|
HC INFUSION CATH LVL 5
|
Facility
|
OP
|
$595.35
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
27200296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.14 |
| Max. Negotiated Rate |
$535.82 |
| Rate for Payer: Aetna Commercial |
$506.05
|
| Rate for Payer: Aetna Medicare |
$297.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$386.98
|
| Rate for Payer: BCBS Complete |
$238.14
|
| Rate for Payer: Cash Price |
$476.28
|
| Rate for Payer: Cofinity Commercial |
$416.74
|
| Rate for Payer: Cofinity Commercial |
$512.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$416.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.28
|
| Rate for Payer: Healthscope Commercial |
$535.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.05
|
| Rate for Payer: PHP Commercial |
$506.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$386.98
|
| Rate for Payer: Priority Health SBD |
$375.07
|
|
|
HC INFUSION CATH LVL 8
|
Facility
|
IP
|
$843.51
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
27200309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$531.41 |
| Max. Negotiated Rate |
$759.16 |
| Rate for Payer: Aetna Commercial |
$716.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$548.28
|
| Rate for Payer: Cash Price |
$674.81
|
| Rate for Payer: Cofinity Commercial |
$590.46
|
| Rate for Payer: Cofinity Commercial |
$725.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$590.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$674.81
|
| Rate for Payer: Healthscope Commercial |
$759.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$716.98
|
| Rate for Payer: PHP Commercial |
$716.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$548.28
|
| Rate for Payer: Priority Health SBD |
$531.41
|
|
|
HC INFUSION CATH LVL 8
|
Facility
|
OP
|
$843.51
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
27200309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$337.40 |
| Max. Negotiated Rate |
$759.16 |
| Rate for Payer: Aetna Commercial |
$716.98
|
| Rate for Payer: Aetna Medicare |
$421.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$548.28
|
| Rate for Payer: BCBS Complete |
$337.40
|
| Rate for Payer: Cash Price |
$674.81
|
| Rate for Payer: Cofinity Commercial |
$590.46
|
| Rate for Payer: Cofinity Commercial |
$725.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$590.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$674.81
|
| Rate for Payer: Healthscope Commercial |
$759.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$716.98
|
| Rate for Payer: PHP Commercial |
$716.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$548.28
|
| Rate for Payer: Priority Health SBD |
$531.41
|
|
|
HC INGESTION CHALLENGE TEST EA ADDL 60 MIN
|
Facility
|
IP
|
$224.40
|
|
|
Service Code
|
CPT 95079
|
| Hospital Charge Code |
51000115
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$141.37 |
| Max. Negotiated Rate |
$201.96 |
| Rate for Payer: Aetna Commercial |
$190.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.86
|
| Rate for Payer: Cash Price |
$179.52
|
| Rate for Payer: Cofinity Commercial |
$157.08
|
| Rate for Payer: Cofinity Commercial |
$192.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$157.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.52
|
| Rate for Payer: Healthscope Commercial |
$201.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.74
|
| Rate for Payer: PHP Commercial |
$190.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.86
|
| Rate for Payer: Priority Health SBD |
$141.37
|
|
|
HC INGESTION CHALLENGE TEST EA ADDL 60 MIN
|
Facility
|
OP
|
$224.40
|
|
|
Service Code
|
CPT 95079
|
| Hospital Charge Code |
51000115
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.94 |
| Max. Negotiated Rate |
$201.96 |
| Rate for Payer: Aetna Commercial |
$190.74
|
| Rate for Payer: Aetna Medicare |
$112.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.86
|
| Rate for Payer: BCBS Complete |
$89.76
|
| Rate for Payer: BCBS Trust/PPO |
$120.70
|
| Rate for Payer: BCN Commercial |
$120.70
|
| Rate for Payer: Cash Price |
$179.52
|
| Rate for Payer: Cash Price |
$179.52
|
| Rate for Payer: Cofinity Commercial |
$157.08
|
| Rate for Payer: Cofinity Commercial |
$192.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$157.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.52
|
| Rate for Payer: Healthscope Commercial |
$201.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.74
|
| Rate for Payer: PHP Commercial |
$190.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.86
|
| Rate for Payer: Priority Health SBD |
$141.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.94
|
|
|
HC INGESTION CHALLENGE TEST INIT 120 MIN
|
Facility
|
IP
|
$1,429.99
|
|
|
Service Code
|
CPT 95076
|
| Hospital Charge Code |
