|
HC PRINCIPAL CARE MGMT 1ST 30 MIN STAFF/CAL MO
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
CPT 99426
|
| Hospital Charge Code |
51000112
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.38 |
| Max. Negotiated Rate |
$227.45 |
| Rate for Payer: Aetna Commercial |
$210.80
|
| Rate for Payer: Aetna Medicare |
$82.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.14
|
| Rate for Payer: BCBS Complete |
$45.56
|
| Rate for Payer: BCBS MAPPO |
$79.31
|
| Rate for Payer: BCN Medicare Advantage |
$79.31
|
| Rate for Payer: Cash Price |
$198.40
|
| Rate for Payer: Cash Price |
$198.40
|
| Rate for Payer: Cofinity Commercial |
$173.60
|
| Rate for Payer: Cofinity Commercial |
$213.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.31
|
| Rate for Payer: Healthscope Commercial |
$223.20
|
| Rate for Payer: Mclaren Medicaid |
$43.38
|
| Rate for Payer: Mclaren Medicare |
$79.31
|
| Rate for Payer: Meridian Medicaid |
$45.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$83.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$210.80
|
| Rate for Payer: PACE Medicare |
$75.34
|
| Rate for Payer: PACE SWMI |
$79.31
|
| Rate for Payer: PHP Commercial |
$210.80
|
| Rate for Payer: PHP Medicare Advantage |
$79.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$227.45
|
| Rate for Payer: Priority Health Medicare |
$79.31
|
| Rate for Payer: Priority Health Narrow Network |
$181.96
|
| Rate for Payer: Priority Health SBD |
$156.24
|
| Rate for Payer: Railroad Medicare Medicare |
$79.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.31
|
| Rate for Payer: UHC Exchange |
$48.13
|
| Rate for Payer: UHC Medicare Advantage |
$81.69
|
| Rate for Payer: VA VA |
$79.31
|
|
|
HC PRINCIPAL CARE MGMT EA ADDL 30 MIN STAFF/CAL MO
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT 99427
|
| Hospital Charge Code |
51000113
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$119.70 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna Commercial |
$161.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.50
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cofinity Commercial |
$133.00
|
| Rate for Payer: Cofinity Commercial |
$163.40
|
| Rate for Payer: Healthscope Commercial |
$171.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.50
|
| Rate for Payer: PHP Commercial |
$161.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.00
|
| Rate for Payer: Priority Health SBD |
$119.70
|
|
|
HC PRINCIPAL CARE MGMT EA ADDL 30 MIN STAFF/CAL MO
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
CPT 99427
|
| Hospital Charge Code |
51000113
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.73 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna Commercial |
$161.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.50
|
| Rate for Payer: BCBS Complete |
$76.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cofinity Commercial |
$133.00
|
| Rate for Payer: Cofinity Commercial |
$163.40
|
| Rate for Payer: Healthscope Commercial |
$171.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.50
|
| Rate for Payer: PHP Commercial |
$161.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.00
|
| Rate for Payer: Priority Health SBD |
$119.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.10
|
| Rate for Payer: UHC Exchange |
$33.73
|
|
|
HC PRO BNP
|
Facility
|
OP
|
$151.20
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
30100304
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.48 |
| Max. Negotiated Rate |
$136.08 |
| Rate for Payer: Aetna Commercial |
$128.52
|
| Rate for Payer: Aetna Medicare |
$40.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.08
|
| Rate for Payer: BCBS Complete |
$22.55
|
| Rate for Payer: BCBS MAPPO |
$39.26
|
| Rate for Payer: BCBS Trust/PPO |
$30.75
|
| Rate for Payer: BCN Medicare Advantage |
$39.26
|
| Rate for Payer: Cash Price |
$120.96
|
| Rate for Payer: Cash Price |
$120.96
|
| Rate for Payer: Cofinity Commercial |
