHC Medicare Advantage |
$42.84
|
| Rate for Payer: UHCCP Medicaid |
$24.12
|
| Rate for Payer: VA VA |
$42.84
|
|
|
HC EPSTEIN BARR VIRUS PCR BLOOD
|
Facility
|
IP
|
$121.73
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
30600172
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$76.69 |
| Max. Negotiated Rate |
$109.56 |
| Rate for Payer: Aetna Commercial |
$103.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.12
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cofinity Commercial |
$104.69
|
| Rate for Payer: Cofinity Commercial |
$85.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.38
|
| Rate for Payer: Healthscope Commercial |
$109.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.47
|
| Rate for Payer: PHP Commercial |
$103.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.12
|
| Rate for Payer: Priority Health SBD |
$76.69
|
|
|
HC EP UPPER EXTREMITY SOMATOSENSO
|
Facility
|
OP
|
$1,120.29
|
|
|
Service Code
|
CPT 95925
|
| Hospital Charge Code |
92200014
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$163.53 |
| Max. Negotiated Rate |
$1,008.26 |
| Rate for Payer: Aetna Commercial |
$952.25
|
| Rate for Payer: Aetna Medicare |
$317.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$728.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.38
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$658.58
|
| Rate for Payer: BCN Commercial |
$658.58
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| Rate for Payer: Cash Price |
$896.23
|
| Rate for Payer: Cash Price |
$896.23
|
| Rate for Payer: Cofinity Commercial |
$963.45
|
| Rate for Payer: Cofinity Commercial |
$784.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$784.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$896.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$1,008.26
|
| Rate for Payer: Mclaren Medicaid |
$163.53
|
| Rate for Payer: Mclaren Medicare |
$305.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.36
|
| Rate for Payer: Meridian Medicaid |
$171.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$952.25
|
| Rate for Payer: Nomi Health Commercial |
$915.30
|
| Rate for Payer: PACE Medicare |
$289.84
|
| Rate for Payer: PACE SWMI |
$305.10
|
| Rate for Payer: PHP Commercial |
$952.25
|
| Rate for Payer: PHP Medicare Advantage |
$305.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$728.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$958.92
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$767.14
|
| Rate for Payer: Priority Health SBD |
$705.78
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.10
|
| Rate for Payer: UHC Exchange |
$829.01
|
| Rate for Payer: UHC Medicare Advantage |
$305.10
|
| Rate for Payer: UHCCP Medicaid |
$171.77
|
| Rate for Payer: VA VA |
$305.10
|
|
|
HC EP UPPER EXTREMITY SOMATOSENSO
|
Facility
|
IP
|
$1,120.29
|
|
|
Service Code
|
CPT 95925
|
| Hospital Charge Code |
92200014
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$705.78 |
| Max. Negotiated Rate |
$1,008.26 |
| Rate for Payer: Aetna Commercial |
$952.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$728.19
|
| Rate for Payer: Cash Price |
$896.23
|
| Rate for Payer: Cofinity Commercial |
$784.20
|
| Rate for Payer: Cofinity Commercial |
$963.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$784.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$896.23
|
| Rate for Payer: Healthscope Commercial |
$1,008.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$952.25
|
| Rate for Payer: PHP Commercial |
$952.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$728.19
|
| Rate for Payer: Priority Health SBD |
$705.78
|
|
|
HC EP UPPER/LOWER EXT. SOMATOSENSORY
|
Facility
|
OP
|
$2,506.92
|
|
|
Service Code
|
CPT 95938
|
| Hospital Charge Code |
92200025
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$278.65 |
| Max. Negotiated Rate |
$2,256.23 |
| Rate for Payer: Aetna Commercial |
$2,130.88
|
| Rate for Payer: Aetna Medicare |
$540.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,629.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$649.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$649.84
|
| Rate for Payer: BCBS Complete |
$292.58
|
| Rate for Payer: BCBS MAPPO |
$519.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,464.82
|
| Rate for Payer: BCN Commercial |
$1,464.82
|
| Rate for Payer: BCN Medicare Advantage |
$519.87
|
| Rate for Payer: Cash Price |
$2,005.54
|
| Rate for Payer: Cash Price |
$2,005.54
|
| Rate for Payer: Cofinity Commercial |
$2,155.95
|
| Rate for Payer: Cofinity Commercial |
$1,754.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,754.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,005.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$519.87