51000114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$900.89 |
| Max. Negotiated Rate |
$1,286.99 |
| Rate for Payer: Aetna Commercial |
$1,215.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$929.49
|
| Rate for Payer: Cash Price |
$1,143.99
|
| Rate for Payer: Cofinity Commercial |
$1,000.99
|
| Rate for Payer: Cofinity Commercial |
$1,229.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,000.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,143.99
|
| Rate for Payer: Healthscope Commercial |
$1,286.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,215.49
|
| Rate for Payer: PHP Commercial |
$1,215.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$929.49
|
| Rate for Payer: Priority Health SBD |
$900.89
|
|
|
HC INGESTION CHALLENGE TEST INIT 120 MIN
|
Facility
|
OP
|
$1,429.99
|
|
|
Service Code
|
CPT 95076
|
| Hospital Charge Code |
51000114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$76.91 |
| Max. Negotiated Rate |
$1,633.95 |
| Rate for Payer: Aetna Commercial |
$1,215.49
|
| Rate for Payer: Aetna Medicare |
$540.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$929.49
|
| 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 |
$174.45
|
| Rate for Payer: BCN Commercial |
$174.45
|
| Rate for Payer: BCN Medicare Advantage |
$519.87
|
| Rate for Payer: Cash Price |
$1,143.99
|
| Rate for Payer: Cash Price |
$1,143.99
|
| Rate for Payer: Cofinity Commercial |
$1,229.79
|
| Rate for Payer: Cofinity Commercial |
$1,000.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,000.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,143.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$519.87
|
| Rate for Payer: Healthscope Commercial |
$1,286.99
|
| 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 |
$1,215.49
|
| 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 |
$1,215.49
|
| 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 |
$929.49
|
| 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 |
$900.89
|
| Rate for Payer: Railroad Medicare Medicare |
$519.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.91
|
| 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 INHALATION BRONCHIAL CHALLENGE TESTING
|
Facility
|
OP
|
$495.05
|
|
|
Service Code
|
CPT 95070
|
| Hospital Charge Code |
46000028
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$34.64 |
| Max. Negotiated Rate |
$1,633.95 |
| Rate for Payer: Aetna Commercial |
$420.79
|
| Rate for Payer: Aetna Medicare |
$540.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.78
|
| 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 |
$49.50
|
| Rate for Payer: BCN Commercial |
$49.50
|
| Rate for Payer: BCN Medicare Advantage |
$519.87
|
| Rate for Payer: Cash Price |
$396.04
|
| Rate for Payer: Cash Price |
$396.04
|
| Rate for Payer: Cofinity Commercial |
$425.74
|
| Rate for Payer: Cofinity Commercial |
$346.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$346.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$519.87
|
| Rate for Payer: Healthscope Commercial |
$445.54
|
| 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 |
$420.79
|
| 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 |
$420.79
|
| 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 |
$321.78
|
| 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 |
$311.88
|
| Rate for Payer: Railroad Medicare Medicare |
$519.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$519.87
|
| Rate for Payer: UHC Exchange |
$366.34
|
| Rate for Payer: UHC Medicare Advantage |
$519.87
|
| Rate for Payer: UHCCP Medicaid |
$292.69
|
| Rate for Payer: VA VA |
$519.87
|
|
|
HC INHALATION BRONCHIAL CHALLENGE TESTING
|
Facility
|
IP
|
$495.05
|
|
|
Service Code
|
CPT 95070
|
| Hospital Charge Code |
46000028
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$311.88 |
| Max. Negotiated Rate |
$445.54 |
| Rate for Payer: Aetna Commercial |
$420.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.78
|
| Rate for Payer: Cash Price |
$396.04
|
| Rate for Payer: Cofinity Commercial |
$346.54
|
| Rate for Payer: Cofinity Commercial |
$425.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$346.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.04
|
| Rate for Payer: Healthscope Commercial |
$445.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.79
|
| Rate for Payer: PHP Commercial |
$420.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.78
|
| Rate for Payer: Priority Health SBD |
$311.88
|
|
|
HC INHIBIN A, TUMOR MARKER, S
|
Facility
|
IP
|
$73.44
|
|
|
Service Code
|
CPT 86336
|
| Hospital Charge Code |
30200460
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.27 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.74
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$51.41