$105.84
|
| Rate for Payer: Cofinity Commercial |
$130.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.26
|
| Rate for Payer: Healthscope Commercial |
$136.08
|
| Rate for Payer: Mclaren Medicaid |
$21.48
|
| Rate for Payer: Mclaren Medicare |
$39.26
|
| Rate for Payer: Meridian Medicaid |
$22.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$41.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$128.52
|
| Rate for Payer: PACE Medicare |
$37.30
|
| Rate for Payer: PACE SWMI |
$39.26
|
| Rate for Payer: PHP Commercial |
$128.52
|
| Rate for Payer: PHP Medicare Advantage |
$39.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.84
|
| Rate for Payer: Priority Health Medicare |
$39.26
|
| Rate for Payer: Priority Health SBD |
$95.26
|
| Rate for Payer: Railroad Medicare Medicare |
$39.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.11
|
| Rate for Payer: UHC Core |
$57.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.26
|
| Rate for Payer: UHC Exchange |
$39.26
|
| Rate for Payer: UHC Medicare Advantage |
$40.44
|
| Rate for Payer: VA VA |
$39.26
|
|
|
HC PRO BNP
|
Facility
|
IP
|
$151.20
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
30100304
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$95.26 |
| Max. Negotiated Rate |
$136.08 |
| Rate for Payer: Aetna Commercial |
$128.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.28
|
| Rate for Payer: Cash Price |
$120.96
|
| Rate for Payer: Cofinity Commercial |
$105.84
|
| Rate for Payer: Cofinity Commercial |
$130.03
|
| Rate for Payer: Healthscope Commercial |
$136.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$128.52
|
| Rate for Payer: PHP Commercial |
$128.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.84
|
| Rate for Payer: Priority Health SBD |
$95.26
|
|
|
HC PROCAINAMIDE AND NAPA LEVEL
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
CPT 80192
|
| Hospital Charge Code |
30100042
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.21 |
| Max. Negotiated Rate |
$60.30 |
| Rate for Payer: Aetna Commercial |
$56.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.55
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cofinity Commercial |
$46.90
|
| Rate for Payer: Cofinity Commercial |
$57.62
|
| Rate for Payer: Healthscope Commercial |
$60.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.95
|
| Rate for Payer: PHP Commercial |
$56.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.90
|
| Rate for Payer: Priority Health SBD |
$42.21
|
|
|
HC PROCAINAMIDE AND NAPA LEVEL
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT 80192
|
| Hospital Charge Code |
30100042
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.16 |
| Max. Negotiated Rate |
$60.30 |
| Rate for Payer: Aetna Commercial |
$56.95
|
| Rate for Payer: Aetna Medicare |
$17.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.94
|
| Rate for Payer: BCBS Complete |
$9.62
|
| Rate for Payer: BCBS MAPPO |
$16.75
|
| Rate for Payer: BCBS Trust/PPO |
$13.11
|
| Rate for Payer: BCN Medicare Advantage |
$16.75
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cofinity Commercial |
$46.90
|
| Rate for Payer: Cofinity Commercial |
$57.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.75
|
| Rate for Payer: Healthscope Commercial |
$60.30
|
| Rate for Payer: Mclaren Medicaid |
$9.16
|
| Rate for Payer: Mclaren Medicare |
$16.75
|
| Rate for Payer: Meridian Medicaid |
$9.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.95
|
| Rate for Payer: PACE Medicare |
$15.91
|
| Rate for Payer: PACE SWMI |
$16.75
|
| Rate for Payer: PHP Commercial |
$56.95
|
| Rate for Payer: PHP Medicare Advantage |
$16.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.90
|
| Rate for Payer: Priority Health Medicare |
$16.75
|
| Rate for Payer: Priority Health SBD |
$42.21
|
| Rate for Payer: Railroad Medicare Medicare |
$16.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.10
|
