|
HC SHAVE LESION TRUNK, ARM, LEGS 1.1 TO 2.0 CM
|
Facility
|
IP
|
$158.65
|
|
|
Service Code
|
CPT 11302
|
| Hospital Charge Code |
76100082
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$99.95 |
| Max. Negotiated Rate |
$142.78 |
| Rate for Payer: Aetna Commercial |
$134.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.12
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cofinity Commercial |
$111.06
|
| Rate for Payer: Cofinity Commercial |
$136.44
|
| Rate for Payer: Healthscope Commercial |
$142.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.85
|
| Rate for Payer: PHP Commercial |
$134.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.06
|
| Rate for Payer: Priority Health SBD |
$99.95
|
|
|
HC SHAVE LESION TRUNK, ARM, LEGS 1.1 TO 2.0 CM
|
Facility
|
OP
|
$158.65
|
|
|
Service Code
|
CPT 11302
|
| Hospital Charge Code |
76100082
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.96 |
| Max. Negotiated Rate |
$541.49 |
| Rate for Payer: Aetna Commercial |
$134.85
|
| Rate for Payer: Aetna Medicare |
$185.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.68
|
| Rate for Payer: BCBS Complete |
$102.32
|
| Rate for Payer: BCBS MAPPO |
$178.14
|
| Rate for Payer: BCBS Trust/PPO |
$79.41
|
| Rate for Payer: BCN Medicare Advantage |
$178.14
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cofinity Commercial |
$136.44
|
| Rate for Payer: Cofinity Commercial |
$111.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.14
|
| Rate for Payer: Healthscope Commercial |
$142.78
|
| Rate for Payer: Mclaren Medicaid |
$97.44
|
| Rate for Payer: Mclaren Medicare |
$178.14
|
| Rate for Payer: Meridian Medicaid |
$102.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$187.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.85
|
| Rate for Payer: PACE Medicare |
$169.23
|
| Rate for Payer: PACE SWMI |
$178.14
|
| Rate for Payer: PHP Commercial |
$134.85
|
| Rate for Payer: PHP Medicare Advantage |
$178.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.49
|
| Rate for Payer: Priority Health Medicare |
$178.14
|
| Rate for Payer: Priority Health Narrow Network |
$433.19
|
| Rate for Payer: Priority Health SBD |
$99.95
|
| Rate for Payer: Railroad Medicare Medicare |
$178.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.14
|
| Rate for Payer: UHC Exchange |
$57.96
|
| Rate for Payer: UHC Medicare Advantage |
$183.48
|
| Rate for Payer: VA VA |
$178.14
|
|
|
HC SHAVE LESION TRUNK, ARM, LEGS OVER 2.0 CM
|
Facility
|
OP
|
$144.23
|
|
|
Service Code
|
CPT 11303
|
| Hospital Charge Code |
76100083
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.09 |
| Max. Negotiated Rate |
$1,076.20 |
| Rate for Payer: Aetna Commercial |
$122.60
|
| Rate for Payer: Aetna Medicare |
$368.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.50
|
| Rate for Payer: BCBS Complete |
$203.80
|
| Rate for Payer: BCBS MAPPO |
$354.80
|
| Rate for Payer: BCBS Trust/PPO |
$152.31
|
| Rate for Payer: BCN Medicare Advantage |
$354.80
|
| Rate for Payer: Cash Price |
$115.38
|
| Rate for Payer: Cash Price |
$115.38
|
| Rate for Payer: Cofinity Commercial |
$124.04
|
| Rate for Payer: Cofinity Commercial |
$100.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.80
|
| Rate for Payer: Healthscope Commercial |
$129.81
|
| Rate for Payer: Mclaren Medicaid |
$194.08
|
| Rate for Payer: Mclaren Medicare |
$354.80
|
| Rate for Payer: Meridian Medicaid |
$203.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$408.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.60
|
| Rate for Payer: PACE Medicare |
$337.06
|
| Rate for Payer: PACE SWMI |
$354.80
|
| Rate for Payer: PHP Commercial |
$122.60
|
| Rate for Payer: PHP Medicare Advantage |
$354.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,076.20
|
| Rate for Payer: Priority Health Medicare |
$354.80
|
| Rate for Payer: Priority Health Narrow Network |
$860.96
|
| Rate for Payer: Priority Health SBD |
$90.86
|
| Rate for Payer: Railroad Medicare Medicare |
$354.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.80
|
| Rate for Payer: UHC Exchange |
$69.09
|
| Rate for Payer: UHC Medicare Advantage |
$365.44
|
| Rate for Payer: VA VA |
$354.80
|
|
|
HC SHAVE LESION TRUNK, ARM, LEGS OVER 2.0 CM
|
Facility
|
IP
|
$144.23
|
|
|
Service Code
|
CPT 11303
|
| Hospital Charge Code |
76100083
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.86 |
| Max. Negotiated Rate |
$129.81 |
| Rate for Payer: Aetna Commercial |
$122.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.75
|
| Rate for Payer: Cash Price |
$115.38
|
| Rate for Payer: Cofinity Commercial |
$124.04
|
| Rate for Payer: Cofinity Commercial |
$100.96
|
| Rate for Payer: Healthscope Commercial |
$129.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.60
|
| Rate for Payer: PHP Commercial |
$122.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.96
|
| Rate for Payer: Priority Health SBD |
$90.86
|
|
|
HC SHEEP SORREL IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200102