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: Priority Health SBD |
$46.27
|
|
|
HC INHIBIN A, TUMOR MARKER, S
|
Facility
|
OP
|
$73.44
|
|
|
Service Code
|
CPT 86336
|
| Hospital Charge Code |
30200460
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna Medicare |
$16.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.49
|
| Rate for Payer: BCBS Complete |
$8.77
|
| Rate for Payer: BCBS MAPPO |
$15.59
|
| Rate for Payer: BCBS Trust/PPO |
$13.80
|
| Rate for Payer: BCN Commercial |
$13.80
|
| Rate for Payer: BCN Medicare Advantage |
$15.59
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Cofinity Commercial |
$51.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.59
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Mclaren Medicaid |
$8.36
|
| Rate for Payer: Mclaren Medicare |
$15.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.37
|
| Rate for Payer: Meridian Medicaid |
$8.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: Nomi Health Commercial |
$23.38
|
| Rate for Payer: PACE Medicare |
$14.81
|
| Rate for Payer: PACE SWMI |
$15.59
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: PHP Medicare Advantage |
$15.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.04
|
| Rate for Payer: Priority Health Medicare |
$15.59
|
| Rate for Payer: Priority Health Narrow Network |
$12.83
|
| Rate for Payer: Priority Health SBD |
$46.27
|
| Rate for Payer: Railroad Medicare Medicare |
$15.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.59
|
| Rate for Payer: UHC Medicare Advantage |
$15.59
|
| Rate for Payer: UHCCP Medicaid |
$8.78
|
| Rate for Payer: VA VA |
$15.59
|
|
|
HC INHIBIN B, CMPT
|
Facility
|
IP
|
$49.94
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100693
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.46 |
| Max. Negotiated Rate |
$44.95 |
| Rate for Payer: Aetna Commercial |
$42.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.46
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cofinity Commercial |
$34.96
|
| Rate for Payer: Cofinity Commercial |
$42.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.95
|
| Rate for Payer: Healthscope Commercial |
$44.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.45
|
| Rate for Payer: PHP Commercial |
$42.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.46
|
| Rate for Payer: Priority Health SBD |
$31.46
|
|
|
HC INHIBIN B, CMPT
|
Facility
|
OP
|
$49.94
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100693
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$44.95 |
| Rate for Payer: Aetna Commercial |
$42.45
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: BCBS Complete |
$9.72
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$15.28
|
| Rate for Payer: BCN Commercial |
$15.28
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cofinity Commercial |
$42.95
|
| Rate for Payer: Cofinity Commercial |
$34.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$44.95
|
| Rate for Payer: Mclaren Medicaid |
$9.26
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: Meridian Medicaid |
$9.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.45
|
| Rate for Payer: Nomi Health Commercial |
$25.90
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$42.45
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.27
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health Narrow Network |
$13.82
|
| Rate for Payer: Priority Health SBD |
$31.46
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Medicare Advantage |
$17.27
|
| Rate for Payer: UHCCP Medicaid |
$9.72
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC INITIAL PREV PHYS EXAM, FIRST 12MOS MEDICARE ENROLLMENT
|
Facility
|
OP
|
$180.93
|
|
|
Service Code
|
CPT G0402
|
| Hospital Charge Code |
51000096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.68 |
| Max. Negotiated Rate |
$396.84 |
| Rate for Payer: Aetna Commercial |
$153.79
|
| Rate for Payer: Aetna Medicare |
$131.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.82
|
| Rate for Payer: BCBS Complete |
$71.06
|
| Rate for Payer: BCBS MAPPO |
$126.26
|
| Rate for Payer: BCN Medicare Advantage |
$126.26
|
| Rate for Payer: Cash Price |
$144.74
|
| Rate for Payer: Cash Price |
$144.74
|
| Rate for Payer: Cofinity Commercial |
$126.65
|
| Rate for Payer: Cofinity Commercial |
$155.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.26
|
| Rate for Payer: Healthscope Commercial |
$162.84
|
| Rate for Payer: Mclaren Medicaid |
$67.68
|
| Rate for Payer: Mclaren Medicare |
$126.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.57
|
| Rate for Payer: Meridian Medicaid |
$71.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.79
|
| Rate for Payer: Nomi Health Commercial |
$378.78
|
| Rate for Payer: PACE Medicare |
$119.95
|
| Rate for Payer: PACE SWMI |
$126.26
|