| Rate for Payer: UHC Core |
$28.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.75
|
| Rate for Payer: UHC Exchange |
$16.75
|
| Rate for Payer: UHC Medicare Advantage |
$17.25
|
| Rate for Payer: VA VA |
$16.75
|
|
|
HC PROCAINAMIDE CHALLENGE
|
Facility
|
OP
|
$7,278.36
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
48100123
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$76.03 |
| Max. Negotiated Rate |
$6,550.52 |
| Rate for Payer: Aetna Commercial |
$6,186.61
|
| Rate for Payer: Aetna Medicare |
$144.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,730.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.74
|
| Rate for Payer: BCBS Complete |
$79.84
|
| Rate for Payer: BCBS MAPPO |
$138.99
|
| Rate for Payer: BCBS Trust/PPO |
$422.58
|
| Rate for Payer: BCN Medicare Advantage |
$138.99
|
| Rate for Payer: Cash Price |
$5,822.69
|
| Rate for Payer: Cash Price |
$5,822.69
|
| Rate for Payer: Cofinity Commercial |
$5,094.85
|
| Rate for Payer: Cofinity Commercial |
$6,259.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.99
|
| Rate for Payer: Healthscope Commercial |
$6,550.52
|
| Rate for Payer: Mclaren Medicaid |
$76.03
|
| Rate for Payer: Mclaren Medicare |
$138.99
|
| Rate for Payer: Meridian Medicaid |
$79.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,186.61
|
| Rate for Payer: PACE Medicare |
$132.04
|
| Rate for Payer: PACE SWMI |
$138.99
|
| Rate for Payer: PHP Commercial |
$6,186.61
|
| Rate for Payer: PHP Medicare Advantage |
$138.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,094.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$436.07
|
| Rate for Payer: Priority Health Medicare |
$138.99
|
| Rate for Payer: Priority Health Narrow Network |
$348.85
|
| Rate for Payer: Priority Health SBD |
$4,585.37
|
| Rate for Payer: Railroad Medicare Medicare |
$138.99
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.99
|
| Rate for Payer: UHC Medicare Advantage |
$143.16
|
| Rate for Payer: VA VA |
$138.99
|
|
|
HC PROCAINAMIDE CHALLENGE
|
Facility
|
IP
|
$7,278.36
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
48100123
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,585.37 |
| Max. Negotiated Rate |
$6,550.52 |
| Rate for Payer: Aetna Commercial |
$6,186.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,730.93
|
| Rate for Payer: Cash Price |
$5,822.69
|
| Rate for Payer: Cofinity Commercial |
$5,094.85
|
| Rate for Payer: Cofinity Commercial |
$6,259.39
|
| Rate for Payer: Healthscope Commercial |
$6,550.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,186.61
|
| Rate for Payer: PHP Commercial |
$6,186.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,094.85
|
| Rate for Payer: Priority Health SBD |
$4,585.37
|
|
|
HC PROCALCITONIN
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 84145
|
| Hospital Charge Code |
30100480
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.26 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$86.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.30
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$71.40
|
| Rate for Payer: Cofinity Commercial |
$87.72
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.70
|
| Rate for Payer: PHP Commercial |
$86.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.40
|
| Rate for Payer: Priority Health SBD |
$64.26
|
|
|
HC PROCALCITONIN
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 84145
|
| Hospital Charge Code |
30100480
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.89 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$86.70
|
| Rate for Payer: Aetna Medicare |
$28.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.02
|
| Rate for Payer: BCBS Complete |
$15.64
|
| Rate for Payer: BCBS MAPPO |
$27.22
|
| Rate for Payer: BCBS Trust/PPO |
$21.32
|
| Rate for Payer: BCN Medicare Advantage |
$27.22
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$87.72
|
| Rate for Payer: Cofinity Commercial |