|
|
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 SHEEP SORREL IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200102
|
|
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 |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| 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 SHINGLES VACCINE
|
Facility
|
OP
|
$271.52
|
|
|
Service Code
|
CPT 90736
|
| Hospital Charge Code |
63600063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.61 |
| Max. Negotiated Rate |
$642.19 |
| Rate for Payer: Aetna Commercial |
$230.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.49
|
| Rate for Payer: BCBS Complete |
$108.61
|
| Rate for Payer: BCBS Trust/PPO |
$642.19
|
| Rate for Payer: Cash Price |
$217.22
|
| Rate for Payer: Cash Price |
$217.22
|
| Rate for Payer: Cofinity Commercial |
$190.06
|
| Rate for Payer: Cofinity Commercial |
$233.51
|
| Rate for Payer: Healthscope Commercial |
$244.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$230.79
|
| Rate for Payer: PHP Commercial |
$230.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.06
|
| Rate for Payer: Priority Health SBD |
$171.06
|
|
|
HC SHINGLES VACCINE
|
Facility
|
IP
|
$271.52
|
|
|
Service Code
|
CPT 90736
|
| Hospital Charge Code |
63600063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$171.06 |
| Max. Negotiated Rate |
$244.37 |
| Rate for Payer: Aetna Commercial |
$230.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.49
|
| Rate for Payer: Cash Price |
$217.22
|
| Rate for Payer: Cofinity Commercial |
$190.06
|
| Rate for Payer: Cofinity Commercial |
$233.51
|
| Rate for Payer: Healthscope Commercial |
$244.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$230.79
|
| Rate for Payer: PHP Commercial |
$230.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.06
|
| Rate for Payer: Priority Health SBD |
$171.06
|
|
|
HC SHRIMP IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200061
|
|
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 |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| 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 SHRIMP IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200061
|
|
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 SICKLE CELL CMS F/U
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51500011
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$125.26 |
| Rate for Payer: Aetna Commercial |
$106.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.25
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS Trust/PPO |
$125.26
|
| Rate for Payer: BCCCP Commercial |
$72.85
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$87.50
|
| Rate for Payer: Cofinity Commercial |
$107.50
|
| Rate for Payer: Healthscope Commercial |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.25
|
| Rate for Payer: PHP Commercial |
$106.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
| Rate for Payer: Priority Health SBD |
$78.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.60
|
| Rate for Payer: UHC Exchange |
$64.18
|
|
|
HC SICKLE CELL CMS F/U
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51500011
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$106.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.25
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$107.50
|
| Rate for Payer: Cofinity Commercial |
$87.50
|
| Rate for Payer: Healthscope Commercial |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.25
|
| Rate for Payer: PHP Commercial |
$106.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
| Rate for Payer: Priority Health SBD |
$78.75
|
|
|
HC SICKLE CELL CMS INITIAL COMP
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500009
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$283.50 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.50
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Cofinity Commercial |
$315.00
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: Priority Health SBD |
$283.50
|
|
|
HC SICKLE CELL CMS INITIAL COMP
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500009
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$140.47 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.50
|
| Rate for Payer: BCBS Complete |
$180.00
|
| Rate for Payer: BCBS Trust/PPO |
$218.48
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$315.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: Priority Health SBD |
$283.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.52
|
| Rate for Payer: UHC Exchange |
$140.47
|
|
|
HC SICKLE CELL CMS SUPP/SERV
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51500012
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$63.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.75
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: BCBS Trust/PPO |
$51.75
|
| Rate for Payer: BCCCP Commercial |
$22.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$52.50
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Healthscope Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