| Rate for Payer: PHP Commercial |
$153.79
|
| Rate for Payer: PHP Medicare Advantage |
$126.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$396.84
|
| Rate for Payer: Priority Health Medicare |
$126.26
|
| Rate for Payer: Priority Health Narrow Network |
$317.47
|
| Rate for Payer: Priority Health SBD |
$113.99
|
| Rate for Payer: Railroad Medicare Medicare |
$126.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.26
|
| Rate for Payer: UHC Medicare Advantage |
$126.26
|
| Rate for Payer: UHCCP Medicaid |
$71.08
|
| Rate for Payer: VA VA |
$126.26
|
|
|
HC INITIAL PREV PHYS EXAM, FIRST 12MOS MEDICARE ENROLLMENT
|
Facility
|
IP
|
$180.93
|
|
|
Service Code
|
CPT G0402
|
| Hospital Charge Code |
51000096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$113.99 |
| Max. Negotiated Rate |
$162.84 |
| Rate for Payer: Aetna Commercial |
$153.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.60
|
| Rate for Payer: Cash Price |
$144.74
|
| Rate for Payer: Cofinity Commercial |
$126.65
|
| Rate for Payer: Cofinity Commercial |
$155.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.74
|
| Rate for Payer: Healthscope Commercial |
$162.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.79
|
| Rate for Payer: PHP Commercial |
$153.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
| Rate for Payer: Priority Health SBD |
$113.99
|
|
|
HC INITIATION PROLONGED INFUSION REQUIRING PUMP
|
Facility
|
IP
|
$579.68
|
|
|
Service Code
|
HCPCS C8957
|
| Hospital Charge Code |
26000012
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$365.20 |
| Max. Negotiated Rate |
$521.71 |
| Rate for Payer: Aetna Commercial |
$492.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$376.79
|
| Rate for Payer: Cash Price |
$463.74
|
| Rate for Payer: Cofinity Commercial |
$405.78
|
| Rate for Payer: Cofinity Commercial |
$498.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$405.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$463.74
|
| Rate for Payer: Healthscope Commercial |
$521.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$492.73
|
| Rate for Payer: PHP Commercial |
$492.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$376.79
|
| Rate for Payer: Priority Health SBD |
$365.20
|
|
|
HC INITIATION PROLONGED INFUSION REQUIRING PUMP
|
Facility
|
OP
|
$579.68
|
|
|
Service Code
|
HCPCS C8957
|
| Hospital Charge Code |
26000012
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$174.19 |
| Max. Negotiated Rate |
$1,021.42 |
| Rate for Payer: Aetna Commercial |
$492.73
|
| Rate for Payer: Aetna Medicare |
$337.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$376.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$406.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$406.22
|
| Rate for Payer: BCBS Complete |
$182.90
|
| Rate for Payer: BCBS MAPPO |
$324.98
|
| Rate for Payer: BCBS Trust/PPO |
$584.99
|
| Rate for Payer: BCN Commercial |
$584.99
|
| Rate for Payer: BCN Medicare Advantage |
$324.98
|
| Rate for Payer: Cash Price |
$463.74
|
| Rate for Payer: Cash Price |
$463.74
|
| Rate for Payer: Cofinity Commercial |
$498.52
|
| Rate for Payer: Cofinity Commercial |
$405.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$405.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$463.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.98
|
| Rate for Payer: Healthscope Commercial |
$521.71
|
| Rate for Payer: Mclaren Medicaid |
$174.19
|
| Rate for Payer: Mclaren Medicare |
$324.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$341.23
|
| Rate for Payer: Meridian Medicaid |
$182.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$373.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$492.73
|
| Rate for Payer: Nomi Health Commercial |
$974.94
|
| Rate for Payer: PACE Medicare |
$308.73
|
| Rate for Payer: PACE SWMI |
$324.98
|
| Rate for Payer: PHP Commercial |
$492.73
|
| Rate for Payer: PHP Medicare Advantage |
$324.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$376.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,021.42
|
| Rate for Payer: Priority Health Medicare |
$324.98
|
| Rate for Payer: Priority Health Narrow Network |
$817.14
|
| Rate for Payer: Priority Health SBD |
$365.20
|
| Rate for Payer: Railroad Medicare Medicare |
$324.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$914.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.98
|
| Rate for Payer: UHC Exchange |
$428.96
|
| Rate for Payer: UHC Medicare Advantage |
$324.98
|
| Rate for Payer: UHCCP Medicaid |
$182.96
|
| Rate for Payer: VA VA |
$324.98
|
|
|
HC INITIAT MED TX IN ER
|
Facility
|
OP
|
$158.10
|
|
|
Service Code
|
HCPCS G2213
|
| Hospital Charge Code |
45000106
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$63.24 |
| Max. Negotiated Rate |
$142.29 |
