|
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 FOUR 99284
|
Facility
|
OP
|
$1,419.01
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
45000024
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$129.32 |
| Max. Negotiated Rate |
$3,546.00 |
| Rate for Payer: Aetna Commercial |
$1,206.16
|
| Rate for Payer: Aetna Medicare |
$433.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$922.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$521.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$521.51
|
| Rate for Payer: BCBS Complete |
$234.81
|
| Rate for Payer: BCBS MAPPO |
$417.21
|
| Rate for Payer: BCBS Trust/PPO |
$572.43
|
| Rate for Payer: BCN Commercial |
$572.43
|
| Rate for Payer: BCN Medicare Advantage |
$417.21
|
| 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 |
$993.31
|
| Rate for Payer: Cofinity Commercial |
$1,220.35
|
| 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 |
$417.21
|
| Rate for Payer: Healthscope Commercial |
$1,277.11
|
| Rate for Payer: Mclaren Medicaid |
$223.62
|
| Rate for Payer: Mclaren Medicare |
$417.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$438.07
|
| Rate for Payer: Meridian Medicaid |
$234.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$479.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,206.16
|
| Rate for Payer: Nomi Health Commercial |
$1,251.63
|
| Rate for Payer: PACE Medicare |
$396.35
|
| Rate for Payer: PACE SWMI |
$417.21
|
| Rate for Payer: PHP Commercial |
$1,206.16
|
| Rate for Payer: PHP Medicare Advantage |
$417.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$223.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$922.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,311.28
|
| Rate for Payer: Priority Health Medicare |
$417.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,049.02
|
| Rate for Payer: Priority Health SBD |
$893.98
|
| Rate for Payer: Railroad Medicare Medicare |
$417.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.32
|
| Rate for Payer: UHC Core |
$2,377.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$417.21
|
| Rate for Payer: UHC Exchange |
$3,546.00
|
| Rate for Payer: UHC Medicare Advantage |
$417.21
|
| Rate for Payer: UHCCP Medicaid |
$234.89
|
| Rate for Payer: VA VA |
$417.21
|
|
|
HC ER LEVEL ONE 99281
|
Facility
|
OP
|
$257.36
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
45000020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$511.00 |
| Rate for Payer: Aetna Commercial |
$218.76
|
| Rate for Payer: Aetna Medicare |
$89.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.84
|
| Rate for Payer: BCBS Complete |
$48.55
|
| Rate for Payer: BCBS MAPPO |
$86.27
|
| Rate for Payer: BCBS Trust/PPO |
$103.82
|
| Rate for Payer: BCN Commercial |
$103.82
|
| Rate for Payer: BCN Medicare Advantage |
$86.27
|
| 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 |
$221.33
|
| Rate for Payer: Cofinity Commercial |
$180.15
|
| 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 |
$86.27
|
| Rate for Payer: Healthscope Commercial |
$231.62
|
| Rate for Payer: Mclaren Medicaid |
$46.24
|
| Rate for Payer: Mclaren Medicare |
$86.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.58
|
| Rate for Payer: Meridian Medicaid |
$48.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.76
|
| Rate for Payer: Nomi Health Commercial |
$258.81
|
| Rate for Payer: PACE Medicare |
$81.96
|
| Rate for Payer: PACE SWMI |
$86.27
|
| Rate for Payer: PHP Commercial |
$218.76
|
| Rate for Payer: PHP Medicare Advantage |
$86.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$271.16
|
| Rate for Payer: Priority Health Medicare |
$86.27
|
| Rate for Payer: Priority Health Narrow Network |
$216.93
|
| Rate for Payer: Priority Health SBD |
$162.14
|
| Rate for Payer: Railroad Medicare Medicare |
$86.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.24
|
| Rate for Payer: UHC Core |
$477.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.27
|
| Rate for Payer: UHC Exchange |
$511.00
|
| Rate for Payer: UHC Medicare Advantage |
$86.27
|
| Rate for Payer: UHCCP Medicaid |
$48.57
|
| Rate for Payer: VA VA |
$86.27
|
|
|
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 THREE 99283
|
Facility
|
OP
|
$903.62
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
