|
HC PEDS ECHO LIMITED
|
Facility
|
IP
|
$809.36
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
48300006
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$509.90 |
| Max. Negotiated Rate |
$728.42 |
| Rate for Payer: Aetna Commercial |
$687.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$526.08
|
| Rate for Payer: Cash Price |
$647.49
|
| Rate for Payer: Cofinity Commercial |
$566.55
|
| Rate for Payer: Cofinity Commercial |
$696.05
|
| Rate for Payer: Healthscope Commercial |
$728.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$687.96
|
| Rate for Payer: PHP Commercial |
$687.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.55
|
| Rate for Payer: Priority Health SBD |
$509.90
|
|
|
HC PEDS ECHO LIMITED
|
Facility
|
OP
|
$809.36
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
48300006
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$96.92 |
| Max. Negotiated Rate |
$728.42 |
| Rate for Payer: Aetna Commercial |
$687.96
|
| Rate for Payer: Aetna Medicare |
$226.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$526.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.54
|
| Rate for Payer: BCBS Complete |
$125.24
|
| Rate for Payer: BCBS MAPPO |
$218.03
|
| Rate for Payer: BCBS Trust/PPO |
$339.24
|
| Rate for Payer: BCN Medicare Advantage |
$218.03
|
| Rate for Payer: Cash Price |
$647.49
|
| Rate for Payer: Cash Price |
$647.49
|
| Rate for Payer: Cofinity Commercial |
$696.05
|
| Rate for Payer: Cofinity Commercial |
$566.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.03
|
| Rate for Payer: Healthscope Commercial |
$728.42
|
| Rate for Payer: Mclaren Medicaid |
$119.26
|
| Rate for Payer: Mclaren Medicare |
$218.03
|
| Rate for Payer: Meridian Medicaid |
$125.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$687.96
|
| Rate for Payer: PACE Medicare |
$207.13
|
| Rate for Payer: PACE SWMI |
$218.03
|
| Rate for Payer: PHP Commercial |
$687.96
|
| Rate for Payer: PHP Medicare Advantage |
$218.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$716.43
|
| Rate for Payer: Priority Health Medicare |
$218.03
|
| Rate for Payer: Priority Health Narrow Network |
$573.14
|
| Rate for Payer: Priority Health SBD |
$509.90
|
| Rate for Payer: Railroad Medicare Medicare |
$218.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.03
|
| Rate for Payer: UHC Exchange |
$96.92
|
| Rate for Payer: UHC Medicare Advantage |
$224.57
|
| Rate for Payer: VA VA |
$218.03
|
|
|
HC PEDS ECHO W/DEFINITY
|
Facility
|
OP
|
$1,458.97
|
|
|
Service Code
|
HCPCS C8921
|
| Hospital Charge Code |
48000028
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$389.70 |
| Max. Negotiated Rate |
$1,997.47 |
| Rate for Payer: Aetna Commercial |
$1,240.12
|
| Rate for Payer: Aetna Medicare |
$740.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$948.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$890.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$890.55
|
| Rate for Payer: BCBS Complete |
$409.23
|
| Rate for Payer: BCBS MAPPO |
$712.44
|
| Rate for Payer: BCBS Trust/PPO |
$773.42
|
| Rate for Payer: BCN Medicare Advantage |
$712.44
|
| Rate for Payer: Cash Price |
$1,167.18
|
| Rate for Payer: Cash Price |
$1,167.18
|
| Rate for Payer: Cofinity Commercial |
$1,254.71
|
| Rate for Payer: Cofinity Commercial |
$1,021.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$712.44
|
| Rate for Payer: Healthscope Commercial |
$1,313.07
|
| Rate for Payer: Mclaren Medicaid |
$389.70
|
| Rate for Payer: Mclaren Medicare |
$712.44
|
| Rate for Payer: Meridian Medicaid |
$409.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$748.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$819.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,240.12
|
| Rate for Payer: PACE Medicare |
$676.82
|
| Rate for Payer: PACE SWMI |
$712.44
|
| Rate for Payer: PHP Commercial |
$1,240.12
|
| Rate for Payer: PHP Medicare Advantage |
$712.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.28