$71.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.22
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Mclaren Medicaid |
$14.89
|
| Rate for Payer: Mclaren Medicare |
$27.22
|
| Rate for Payer: Meridian Medicaid |
$15.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.70
|
| Rate for Payer: PACE Medicare |
$25.86
|
| Rate for Payer: PACE SWMI |
$27.22
|
| Rate for Payer: PHP Commercial |
$86.70
|
| Rate for Payer: PHP Medicare Advantage |
$27.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.40
|
| Rate for Payer: Priority Health Medicare |
$27.22
|
| Rate for Payer: Priority Health SBD |
$64.26
|
| Rate for Payer: Railroad Medicare Medicare |
$27.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.66
|
| Rate for Payer: UHC Core |
$45.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.22
|
| Rate for Payer: UHC Exchange |
$27.22
|
| Rate for Payer: UHC Medicare Advantage |
$28.04
|
| Rate for Payer: VA VA |
$27.22
|
|
|
HC PROCESS FEE
|
Facility
|
OP
|
$36.00
|
|
| Hospital Charge Code |
30000106
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna Commercial |
$30.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.40
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$25.20
|
| Rate for Payer: Cofinity Commercial |
$30.96
|
| Rate for Payer: Healthscope Commercial |
$32.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.60
|
| Rate for Payer: PHP Commercial |
$30.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.20
|
| Rate for Payer: Priority Health SBD |
$22.68
|
|
|
HC PROCESS FEE
|
Facility
|
IP
|
$36.00
|
|
| Hospital Charge Code |
30000106
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.68 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna Commercial |
$30.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$25.20
|
| Rate for Payer: Cofinity Commercial |
$30.96
|
| Rate for Payer: Healthscope Commercial |
$32.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.60
|
| Rate for Payer: PHP Commercial |
$30.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.20
|
| Rate for Payer: Priority Health SBD |
$22.68
|
|
|
HC PROCTOSIGMOIDOSCOY RIGID DX
|
Facility
|
OP
|
$1,139.69
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
76100185
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.15 |
| Max. Negotiated Rate |
$2,470.91 |
| Rate for Payer: Aetna Commercial |
$968.74
|
| Rate for Payer: Aetna Medicare |
$845.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$740.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,016.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,016.54
|
| Rate for Payer: BCBS Complete |
$467.12
|
| Rate for Payer: BCBS MAPPO |
$813.23
|
| Rate for Payer: BCBS Trust/PPO |
$68.27
|
| Rate for Payer: BCN Medicare Advantage |
$813.23
|
| Rate for Payer: Cash Price |
$911.75
|
| Rate for Payer: Cash Price |
$911.75
|
| Rate for Payer: Cofinity Commercial |
$980.13
|
| Rate for Payer: Cofinity Commercial |
$797.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$813.23
|
| Rate for Payer: Healthscope Commercial |
$1,025.72
|
| Rate for Payer: Mclaren Medicaid |
$444.84
|
| Rate for Payer: Mclaren Medicare |
$813.23
|
| Rate for Payer: Meridian Medicaid |
$467.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$853.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$935.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$968.74
|
| Rate for Payer: PACE Medicare |
$772.57
|
| Rate for Payer: PACE SWMI |
$813.23
|
| Rate for Payer: PHP Commercial |
$968.74
|
| Rate for Payer: PHP Medicare Advantage |
$813.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$797.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,470.91
|
| Rate for Payer: Priority Health Medicare |
$813.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,976.73
|
| Rate for Payer: Priority Health SBD |
$718.00
|
| Rate for Payer: Railroad Medicare Medicare |
$813.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$813.23