|
| Rate for Payer: Healthscope Commercial |
$2,256.23
|
| Rate for Payer: Mclaren Medicaid |
$278.65
|
| Rate for Payer: Mclaren Medicare |
$519.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$545.86
|
| Rate for Payer: Meridian Medicaid |
$292.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$597.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,130.88
|
| Rate for Payer: Nomi Health Commercial |
$1,559.61
|
| Rate for Payer: PACE Medicare |
$493.88
|
| Rate for Payer: PACE SWMI |
$519.87
|
| Rate for Payer: PHP Commercial |
$2,130.88
|
| Rate for Payer: PHP Medicare Advantage |
$519.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,629.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,633.95
|
| Rate for Payer: Priority Health Medicare |
$519.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,307.16
|
| Rate for Payer: Priority Health SBD |
$1,579.36
|
| Rate for Payer: Railroad Medicare Medicare |
$519.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$372.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$519.87
|
| Rate for Payer: UHC Exchange |
$1,855.12
|
| Rate for Payer: UHC Medicare Advantage |
$519.87
|
| Rate for Payer: UHCCP Medicaid |
$292.69
|
| Rate for Payer: VA VA |
$519.87
|
|
|
HC EP UPPER/LOWER EXT. SOMATOSENSORY
|
Facility
|
IP
|
$2,506.92
|
|
|
Service Code
|
CPT 95938
|
| Hospital Charge Code |
92200025
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,579.36 |
| Max. Negotiated Rate |
$2,256.23 |
| Rate for Payer: Aetna Commercial |
$2,130.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,629.50
|
| Rate for Payer: Cash Price |
$2,005.54
|
| Rate for Payer: Cofinity Commercial |
$1,754.84
|
| Rate for Payer: Cofinity Commercial |
$2,155.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,754.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,005.54
|
| Rate for Payer: Healthscope Commercial |
$2,256.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,130.88
|
| Rate for Payer: PHP Commercial |
$2,130.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,629.50
|
| Rate for Payer: Priority Health SBD |
$1,579.36
|
|
|
HC EP VISUAL
|
Facility
|
OP
|
$785.92
|
|
|
Service Code
|
CPT 95930
|
| Hospital Charge Code |
92200018
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$958.92 |
| Rate for Payer: Aetna Commercial |
$668.03
|
| Rate for Payer: Aetna Medicare |
$317.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$510.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.38
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$218.53
|
| Rate for Payer: BCN Commercial |
$218.53
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| Rate for Payer: Cash Price |
$628.74
|
| Rate for Payer: Cash Price |
$628.74
|
| Rate for Payer: Cofinity Commercial |
$675.89
|
| Rate for Payer: Cofinity Commercial |
$550.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$550.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$628.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$707.33
|
| Rate for Payer: Mclaren Medicaid |
$163.53
|
| Rate for Payer: Mclaren Medicare |
$305.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.36
|
| Rate for Payer: Meridian Medicaid |
$171.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$668.03
|
| Rate for Payer: Nomi Health Commercial |
$915.30
|
| Rate for Payer: PACE Medicare |
$289.84
|
| Rate for Payer: PACE SWMI |
$305.10
|
| Rate for Payer: PHP Commercial |
$668.03
|
| Rate for Payer: PHP Medicare Advantage |
$305.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$958.92
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$767.14
|
| Rate for Payer: Priority Health SBD |
$495.13
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.10
|
| Rate for Payer: UHC Exchange |
$581.58
|
| Rate for Payer: UHC Medicare Advantage |
$305.10
|
| Rate for Payer: UHCCP Medicaid |
$171.77
|
| Rate for Payer: VA VA |
$305.10
|
|
|
HC EP VISUAL
|
Facility
|
IP
|
$785.92
|
|
|
Service Code
|
CPT 95930
|
| Hospital Charge Code |
92200018
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$495.13 |
| Max. Negotiated Rate |
$707.33 |
| Rate for Payer: Aetna Commercial |
$668.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$510.85
|
| Rate for Payer: Cash Price |
$628.74
|
| Rate for Payer: Cofinity Commercial |
$550.14
|
| Rate for Payer: Cofinity Commercial |
$675.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$550.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$628.74
|
| Rate for Payer: Healthscope Commercial |
$707.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$668.03
|
| Rate for Payer: PHP Commercial |
$668.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.85