45000022
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$75.97 |
| Max. Negotiated Rate |
$1,475.00 |
| Rate for Payer: Aetna Commercial |
$768.08
|
| Rate for Payer: Aetna Medicare |
$282.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$587.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$339.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$339.11
|
| Rate for Payer: BCBS Complete |
$152.68
|
| Rate for Payer: BCBS MAPPO |
$271.29
|
| Rate for Payer: BCBS Trust/PPO |
$333.65
|
| Rate for Payer: BCN Commercial |
$333.65
|
| Rate for Payer: BCN Medicare Advantage |
$271.29
|
| 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 |
$777.11
|
| Rate for Payer: Cofinity Commercial |
$632.53
|
| 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 |
$271.29
|
| Rate for Payer: Healthscope Commercial |
$813.26
|
| Rate for Payer: Mclaren Medicaid |
$145.41
|
| Rate for Payer: Mclaren Medicare |
$271.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$284.85
|
| Rate for Payer: Meridian Medicaid |
$152.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$311.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$768.08
|
| Rate for Payer: Nomi Health Commercial |
$813.87
|
| Rate for Payer: PACE Medicare |
$257.73
|
| Rate for Payer: PACE SWMI |
$271.29
|
| Rate for Payer: PHP Commercial |
$768.08
|
| Rate for Payer: PHP Medicare Advantage |
$271.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$145.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$587.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$852.66
|
| Rate for Payer: Priority Health Medicare |
$271.29
|
| Rate for Payer: Priority Health Narrow Network |
$682.13
|
| Rate for Payer: Priority Health SBD |
$569.28
|
| Rate for Payer: Railroad Medicare Medicare |
$271.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.97
|
| Rate for Payer: UHC Core |
$1,378.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$271.29
|
| Rate for Payer: UHC Exchange |
$1,475.00
|
| Rate for Payer: UHC Medicare Advantage |
$271.29
|
| Rate for Payer: UHCCP Medicaid |
$152.74
|
| Rate for Payer: VA VA |
$271.29
|
|
|
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 |
$44.62 |
| Max. Negotiated Rate |
$1,022.00 |
| Rate for Payer: Aetna Commercial |
$435.25
|
| Rate for Payer: Aetna Medicare |
$161.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$332.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$193.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$193.95
|
| Rate for Payer: BCBS Complete |
$87.32
|
| Rate for Payer: BCBS MAPPO |
$155.16
|
| Rate for Payer: BCBS Trust/PPO |
$198.74
|
| Rate for Payer: BCN Commercial |
$198.74
|
| Rate for Payer: BCN Medicare Advantage |
$155.16
|
| 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 |
$440.37
|
| Rate for Payer: Cofinity Commercial |
$358.44
|
| 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 |
$155.16
|
| Rate for Payer: Healthscope Commercial |
$460.85
|
| Rate for Payer: Mclaren Medicaid |
$83.17
|
| Rate for Payer: Mclaren Medicare |
$155.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.92
|
| Rate for Payer: Meridian Medicaid |
$87.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$178.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$435.25
|
| Rate for Payer: Nomi Health Commercial |
$465.48
|
| Rate for Payer: PACE Medicare |
$147.40
|
| Rate for Payer: PACE SWMI |
$155.16
|
| Rate for Payer: PHP Commercial |
$435.25
|
| Rate for Payer: PHP Medicare Advantage |
$155.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$487.64
|
| Rate for Payer: Priority Health Medicare |
$155.16
|
| Rate for Payer: Priority Health Narrow Network |
$390.11
|
| Rate for Payer: Priority Health SBD |
$322.60
|
| Rate for Payer: Railroad Medicare Medicare |
$155.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.62
|
| Rate for Payer: UHC Core |
$954.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$155.16
|
| Rate for Payer: UHC Exchange |
$1,022.00
|
| Rate for Payer: UHC Medicare Advantage |
$155.16
|
| Rate for Payer: UHCCP Medicaid |
$87.36
|
| Rate for Payer: VA VA |
$155.16
|
|
|
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: BCBS Trust/PPO |
$108.07
|
| Rate for Payer: BCN Commercial |
$108.07
|
| Rate for Payer: Cash Price |
$116.06
|