|
| Rate for Payer: Priority Health Medicare |
$712.44
|
| Rate for Payer: Priority Health SBD |
$919.15
|
| Rate for Payer: Railroad Medicare Medicare |
$712.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,997.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$712.44
|
| Rate for Payer: UHC Exchange |
$1,361.54
|
| Rate for Payer: UHC Medicare Advantage |
$733.81
|
| Rate for Payer: VA VA |
$712.44
|
|
|
HC PEDS ECHO W/DEFINITY
|
Facility
|
IP
|
$1,458.97
|
|
|
Service Code
|
HCPCS C8921
|
| Hospital Charge Code |
48000028
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$919.15 |
| Max. Negotiated Rate |
$1,313.07 |
| Rate for Payer: Aetna Commercial |
$1,240.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$948.33
|
| Rate for Payer: Cash Price |
$1,167.18
|
| Rate for Payer: Cofinity Commercial |
$1,021.28
|
| Rate for Payer: Cofinity Commercial |
$1,254.71
|
| Rate for Payer: Healthscope Commercial |
$1,313.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,240.12
|
| Rate for Payer: PHP Commercial |
$1,240.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.28
|
| Rate for Payer: Priority Health SBD |
$919.15
|
|
|
HC PEDS OBS OVERFLOW PER HR
|
Facility
|
OP
|
$153.31
|
|
| Hospital Charge Code |
76900003
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$61.32 |
| Max. Negotiated Rate |
$137.98 |
| Rate for Payer: Aetna Commercial |
$130.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.65
|
| Rate for Payer: BCBS Complete |
$61.32
|
| Rate for Payer: Cash Price |
$122.65
|
| Rate for Payer: Cofinity Commercial |
$107.32
|
| Rate for Payer: Cofinity Commercial |
$131.85
|
| Rate for Payer: Healthscope Commercial |
$137.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.31
|
| Rate for Payer: PHP Commercial |
$130.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.32
|
| Rate for Payer: Priority Health SBD |
$96.59
|
|
|
HC PEDS OBS OVERFLOW PER HR
|
Facility
|
IP
|
$153.31
|
|
| Hospital Charge Code |
76900003
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$96.59 |
| Max. Negotiated Rate |
$137.98 |
| Rate for Payer: Aetna Commercial |
$130.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.65
|
| Rate for Payer: Cash Price |
$122.65
|
| Rate for Payer: Cofinity Commercial |
$107.32
|
| Rate for Payer: Cofinity Commercial |
$131.85
|
| Rate for Payer: Healthscope Commercial |
$137.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.31
|
| Rate for Payer: PHP Commercial |
$130.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.32
|
| Rate for Payer: Priority Health SBD |
$96.59
|
|
|
HC PEDS VENT INIT DAY
|
Facility
|
OP
|
$1,491.66
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000035
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$82.90 |
| Max. Negotiated Rate |
$1,342.49 |
| Rate for Payer: Aetna Commercial |
$1,267.91
|
| Rate for Payer: Aetna Medicare |
$579.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$969.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$697.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$697.00
|
| Rate for Payer: BCBS Complete |
$320.29
|
| Rate for Payer: BCBS MAPPO |
$557.60
|
| Rate for Payer: BCBS Trust/PPO |
$82.90
|
| Rate for Payer: BCN Medicare Advantage |
$557.60
|
| Rate for Payer: Cash Price |
$1,193.33
|
| Rate for Payer: Cash Price |
$1,193.33
|
| Rate for Payer: Cofinity Commercial |
$1,282.83
|
| Rate for Payer: Cofinity Commercial |
$1,044.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$557.60
|
| Rate for Payer: Healthscope Commercial |
$1,342.49
|
| Rate for Payer: Mclaren Medicaid |
$305.01
|
| Rate for Payer: Mclaren Medicare |
$557.60
|
| Rate for Payer: Meridian Medicaid |
$320.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$585.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$641.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,267.91
|
| Rate for Payer: PACE Medicare |
$529.72
|
| Rate for Payer: PACE SWMI |