|
| Rate for Payer: Priority Health SBD |
$495.13
|
|
|
HC ERBE IRRIGATION
|
Facility
|
OP
|
$315.83
|
|
| Hospital Charge Code |
27000070
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$126.33 |
| Max. Negotiated Rate |
$284.25 |
| Rate for Payer: Aetna Commercial |
$268.46
|
| Rate for Payer: Aetna Medicare |
$157.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.29
|
| Rate for Payer: BCBS Complete |
$126.33
|
| Rate for Payer: Cash Price |
$252.66
|
| Rate for Payer: Cofinity Commercial |
$221.08
|
| Rate for Payer: Cofinity Commercial |
$271.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$221.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.66
|
| Rate for Payer: Healthscope Commercial |
$284.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.46
|
| Rate for Payer: PHP Commercial |
$268.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.29
|
| Rate for Payer: Priority Health SBD |
$198.97
|
|
|
HC ERBE IRRIGATION
|
Facility
|
IP
|
$315.83
|
|
| Hospital Charge Code |
27000070
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$198.97 |
| Max. Negotiated Rate |
$284.25 |
| Rate for Payer: Aetna Commercial |
$268.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.29
|
| Rate for Payer: Cash Price |
$252.66
|
| Rate for Payer: Cofinity Commercial |
$221.08
|
| Rate for Payer: Cofinity Commercial |
$271.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$221.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.66
|
| Rate for Payer: Healthscope Commercial |
$284.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.46
|
| Rate for Payer: PHP Commercial |
$268.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.29
|
| Rate for Payer: Priority Health SBD |
$198.97
|
|
|
HC ER BURN CARE
|
Facility
|
IP
|
$404.07
|
|
| Hospital Charge Code |
45000038
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$254.56 |
| Max. Negotiated Rate |
$363.66 |
| Rate for Payer: Aetna Commercial |
$343.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.65
|
| Rate for Payer: Cash Price |
$323.26
|
| Rate for Payer: Cofinity Commercial |
$282.85
|
| Rate for Payer: Cofinity Commercial |
$347.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$282.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.26
|
| Rate for Payer: Healthscope Commercial |
$363.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.46
|
| Rate for Payer: PHP Commercial |
$343.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.65
|
| Rate for Payer: Priority Health SBD |
$254.56
|
|
|
HC ER BURN CARE
|
Facility
|
OP
|
$404.07
|
|
| Hospital Charge Code |
45000038
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$161.63 |
| Max. Negotiated Rate |
$363.66 |
| Rate for Payer: Aetna Commercial |
$343.46
|
| Rate for Payer: Aetna Medicare |
$202.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.65
|
| Rate for Payer: BCBS Complete |
$161.63
|
| Rate for Payer: Cash Price |
$323.26
|
| Rate for Payer: Cofinity Commercial |
$282.85
|
| Rate for Payer: Cofinity Commercial |
$347.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$282.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.26
|
| Rate for Payer: Healthscope Commercial |
$363.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.46
|
| Rate for Payer: PHP Commercial |
$343.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.65
|
| Rate for Payer: Priority Health SBD |
$254.56
|
|
|
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
|
Facility
|
OP
|
$3,396.96
|
|
| Hospital Charge Code |
36000039
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,358.78 |
| Max. Negotiated Rate |
$3,057.26 |
| Rate for Payer: Aetna Commercial |
$2,887.42
|
| Rate for Payer: Aetna Medicare |
$1,698.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,208.02
|
| Rate for Payer: BCBS Complete |
$1,358.78
|
| 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
|
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 |
$3,439.02
|
| 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 |
$3,439.02
|
| Rate for Payer: PHP Commercial |
$3,439.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,629.84
|
| Rate for Payer: Priority Health SBD |
$2,548.92
|
|
|
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 |
$3,439.02
|
| 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 |
$3,439.02
|
| Rate for Payer: PHP Commercial |
$3,439.02
|
| 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
|
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 EA ADDL 30 MIN
|
Facility
|
OP
|
$895.36
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
45000081
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.73 |
| Max. Negotiated Rate |
$1,435.51 |