|
| Rate for Payer: UHC Exchange |
$47.15
|
| Rate for Payer: UHC Medicare Advantage |
$837.63
|
| Rate for Payer: VA VA |
$813.23
|
|
|
HC PROCTOSIGMOIDOSCOY RIGID DX
|
Facility
|
IP
|
$1,139.69
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
76100185
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$718.00 |
| Max. Negotiated Rate |
$1,025.72 |
| Rate for Payer: Aetna Commercial |
$968.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$740.80
|
| Rate for Payer: Cash Price |
$911.75
|
| Rate for Payer: Cofinity Commercial |
$797.78
|
| Rate for Payer: Cofinity Commercial |
$980.13
|
| Rate for Payer: Healthscope Commercial |
$1,025.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$968.74
|
| Rate for Payer: PHP Commercial |
$968.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$797.78
|
| Rate for Payer: Priority Health SBD |
$718.00
|
|
|
HC PROF SVC ALLERGEN IMMUNOTHERAPY 2 OR MORE INJECT
|
Facility
|
IP
|
$37.78
|
|
|
Service Code
|
CPT 95117
|
| Hospital Charge Code |
51000082
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Aetna Commercial |
$32.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.56
|
| Rate for Payer: Cash Price |
$30.22
|
| Rate for Payer: Cofinity Commercial |
$26.45
|
| Rate for Payer: Cofinity Commercial |
$32.49
|
| Rate for Payer: Healthscope Commercial |
$34.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.11
|
| Rate for Payer: PHP Commercial |
$32.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.45
|
| Rate for Payer: Priority Health SBD |
$23.80
|
|
|
HC PROF SVC ALLERGEN IMMUNOTHERAPY 2 OR MORE INJECT
|
Facility
|
OP
|
$37.78
|
|
|
Service Code
|
CPT 95117
|
| Hospital Charge Code |
51000082
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.12 |
| Max. Negotiated Rate |
$52.84 |
| Rate for Payer: Aetna Commercial |
$32.11
|
| Rate for Payer: Aetna Medicare |
$43.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.84
|
| Rate for Payer: BCBS Complete |
$24.28
|
| Rate for Payer: BCBS MAPPO |
$42.27
|
| Rate for Payer: BCBS Trust/PPO |
$52.19
|
| Rate for Payer: BCN Medicare Advantage |
$42.27
|
| Rate for Payer: Cash Price |
$30.22
|
| Rate for Payer: Cash Price |
$30.22
|
| Rate for Payer: Cofinity Commercial |
$32.49
|
| Rate for Payer: Cofinity Commercial |
$26.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.27
|
| Rate for Payer: Healthscope Commercial |
$34.00
|
| Rate for Payer: Mclaren Medicaid |
$23.12
|
| Rate for Payer: Mclaren Medicare |
$42.27
|
| Rate for Payer: Meridian Medicaid |
$24.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.11
|
| Rate for Payer: PACE Medicare |
$40.16
|
| Rate for Payer: PACE SWMI |
$42.27
|
| Rate for Payer: PHP Commercial |
$32.11
|
| Rate for Payer: PHP Medicare Advantage |
$42.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.45
|
| Rate for Payer: Priority Health Medicare |
$42.27
|
| Rate for Payer: Priority Health SBD |
$23.80
|
| Rate for Payer: Railroad Medicare Medicare |
$42.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.27
|
| Rate for Payer: UHC Exchange |
$12.12
|
| Rate for Payer: UHC Medicare Advantage |
$43.54
|
| Rate for Payer: VA VA |
$42.27
|
|
|
HC PROF SVC ALLERGEN IMMUNOTHERAPY SINGLE INJECT
|
Facility
|
IP
|
$37.78
|
|
|
Service Code
|
CPT 95115
|
| Hospital Charge Code |
51000081
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Aetna Commercial |
$32.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.56
|
| Rate for Payer: Cash Price |
$30.22
|
| Rate for Payer: Cofinity Commercial |
$26.45
|
| Rate for Payer: Cofinity Commercial |
$32.49
|
| Rate for Payer: Healthscope Commercial |
$34.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.11
|
| Rate for Payer: PHP Commercial |
$32.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.45
|
| Rate for Payer: Priority Health SBD |
$23.80
|
|
|
HC PROF SVC ALLERGEN IMMUNOTHERAPY SINGLE INJECT
|
Facility
|
OP
|
$37.78
|
|
|
Service Code