$557.60
|
| Rate for Payer: PHP Commercial |
$1,267.91
|
| Rate for Payer: PHP Medicare Advantage |
$557.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,044.16
|
| Rate for Payer: Priority Health Medicare |
$557.60
|
| Rate for Payer: Priority Health SBD |
$939.75
|
| Rate for Payer: Railroad Medicare Medicare |
$557.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$557.60
|
| Rate for Payer: UHC Exchange |
$88.41
|
| Rate for Payer: UHC Medicare Advantage |
$574.33
|
| Rate for Payer: VA VA |
$557.60
|
|
|
HC PEDS VENT INIT DAY
|
Facility
|
IP
|
$1,491.66
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000035
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$939.75 |
| Max. Negotiated Rate |
$1,342.49 |
| Rate for Payer: Aetna Commercial |
$1,267.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$969.58
|
| Rate for Payer: Cash Price |
$1,193.33
|
| Rate for Payer: Cofinity Commercial |
$1,044.16
|
| Rate for Payer: Cofinity Commercial |
$1,282.83
|
| Rate for Payer: Healthscope Commercial |
$1,342.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,267.91
|
| Rate for Payer: PHP Commercial |
$1,267.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,044.16
|
| Rate for Payer: Priority Health SBD |
$939.75
|
|
|
HC PEDS VENT SUB DAY
|
Facility
|
OP
|
$1,289.42
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000036
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$62.21 |
| Max. Negotiated Rate |
$1,160.48 |
| Rate for Payer: Aetna Commercial |
$1,096.01
|
| Rate for Payer: Aetna Medicare |
$579.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$838.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$697.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$697.00
|
| Rate for Payer: BCBS Complete |
$320.29
|
| Rate for Payer: BCBS MAPPO |
$557.60
|
| Rate for Payer: BCBS Trust/PPO |
$62.94
|
| Rate for Payer: BCN Medicare Advantage |
$557.60
|
| Rate for Payer: Cash Price |
$1,031.54
|
| Rate for Payer: Cash Price |
$1,031.54
|
| Rate for Payer: Cofinity Commercial |
$1,108.90
|
| Rate for Payer: Cofinity Commercial |
$902.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$557.60
|
| Rate for Payer: Healthscope Commercial |
$1,160.48
|
| Rate for Payer: Mclaren Medicaid |
$305.01
|
| Rate for Payer: Mclaren Medicare |
$557.60
|
| Rate for Payer: Meridian Medicaid |
$320.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$585.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$641.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,096.01
|
| Rate for Payer: PACE Medicare |
$529.72
|
| Rate for Payer: PACE SWMI |
$557.60
|
| Rate for Payer: PHP Commercial |
$1,096.01
|
| Rate for Payer: PHP Medicare Advantage |
$557.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.59
|
| Rate for Payer: Priority Health Medicare |
$557.60
|
| Rate for Payer: Priority Health SBD |
$812.33
|
| Rate for Payer: Railroad Medicare Medicare |
$557.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$557.60
|
| Rate for Payer: UHC Exchange |
$62.21
|
| Rate for Payer: UHC Medicare Advantage |
$574.33
|
| Rate for Payer: VA VA |
$557.60
|
|
|
HC PEDS VENT SUB DAY
|
Facility
|
IP
|
$1,289.42
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000036
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$812.33 |
| Max. Negotiated Rate |
$1,160.48 |
| Rate for Payer: Aetna Commercial |
$1,096.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$838.12
|
| Rate for Payer: Cash Price |
$1,031.54
|
| Rate for Payer: Cofinity Commercial |
$902.59
|
| Rate for Payer: Cofinity Commercial |
$1,108.90
|
| Rate for Payer: Healthscope Commercial |
$1,160.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,096.01
|
| Rate for Payer: PHP Commercial |
$1,096.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.59
|
| Rate for Payer: Priority Health SBD |
$812.33
|
|
|
HC PEG TUBE INSERTION/TRAY
|
Facility
|
OP
|
$1,187.11
|
|
| Hospital Charge Code |
36000079