| 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 |
$345.30
|
| 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
|
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 |
$345.30
|
| 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 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
|
|
|
HC ERYTHROPOIETIN
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
30100191
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna Medicare |
$19.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.49
|
| Rate for Payer: BCBS Complete |
$10.58
|
| Rate for Payer: BCBS MAPPO |
$18.79
|
| Rate for Payer: BCBS Trust/PPO |
$16.63
|
| Rate for Payer: BCN Commercial |
$16.63
|
| Rate for Payer: BCN Medicare Advantage |
$18.79
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Cofinity Commercial |
$29.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.79
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Mclaren Medicaid |
$10.07
|
| Rate for Payer: Mclaren Medicare |
$18.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.73
|
| Rate for Payer: Meridian Medicaid |
$10.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$28.18
|
| Rate for Payer: PACE Medicare |
$17.85
|
| Rate for Payer: PACE SWMI |
$18.79
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: PHP Medicare Advantage |
$18.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.34
|
| Rate for Payer: Priority Health Medicare |
$18.79
|
| Rate for Payer: Priority Health Narrow Network |
$15.47
|
| Rate for Payer: Priority Health SBD |
$26.22
|
| Rate for Payer: Railroad Medicare Medicare |
$18.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.79
|
| Rate for Payer: UHC Medicare Advantage |
$18.79
|
| Rate for Payer: UHCCP Medicaid |
$10.58
|
| Rate for Payer: VA VA |
$18.79
|
|
|
HC ESCHERICHIA COLI K1
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600268
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$52.64 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| 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 |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| 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 |
$44.22
|
| 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 |
$44.22
|
| 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 |
$33.81
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$32.77
|
| 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 ESCHERICHIA COLI K1
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600268
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health SBD |
$32.77
|
|
|
HC ESOPHAGOSCOPY
|
Facility
|
IP
|
$1,377.23
|
|
| Hospital Charge Code |
36000041
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$867.65 |
| Max. Negotiated Rate |
$1,239.51 |
| Rate for Payer: Aetna Commercial |
$1,170.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$895.20
|
| Rate for Payer: Cash Price |
$1,101.78
|
| Rate for Payer: Cofinity Commercial |
$1,184.42
|
| Rate for Payer: Cofinity Commercial |
$964.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$964.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.78
|
| Rate for Payer: Healthscope Commercial |
$1,239.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,170.65
|
| Rate for Payer: PHP Commercial |
$1,170.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$895.20
|
| Rate for Payer: Priority Health SBD |
$867.65
|
|
|
HC ESOPHAGOSCOPY
|
Facility
|
OP
|
$1,377.23
|
|
| Hospital Charge Code |
36000041
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$550.89 |
| Max. Negotiated Rate |
$1,239.51 |
| Rate for Payer: Aetna Commercial |
$1,170.65
|
| Rate for Payer: Aetna Medicare |
$688.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$895.20
|
| Rate for Payer: BCBS Complete |
$550.89
|
| Rate for Payer: Cash Price |
$1,101.78
|
| Rate for Payer: Cofinity Commercial |
$1,184.42
|
| Rate for Payer: Cofinity Commercial |
$964.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$964.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.78
|
| Rate for Payer: Healthscope Commercial |
$1,239.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,170.65
|
| Rate for Payer: PHP Commercial |
$1,170.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$895.20
|
| Rate for Payer: Priority Health SBD |
$867.65