| 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: BCBS Trust/PPO |
$1,435.51
|
| Rate for Payer: BCN Commercial |
$1,435.51
|
| Rate for Payer: Cash Price |
$716.29
|
| 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
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.73
|
|
|
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 |
$225.43 |
| Max. Negotiated Rate |
$3,917.00 |
| Rate for Payer: Aetna Commercial |
$2,918.53
|
| Rate for Payer: Aetna Medicare |
$858.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,231.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,031.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,031.96
|
| Rate for Payer: BCBS Complete |
$464.63
|
| Rate for Payer: BCBS MAPPO |
$825.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,385.09
|
| Rate for Payer: BCN Commercial |
$1,385.09
|
| Rate for Payer: BCN Medicare Advantage |
$825.57
|
| 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 |
$2,952.86
|
| Rate for Payer: Cofinity Commercial |
$2,403.49
|
| 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 |
$825.57
|
| Rate for Payer: Healthscope Commercial |
$3,090.20
|
| Rate for Payer: Mclaren Medicaid |
$442.51
|
| Rate for Payer: Mclaren Medicare |
$825.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$866.85
|
| Rate for Payer: Meridian Medicaid |
$464.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$949.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,918.53
|
| Rate for Payer: Nomi Health Commercial |
$2,476.71
|
| Rate for Payer: PACE Medicare |
$784.29
|
| Rate for Payer: PACE SWMI |
$825.57
|
| Rate for Payer: PHP Commercial |
$2,918.53
|
| Rate for Payer: PHP Medicare Advantage |
$825.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$442.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,231.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,594.77
|
| Rate for Payer: Priority Health Medicare |
$825.57
|
| Rate for Payer: Priority Health Narrow Network |
$2,075.82
|
| Rate for Payer: Priority Health SBD |
$2,163.14
|
| Rate for Payer: Railroad Medicare Medicare |
$825.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.43
|
| Rate for Payer: UHC Core |
$3,657.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$825.57
|
| Rate for Payer: UHC Exchange |
$3,917.00
|
| Rate for Payer: UHC Medicare Advantage |
$825.57
|
| Rate for Payer: UHCCP Medicaid |
$464.80
|
| Rate for Payer: VA VA |
$825.57
|
|
|
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
|
OP
|
$2,047.66
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
45000025
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$187.42 |
| Max. Negotiated Rate |
$3,263.00 |
| Rate for Payer: Aetna Commercial |
$1,740.51
|
| Rate for Payer: Aetna Medicare |
$624.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,330.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$750.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$750.88
|
| Rate for Payer: BCBS Complete |
$338.07
|
| Rate for Payer: BCBS MAPPO |
$600.70
|
| Rate for Payer: BCBS Trust/PPO |
$826.02
|
| Rate for Payer: BCN Commercial |
$826.02
|
| Rate for Payer: BCN Medicare Advantage |
$600.70
|
| 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 |
$1,760.99
|
| Rate for Payer: Cofinity Commercial |
$1,433.36
|
| 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 |
$600.70
|
| Rate for Payer: Healthscope Commercial |
$1,842.89
|
| Rate for Payer: Mclaren Medicaid |
$321.98
|
| Rate for Payer: Mclaren Medicare |
$600.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$630.74
|
| Rate for Payer: Meridian Medicaid |
$338.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$690.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,740.51
|
| Rate for Payer: Nomi Health Commercial |
$1,802.10
|
| Rate for Payer: PACE Medicare |
$570.66
|
| Rate for Payer: PACE SWMI |
$600.70
|
| Rate for Payer: PHP Commercial |
$1,740.51
|
| Rate for Payer: PHP Medicare Advantage |
$600.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,330.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,888.00
|
| Rate for Payer: Priority Health Medicare |
$600.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,510.40
|
| Rate for Payer: Priority Health SBD |
$1,290.03
|
| Rate for Payer: Railroad Medicare Medicare |
$600.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.42
|
| Rate for Payer: UHC Core |
$3,048.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$600.70
|
| Rate for Payer: UHC Exchange |
$3,263.00
|
| Rate for Payer: UHC Medicare Advantage |
$600.70
|
| Rate for Payer: UHCCP Medicaid |
$338.19
|
| Rate for Payer: VA VA |
$600.70
|
|
|
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
|
|