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$474.84 |
| Max. Negotiated Rate |
$1,068.40 |
| Rate for Payer: Aetna Commercial |
$1,009.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$771.62
|
| Rate for Payer: BCBS Complete |
$474.84
|
| Rate for Payer: Cash Price |
$949.69
|
| Rate for Payer: Cofinity Commercial |
$1,020.91
|
| Rate for Payer: Cofinity Commercial |
$830.98
|
| Rate for Payer: Healthscope Commercial |
$1,068.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,009.04
|
| Rate for Payer: PHP Commercial |
$1,009.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$830.98
|
| Rate for Payer: Priority Health SBD |
$747.88
|
|
|
HC PEG TUBE INSERTION/TRAY
|
Facility
|
IP
|
$1,187.11
|
|
| Hospital Charge Code |
36000079
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$747.88 |
| Max. Negotiated Rate |
$1,068.40 |
| Rate for Payer: Aetna Commercial |
$1,009.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$771.62
|
| Rate for Payer: Cash Price |
$949.69
|
| Rate for Payer: Cofinity Commercial |
$1,020.91
|
| Rate for Payer: Cofinity Commercial |
$830.98
|
| Rate for Payer: Healthscope Commercial |
$1,068.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,009.04
|
| Rate for Payer: PHP Commercial |
$1,009.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$830.98
|
| Rate for Payer: Priority Health SBD |
$747.88
|
|
|
HC PEJ FDG TUBE INSERTION/REPLACE
|
Facility
|
IP
|
$1,495.13
|
|
| Hospital Charge Code |
36000059
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$941.93 |
| Max. Negotiated Rate |
$1,345.62 |
| Rate for Payer: Aetna Commercial |
$1,270.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$971.83
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Cofinity Commercial |
$1,046.59
|
| Rate for Payer: Cofinity Commercial |
$1,285.81
|
| Rate for Payer: Healthscope Commercial |
$1,345.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,270.86
|
| Rate for Payer: PHP Commercial |
$1,270.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,046.59
|
| Rate for Payer: Priority Health SBD |
$941.93
|
|
|
HC PEJ FDG TUBE INSERTION/REPLACE
|
Facility
|
OP
|
$1,495.13
|
|
| Hospital Charge Code |
36000059
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$598.05 |
| Max. Negotiated Rate |
$1,345.62 |
| Rate for Payer: Aetna Commercial |
$1,270.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$971.83
|
| Rate for Payer: BCBS Complete |
$598.05
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Cofinity Commercial |
$1,046.59
|
| Rate for Payer: Cofinity Commercial |
$1,285.81
|
| Rate for Payer: Healthscope Commercial |
$1,345.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,270.86
|
| Rate for Payer: PHP Commercial |
$1,270.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,046.59
|
| Rate for Payer: Priority Health SBD |
$941.93
|
|
|
HC PELVIC EXAMINATION
|
Facility
|
OP
|
$20.28
|
|
|
Service Code
|
CPT 99459
|
| Hospital Charge Code |
51000129
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: Aetna Commercial |
$17.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.18
|
| Rate for Payer: BCBS Complete |
$8.11
|
| Rate for Payer: Cash Price |
$16.22
|
| Rate for Payer: Cash Price |
$16.22
|
| Rate for Payer: Cofinity Commercial |
$17.44
|
| Rate for Payer: Cofinity Commercial |
$14.20
|
| Rate for Payer: Healthscope Commercial |
$18.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.24
|
| Rate for Payer: PHP Commercial |
$17.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.20
|
| Rate for Payer: Priority Health SBD |
$12.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.50
|
| Rate for Payer: UHC Exchange |
$22.27
|
|
|
HC PELVIC EXAMINATION
|
Facility
|
IP
|
$20.28
|
|
|
Service Code
|
CPT 99459
|
| Hospital Charge Code |
51000129
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.78 |
| Max. Negotiated Rate |
$18.25 |
| Rate for Payer: Aetna Commercial |
$17.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.18