| Rate for Payer: Aetna Commercial |
$134.38
|
| Rate for Payer: Aetna Medicare |
$79.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.76
|
| Rate for Payer: BCBS Complete |
$63.24
|
| Rate for Payer: BCBS Trust/PPO |
$73.83
|
| Rate for Payer: BCN Commercial |
$73.83
|
| Rate for Payer: Cash Price |
$126.48
|
| Rate for Payer: Cash Price |
$126.48
|
| Rate for Payer: Cofinity Commercial |
$135.97
|
| Rate for Payer: Cofinity Commercial |
$110.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$110.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.48
|
| Rate for Payer: Healthscope Commercial |
$142.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.38
|
| Rate for Payer: PHP Commercial |
$134.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.76
|
| Rate for Payer: Priority Health SBD |
$99.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.27
|
|
|
HC INITIAT MED TX IN ER
|
Facility
|
IP
|
$158.10
|
|
|
Service Code
|
HCPCS G2213
|
| Hospital Charge Code |
45000106
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$99.60 |
| Max. Negotiated Rate |
$142.29 |
| Rate for Payer: Aetna Commercial |
$134.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.76
|
| Rate for Payer: Cash Price |
$126.48
|
| Rate for Payer: Cofinity Commercial |
$110.67
|
| Rate for Payer: Cofinity Commercial |
$135.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$110.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.48
|
| Rate for Payer: Healthscope Commercial |
$142.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.38
|
| Rate for Payer: PHP Commercial |
$134.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.76
|
| Rate for Payer: Priority Health SBD |
$99.60
|
|
|
HC INIT SUB PSYCH 1ST 30 MIN
|
Facility
|
IP
|
$126.93
|
|
|
Service Code
|
HCPCS G2214
|
| Hospital Charge Code |
76100344
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$79.97 |
| Max. Negotiated Rate |
$114.24 |
| Rate for Payer: Aetna Commercial |
$107.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.50
|
| Rate for Payer: Cash Price |
$101.54
|
| Rate for Payer: Cofinity Commercial |
$109.16
|
| Rate for Payer: Cofinity Commercial |
$88.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$88.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.54
|
| Rate for Payer: Healthscope Commercial |
$114.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.89
|
| Rate for Payer: PHP Commercial |
$107.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.50
|
| Rate for Payer: Priority Health SBD |
$79.97
|
|
|
HC INIT SUB PSYCH 1ST 30 MIN
|
Facility
|
OP
|
$126.93
|
|
|
Service Code
|
HCPCS G2214
|
| Hospital Charge Code |
76100344
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.35 |
| Max. Negotiated Rate |
$284.86 |
| Rate for Payer: Aetna Commercial |
$107.89
|
| Rate for Payer: Aetna Medicare |
$94.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$113.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$113.29
|
| Rate for Payer: BCBS Complete |
$51.01
|
| Rate for Payer: BCBS MAPPO |
$90.63
|
| Rate for Payer: BCN Medicare Advantage |
$90.63
|
| Rate for Payer: Cash Price |
$101.54
|
| Rate for Payer: Cash Price |
$101.54
|
| Rate for Payer: Cofinity Commercial |
$109.16
|
| Rate for Payer: Cofinity Commercial |
$88.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$88.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.63
|
| Rate for Payer: Healthscope Commercial |
$114.24
|
| Rate for Payer: Mclaren Medicaid |
$48.58
|
| Rate for Payer: Mclaren Medicare |
$90.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.16
|
| Rate for Payer: Meridian Medicaid |
$51.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.89
|
| Rate for Payer: Nomi Health Commercial |
$271.89
|
| Rate for Payer: PACE Medicare |
$86.10
|
| Rate for Payer: PACE SWMI |
$90.63
|
| Rate for Payer: PHP Commercial |
$107.89
|
| Rate for Payer: PHP Medicare Advantage |
$90.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$284.86
|
| Rate for Payer: Priority Health Medicare |
$90.63
|
| Rate for Payer: Priority Health Narrow Network |
$227.89
|
| Rate for Payer: Priority Health SBD |
$79.97
|
| Rate for Payer: Railroad Medicare Medicare |
$90.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.63
|
| Rate for Payer: UHC Medicare Advantage |
$90.63
|
| Rate for Payer: UHCCP Medicaid |
$51.02
|
| Rate for Payer: VA VA |
$90.63
|
|
|
HC INJ AIR CONTRAST PERITONEAL CAVITY
|
Facility
|
IP
|
$964.47
|
|
|
Service Code
|
CPT 49400
|
| Hospital Charge Code |
36100446
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$607.62 |
| Max. Negotiated Rate |
$868.02 |
| Rate for Payer: Aetna Commercial |
$819.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$626.91
|
| Rate for Payer: Cash Price |
$771.58
|
| Rate for Payer: Cofinity Commercial |