|
|
|
HC ESOPHGL FUNC G-ESOP RFLX IMPD ELTRD PROLNG
|
Facility
|
IP
|
$2,391.90
|
|
|
Service Code
|
CPT 91038
|
| Hospital Charge Code |
76100426
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,506.90 |
| Max. Negotiated Rate |
$2,152.71 |
| Rate for Payer: Aetna Commercial |
$2,033.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,554.74
|
| Rate for Payer: Cash Price |
$1,913.52
|
| Rate for Payer: Cofinity Commercial |
$1,674.33
|
| Rate for Payer: Cofinity Commercial |
$2,057.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,674.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,913.52
|
| Rate for Payer: Healthscope Commercial |
$2,152.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,033.12
|
| Rate for Payer: PHP Commercial |
$2,033.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,554.74
|
| Rate for Payer: Priority Health SBD |
$1,506.90
|
|
|
HC ESOPHGL FUNC G-ESOP RFLX IMPD ELTRD PROLNG
|
Facility
|
OP
|
$2,391.90
|
|
|
Service Code
|
CPT 91038
|
| Hospital Charge Code |
76100426
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$278.65 |
| Max. Negotiated Rate |
$2,152.71 |
| Rate for Payer: Aetna Commercial |
$2,033.12
|
| Rate for Payer: Aetna Medicare |
$540.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,554.74
|
| 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 |
$1,543.09
|
| Rate for Payer: BCN Commercial |
$1,543.09
|
| Rate for Payer: BCN Medicare Advantage |
$519.87
|
| Rate for Payer: Cash Price |
$1,913.52
|
| Rate for Payer: Cash Price |
$1,913.52
|
| Rate for Payer: Cash Price |
$1,913.52
|
| Rate for Payer: Cofinity Commercial |
$1,674.33
|
| Rate for Payer: Cofinity Commercial |
$2,057.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,674.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,913.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$519.87
|
| Rate for Payer: Healthscope Commercial |
$2,152.71
|
| 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 |
$2,033.12
|
| 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 |
$2,033.12
|
| 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 |
$1,554.74
|
| 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 |
$1,506.90
|
| Rate for Payer: Railroad Medicare Medicare |
$519.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$400.56
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$519.87
|
| Rate for Payer: UHC Medicare Advantage |
$519.87
|
| Rate for Payer: UHCCP Medicaid |
$292.69
|
| Rate for Payer: VA VA |
$519.87
|
|
|
HC ESOPH IMPEDENCE MONITOR/MANOMETRY
|
Facility
|
IP
|
$1,451.42
|
|
| Hospital Charge Code |
75000003
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$914.39 |
| Max. Negotiated Rate |
$1,306.28 |
| Rate for Payer: Aetna Commercial |
$1,233.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$943.42
|
| Rate for Payer: Cash Price |
$1,161.14
|
| Rate for Payer: Cofinity Commercial |
$1,015.99
|
| Rate for Payer: Cofinity Commercial |
$1,248.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,015.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,161.14
|
| Rate for Payer: Healthscope Commercial |
$1,306.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,233.71
|
| Rate for Payer: PHP Commercial |
$1,233.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$943.42
|
| Rate for Payer: Priority Health SBD |
$914.39
|
|
|
HC ESOPH IMPEDENCE MONITOR/MANOMETRY
|
Facility
|
OP
|
$1,451.42
|
|
| Hospital Charge Code |
75000003
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$580.57 |
| Max. Negotiated Rate |
$1,306.28 |
| Rate for Payer: Aetna Commercial |
$1,233.71
|
| Rate for Payer: Aetna Medicare |
$725.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$943.42
|
| Rate for Payer: BCBS Complete |
$580.57
|
| Rate for Payer: Cash Price |
$1,161.14
|
| Rate for Payer: Cofinity Commercial |
$1,015.99
|
| Rate for Payer: Cofinity Commercial |
$1,248.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,015.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,161.14
|
| Rate for Payer: Healthscope Commercial |
$1,306.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,233.71
|
| Rate for Payer: PHP Commercial |
$1,233.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$943.42
|
| Rate for Payer: Priority Health SBD |
$914.39
|
|