|
| Rate for Payer: Cash Price |
$16.22
|
| Rate for Payer: Cofinity Commercial |
$14.20
|
| Rate for Payer: Cofinity Commercial |
$17.44
|
| Rate for Payer: Healthscope Commercial |
$18.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.24
|
| Rate for Payer: PHP Commercial |
$17.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.20
|
| Rate for Payer: Priority Health SBD |
$12.78
|
|
|
HC PENICILLIUM IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200055
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.09
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC PENICILLIUM IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200055
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
|
|
HC PENTAMIDINE THERAPY
|
Facility
|
IP
|
$1,013.28
|
|
|
Service Code
|
CPT 94642
|
| Hospital Charge Code |
41000005
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$638.37 |
| Max. Negotiated Rate |
$911.95 |
| Rate for Payer: Aetna Commercial |
$861.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$658.63
|
| Rate for Payer: Cash Price |
$810.62
|
| Rate for Payer: Cofinity Commercial |
$709.30
|
| Rate for Payer: Cofinity Commercial |
$871.42
|
| Rate for Payer: Healthscope Commercial |
$911.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$861.29
|
| Rate for Payer: PHP Commercial |
$861.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$709.30
|
| Rate for Payer: Priority Health SBD |
$638.37
|
|
|
HC PENTAMIDINE THERAPY
|
Facility
|
OP
|
$1,013.28
|
|
|
Service Code
|
CPT 94642
|
| Hospital Charge Code |
41000005
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$103.81 |
| Max. Negotiated Rate |
$911.95 |
| Rate for Payer: Aetna Commercial |
$861.29
|
| Rate for Payer: Aetna Medicare |
$197.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$658.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$237.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$237.22
|
| Rate for Payer: BCBS Complete |
$109.01
|
| Rate for Payer: BCBS MAPPO |
$189.78
|
| Rate for Payer: BCBS Trust/PPO |
$556.44
|
| Rate for Payer: BCN Medicare Advantage |
$189.78
|
| Rate for Payer: Cash Price |
$810.62
|
| Rate for Payer: Cash Price |
$810.62
|
| Rate for Payer: Cofinity Commercial |
$871.42
|
| Rate for Payer: Cofinity Commercial |
$709.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.78
|
| Rate for Payer: Healthscope Commercial |
$911.95
|
| Rate for Payer: Mclaren Medicaid |
$103.81
|
| Rate for Payer: Mclaren Medicare |
$189.78
|
| Rate for Payer: Meridian Medicaid |
$109.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$199.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$861.29
|
| Rate for Payer: PACE Medicare |
$180.29
|
| Rate for Payer: PACE SWMI |
$189.78
|
| Rate for Payer: PHP Commercial |
$861.29
|
| Rate for Payer: PHP Medicare Advantage |
$189.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$709.30
|
| Rate for Payer: Priority Health Medicare |
$189.78
|
| Rate for Payer: Priority Health SBD |
$638.37
|
| Rate for Payer: Railroad Medicare Medicare |
$189.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.78
|
| Rate for Payer: UHC Medicare Advantage |
$195.47
|
| Rate for Payer: VA VA |
$189.78
|
|
|
HC PENTOBARBITOL NEMBUTAL LVL
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
30100572
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna Commercial |
$148.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.75
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$122.50
|
| Rate for Payer: Cofinity Commercial |
$150.50
|
| Rate for Payer: Healthscope Commercial |
$157.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.75
|
| Rate for Payer: PHP Commercial |
$148.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.50
|
| Rate for Payer: Priority Health SBD |
$110.25
|
|
|
HC PENTOBARBITOL NEMBUTAL LVL
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
30100572
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna Commercial |