|
CPT 95115
|
| Hospital Charge Code |
51000081
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$52.84 |
| Rate for Payer: Aetna Commercial |
$32.11
|
| Rate for Payer: Aetna Medicare |
$43.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.84
|
| Rate for Payer: BCBS Complete |
$24.28
|
| Rate for Payer: BCBS MAPPO |
$42.27
|
| Rate for Payer: BCBS Trust/PPO |
$44.52
|
| Rate for Payer: BCN Medicare Advantage |
$42.27
|
| Rate for Payer: Cash Price |
$30.22
|
| Rate for Payer: Cash Price |
$30.22
|
| Rate for Payer: Cofinity Commercial |
$26.45
|
| Rate for Payer: Cofinity Commercial |
$32.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.27
|
| Rate for Payer: Healthscope Commercial |
$34.00
|
| Rate for Payer: Mclaren Medicaid |
$23.12
|
| Rate for Payer: Mclaren Medicare |
$42.27
|
| Rate for Payer: Meridian Medicaid |
$24.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.11
|
| Rate for Payer: PACE Medicare |
$40.16
|
| Rate for Payer: PACE SWMI |
$42.27
|
| Rate for Payer: PHP Commercial |
$32.11
|
| Rate for Payer: PHP Medicare Advantage |
$42.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.45
|
| Rate for Payer: Priority Health Medicare |
$42.27
|
| Rate for Payer: Priority Health SBD |
$23.80
|
| Rate for Payer: Railroad Medicare Medicare |
$42.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.27
|
| Rate for Payer: UHC Exchange |
$10.15
|
| Rate for Payer: UHC Medicare Advantage |
$43.54
|
| Rate for Payer: VA VA |
$42.27
|
|
|
HC PROGESTERONE LEVEL
|
Facility
|
IP
|
$76.97
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
30100400
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.49 |
| Max. Negotiated Rate |
$69.27 |
| Rate for Payer: Aetna Commercial |
$65.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.03
|
| Rate for Payer: Cash Price |
$61.58
|
| Rate for Payer: Cofinity Commercial |
$53.88
|
| Rate for Payer: Cofinity Commercial |
$66.19
|
| Rate for Payer: Healthscope Commercial |
$69.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.42
|
| Rate for Payer: PHP Commercial |
$65.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.88
|
| Rate for Payer: Priority Health SBD |
$48.49
|
|
|
HC PROGESTERONE LEVEL
|
Facility
|
OP
|
$76.97
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
30100400
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.41 |
| Max. Negotiated Rate |
$69.27 |
| Rate for Payer: Aetna Commercial |
$65.42
|
| Rate for Payer: Aetna Medicare |
$21.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.08
|
| Rate for Payer: BCBS Complete |
$11.98
|
| Rate for Payer: BCBS MAPPO |
$20.86
|
| Rate for Payer: BCBS Trust/PPO |
$16.34
|
| Rate for Payer: BCN Medicare Advantage |
$20.86
|
| Rate for Payer: Cash Price |
$61.58
|
| Rate for Payer: Cash Price |
$61.58
|
| Rate for Payer: Cofinity Commercial |
$66.19
|
| Rate for Payer: Cofinity Commercial |
$53.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.86
|
| Rate for Payer: Healthscope Commercial |
$69.27
|
| Rate for Payer: Mclaren Medicaid |
$11.41
|
| Rate for Payer: Mclaren Medicare |
$20.86
|
| Rate for Payer: Meridian Medicaid |
$11.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.42
|
| Rate for Payer: PACE Medicare |
$19.82
|
| Rate for Payer: PACE SWMI |
$20.86
|
| Rate for Payer: PHP Commercial |
$65.42
|
| Rate for Payer: PHP Medicare Advantage |
$20.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.88
|
| Rate for Payer: Priority Health Medicare |
$20.86
|
| Rate for Payer: Priority Health SBD |
$48.49
|
| Rate for Payer: Railroad Medicare Medicare |
$20.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.03
|
| Rate for Payer: UHC Core |
$35.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.86
|
| Rate for Payer: UHC Exchange |
$20.86
|
| Rate for Payer: UHC Medicare Advantage |
$21.49
|
| Rate for Payer: VA VA |
$20.86
|
|
|
HC PROLACTIN
|
Facility
|
OP
|
$72.42
|
|
|
Service Code
|
CPT 84146
|