$675.13
|
| Rate for Payer: Cofinity Commercial |
$829.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$675.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.58
|
| Rate for Payer: Healthscope Commercial |
$868.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$819.80
|
| Rate for Payer: PHP Commercial |
$819.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.91
|
| Rate for Payer: Priority Health SBD |
$607.62
|
|
|
HC INJ AIR CONTRAST PERITONEAL CAVITY
|
Facility
|
OP
|
$964.47
|
|
|
Service Code
|
CPT 49400
|
| Hospital Charge Code |
36100446
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$94.63 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Commercial |
$819.80
|
| Rate for Payer: Aetna Medicare |
$482.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$626.91
|
| Rate for Payer: BCBS Complete |
$385.79
|
| Rate for Payer: BCBS Trust/PPO |
$279.17
|
| Rate for Payer: BCN Commercial |
$279.17
|
| Rate for Payer: Cash Price |
$771.58
|
| Rate for Payer: Cash Price |
$771.58
|
| Rate for Payer: Cash Price |
$771.58
|
| Rate for Payer: Cofinity Commercial |
$675.13
|
| Rate for Payer: Cofinity Commercial |
$829.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$675.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.58
|
| Rate for Payer: Healthscope Commercial |
$868.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$819.80
|
| Rate for Payer: PHP Commercial |
$819.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.91
|
| Rate for Payer: Priority Health SBD |
$607.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.63
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC INJ ANES CELIAC PLEXUS
|
Facility
|
IP
|
$1,267.21
|
|
|
Service Code
|
CPT 64517
|
| Hospital Charge Code |
36100605
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$798.34 |
| Max. Negotiated Rate |
$1,140.49 |
| Rate for Payer: Aetna Commercial |
$1,077.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$823.69
|
| Rate for Payer: Cash Price |
$1,013.77
|
| Rate for Payer: Cofinity Commercial |
$1,089.80
|
| Rate for Payer: Cofinity Commercial |
$887.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$887.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,013.77
|
| Rate for Payer: Healthscope Commercial |
$1,140.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,077.13
|
| Rate for Payer: PHP Commercial |
$1,077.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$823.69
|
| Rate for Payer: Priority Health SBD |
$798.34
|
|
|
HC INJ ANES CELIAC PLEXUS
|
Facility
|
OP
|
$1,267.21
|
|
|
Service Code
|
CPT 64517
|
| Hospital Charge Code |
36100605
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$132.22 |
| Max. Negotiated Rate |
$2,741.59 |
| Rate for Payer: Aetna Commercial |
$1,077.13
|
| Rate for Payer: Aetna Medicare |
$907.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$823.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,090.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,090.36
|
| Rate for Payer: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS MAPPO |
$872.29
|
| Rate for Payer: BCBS Trust/PPO |
$398.64
|
| Rate for Payer: BCN Commercial |
$398.64
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$1,013.77
|
| Rate for Payer: Cash Price |
$1,013.77
|
| Rate for Payer: Cash Price |
$1,013.77
|
| Rate for Payer: Cofinity Commercial |
$1,089.80
|
| Rate for Payer: Cofinity Commercial |
$887.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$887.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,013.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.29
|
| Rate for Payer: Healthscope Commercial |
$1,140.49
|
| Rate for Payer: Mclaren Medicaid |
$467.55
|
| Rate for Payer: Mclaren Medicare |
$872.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.90
|
| Rate for Payer: Meridian Medicaid |
$490.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,003.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,077.13
|
| Rate for Payer: Nomi Health Commercial |
$1,831.81
|
| Rate for Payer: PACE Medicare |
$828.68
|
| Rate for Payer: PACE SWMI |
$872.29
|
| Rate for Payer: PHP Commercial |
$1,077.13
|
| Rate for Payer: PHP Medicare Advantage |
$872.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$823.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,741.59
|
| Rate for Payer: Priority Health Medicare |
$872.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,193.27
|
| Rate for Payer: Priority Health SBD |
$798.34
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.22
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$872.29
|
| Rate for Payer: UHC Exchange |
$1,566.00
|
| Rate for Payer: UHC Medicare Advantage |
$872.29
|
| Rate for Payer: UHCCP Medicaid |
$491.10
|
| Rate for Payer: VA VA |
$872.29
|
|