$148.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.75
|
| Rate for Payer: BCBS Complete |
$70.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$122.50
|
| Rate for Payer: Cofinity Commercial |
$150.50
|
| Rate for Payer: Healthscope Commercial |
$157.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.75
|
| Rate for Payer: PHP Commercial |
$148.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.50
|
| Rate for Payer: Priority Health SBD |
$110.25
|
| Rate for Payer: UHC Core |
$18.70
|
|
|
HC PEP VALVE SUPPLY
|
Facility
|
IP
|
$53.51
|
|
| Hospital Charge Code |
27000134
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.71 |
| Max. Negotiated Rate |
$48.16 |
| Rate for Payer: Aetna Commercial |
$45.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.78
|
| Rate for Payer: Cash Price |
$42.81
|
| Rate for Payer: Cofinity Commercial |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$46.02
|
| Rate for Payer: Healthscope Commercial |
$48.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.48
|
| Rate for Payer: PHP Commercial |
$45.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.46
|
| Rate for Payer: Priority Health SBD |
$33.71
|
|
|
HC PEP VALVE SUPPLY
|
Facility
|
OP
|
$53.51
|
|
| Hospital Charge Code |
27000134
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.40 |
| Max. Negotiated Rate |
$48.16 |
| Rate for Payer: Aetna Commercial |
$45.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.78
|
| Rate for Payer: BCBS Complete |
$21.40
|
| Rate for Payer: Cash Price |
$42.81
|
| Rate for Payer: Cofinity Commercial |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$46.02
|
| Rate for Payer: Healthscope Commercial |
$48.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.48
|
| Rate for Payer: PHP Commercial |
$45.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.46
|
| Rate for Payer: Priority Health SBD |
$33.71
|
|
|
HC PERC CHOLECYSTOSTOMY
|
Facility
|
OP
|
$5,063.57
|
|
|
Service Code
|
CPT 47490
|
| Hospital Charge Code |
36100200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$320.57 |
| Max. Negotiated Rate |
$5,427.00 |
| Rate for Payer: Aetna Commercial |
$4,304.03
|
| Rate for Payer: Aetna Medicare |
$3,201.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,291.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,847.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,847.99
|
| Rate for Payer: BCBS Complete |
$1,768.23
|
| Rate for Payer: BCBS MAPPO |
$3,078.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,490.15
|
| Rate for Payer: BCN Medicare Advantage |
$3,078.39
|
| Rate for Payer: Cash Price |
$4,050.86
|
| Rate for Payer: Cash Price |
$4,050.86
|
| Rate for Payer: Cofinity Commercial |
$4,354.67
|
| Rate for Payer: Cofinity Commercial |
$3,544.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,078.39
|
| Rate for Payer: Healthscope Commercial |
$4,557.21
|
| Rate for Payer: Mclaren Medicaid |
$1,683.88
|
| Rate for Payer: Mclaren Medicare |
$3,078.39
|
| Rate for Payer: Meridian Medicaid |
$1,768.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,232.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,540.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,304.03
|
| Rate for Payer: PACE Medicare |
$2,924.47
|
| Rate for Payer: PACE SWMI |
$3,078.39
|
| Rate for Payer: PHP Commercial |
$4,304.03
|
| Rate for Payer: PHP Medicare Advantage |
$3,078.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,683.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,544.50
|
| Rate for Payer: Priority Health Medicare |
$3,078.39
|
| Rate for Payer: Priority Health SBD |
$3,190.05
|
| Rate for Payer: Railroad Medicare Medicare |
$3,078.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.63
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,078.39
|
| Rate for Payer: UHC Exchange |
$320.57
|
| Rate for Payer: UHC Medicare Advantage |
$3,170.74
|
| Rate for Payer: VA VA |
$3,078.39
|
|