| Hospital Charge Code |
30100402
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$65.18 |
| Rate for Payer: Aetna Commercial |
$61.56
|
| Rate for Payer: Aetna Medicare |
$20.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.22
|
| Rate for Payer: BCBS Complete |
$11.13
|
| Rate for Payer: BCBS MAPPO |
$19.38
|
| Rate for Payer: BCBS Trust/PPO |
$15.18
|
| Rate for Payer: BCN Medicare Advantage |
$19.38
|
| Rate for Payer: Cash Price |
$57.94
|
| Rate for Payer: Cash Price |
$57.94
|
| Rate for Payer: Cofinity Commercial |
$50.69
|
| Rate for Payer: Cofinity Commercial |
$62.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.38
|
| Rate for Payer: Healthscope Commercial |
$65.18
|
| Rate for Payer: Mclaren Medicaid |
$10.60
|
| Rate for Payer: Mclaren Medicare |
$19.38
|
| Rate for Payer: Meridian Medicaid |
$11.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.56
|
| Rate for Payer: PACE Medicare |
$18.41
|
| Rate for Payer: PACE SWMI |
$19.38
|
| Rate for Payer: PHP Commercial |
$61.56
|
| Rate for Payer: PHP Medicare Advantage |
$19.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.69
|
| Rate for Payer: Priority Health Medicare |
$19.38
|
| Rate for Payer: Priority Health SBD |
$45.62
|
| Rate for Payer: Railroad Medicare Medicare |
$19.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.26
|
| Rate for Payer: UHC Core |
$32.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.38
|
| Rate for Payer: UHC Exchange |
$19.38
|
| Rate for Payer: UHC Medicare Advantage |
$19.96
|
| Rate for Payer: VA VA |
$19.38
|
|
|
HC PROLACTIN
|
Facility
|
IP
|
$72.42
|
|
|
Service Code
|
CPT 84146
|
| Hospital Charge Code |
30100402
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.62 |
| Max. Negotiated Rate |
$65.18 |
| Rate for Payer: Aetna Commercial |
$61.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.07
|
| Rate for Payer: Cash Price |
$57.94
|
| Rate for Payer: Cofinity Commercial |
$50.69
|
| Rate for Payer: Cofinity Commercial |
$62.28
|
| Rate for Payer: Healthscope Commercial |
$65.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.56
|
| Rate for Payer: PHP Commercial |
$61.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.69
|
| Rate for Payer: Priority Health SBD |
$45.62
|
|
|
HC PROLONGED E/M BEFORE/AFTER DIRECT CARE 1ST HR
|
Facility
|
IP
|
$129.03
|
|
|
Service Code
|
CPT 99358
|
| Hospital Charge Code |
51000084
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$81.29 |
| Max. Negotiated Rate |
$116.13 |
| Rate for Payer: Aetna Commercial |
$109.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.87
|
| Rate for Payer: Cash Price |
$103.22
|
| Rate for Payer: Cofinity Commercial |
$110.97
|
| Rate for Payer: Cofinity Commercial |
$90.32
|
| Rate for Payer: Healthscope Commercial |
$116.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.68
|
| Rate for Payer: PHP Commercial |
$109.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.32
|
| Rate for Payer: Priority Health SBD |
$81.29
|
|
|
HC PROLONGED E/M BEFORE/AFTER DIRECT CARE 1ST HR
|
Facility
|
OP
|
$129.03
|
|
|
Service Code
|
CPT 99358
|
| Hospital Charge Code |
51000084
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.61 |
| Max. Negotiated Rate |
$116.13 |
| Rate for Payer: Aetna Commercial |
$109.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.87
|
| Rate for Payer: BCBS Complete |
$51.61
|
| Rate for Payer: BCBS Trust/PPO |
$115.12
|
| Rate for Payer: Cash Price |
$103.22
|
| Rate for Payer: Cash Price |
$103.22
|
| Rate for Payer: Cofinity Commercial |
$90.32
|
| Rate for Payer: Cofinity Commercial |
$110.97
|
| Rate for Payer: Healthscope Commercial |
$116.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.68
|
| Rate for Payer: PHP Commercial |
$109.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.32
|
| Rate for Payer: Priority Health SBD |
$81.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.01
|
| Rate for Payer: UHC Exchange |
$85.46
|
|