| Rate for Payer: PHP Commercial |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: Priority Health SBD |
$47.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.36
|
| Rate for Payer: UHC Exchange |
$8.51
|
|
|
HC SICKLE CELL CMS SUPP/SERV
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51500012
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$47.25 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$63.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.75
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$52.50
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Healthscope Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
| Rate for Payer: PHP Commercial |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: Priority Health SBD |
$47.25
|
|
|
HC SICKLE CELLS CMS COMP
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500010
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.00
|
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: BCBS Trust/PPO |
$218.48
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$210.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: Priority Health SBD |
$189.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.52
|
| Rate for Payer: UHC Exchange |
$140.47
|
|
|
HC SICKLE CELLS CMS COMP
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500010
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$210.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: Priority Health SBD |
$189.00
|
|
|
HC SICKLE CELL TEST
|
Facility
|
OP
|
$30.70
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
30500061
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$27.63 |
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Medicare |
$5.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.89
|
| Rate for Payer: BCBS Complete |
$3.16
|
| Rate for Payer: BCBS MAPPO |
$5.51
|
| Rate for Payer: BCBS Trust/PPO |
$4.31
|
| Rate for Payer: BCN Medicare Advantage |
$5.51
|
| Rate for Payer: Cash Price |
$24.56
|
| Rate for Payer: Cash Price |
$24.56
|
| Rate for Payer: Cofinity Commercial |
$21.49
|
| Rate for Payer: Cofinity Commercial |
$26.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.51
|
| Rate for Payer: Healthscope Commercial |
$27.63
|
| Rate for Payer: Mclaren Medicaid |
$3.01
|
| Rate for Payer: Mclaren Medicare |
$5.51
|
| Rate for Payer: Meridian Medicaid |
$3.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.10
|
| Rate for Payer: PACE Medicare |
$5.23
|
| Rate for Payer: PACE SWMI |
$5.51
|
| Rate for Payer: PHP Commercial |
$26.10
|
| Rate for Payer: PHP Medicare Advantage |
$5.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.49
|
| Rate for Payer: Priority Health Medicare |
$5.51
|
| Rate for Payer: Priority Health SBD |
$19.34
|
| Rate for Payer: Railroad Medicare Medicare |
$5.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.61
|
| Rate for Payer: UHC Core |
$9.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.51
|
| Rate for Payer: UHC Exchange |
$5.51
|
| Rate for Payer: UHC Medicare Advantage |
$5.68
|
| Rate for Payer: VA VA |
$5.51
|
|
|
HC SICKLE CELL TEST
|
Facility
|
IP
|
$30.70
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
30500061
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.34 |
| Max. Negotiated Rate |
$27.63 |
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.96
|
| Rate for Payer: Cash Price |
$24.56
|
| Rate for Payer: Cofinity Commercial |
$21.49
|
| Rate for Payer: Cofinity Commercial |
$26.40
|
| Rate for Payer: Healthscope Commercial |
$27.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.10
|
| Rate for Payer: PHP Commercial |
$26.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.49
|
| Rate for Payer: Priority Health SBD |
$19.34
|
|
|
HC SIGMOIDOSCOPY FLX DX W/COLL SPEC BR/WA
|
Facility
|
OP
|
$1,139.69
|
|
|
Service Code
|
CPT 45330
|
| Hospital Charge Code |
76100186
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.34 |
| 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 |
$519.48
|
| 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) |
$60.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$813.23
|
| Rate for Payer: UHC Exchange |
$55.34
|
| Rate for Payer: UHC Medicare Advantage |
$837.63
|
| Rate for Payer: VA VA |
$813.23
|
|
|
HC SIGMOIDOSCOPY FLX DX W/COLL SPEC BR/WA
|
Facility
|
IP
|
$1,139.69
|
|
|
Service Code
|
CPT 45330
|
| Hospital Charge Code |
76100186
|
|
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 SIGMOIDOSCOPY W EUS EXAM
|
Facility
|
OP
|
$2,569.73
|
|
| Hospital Charge Code |
36000082
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,027.89 |
| Max. Negotiated Rate |
$2,312.76 |
| Rate for Payer: Aetna Commercial |
$2,184.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,670.32
|
| Rate for Payer: BCBS Complete |
$1,027.89
|
| Rate for Payer: Cash Price |
$2,055.78
|
| Rate for Payer: Cofinity Commercial |
$1,798.81
|
| Rate for Payer: Cofinity Commercial |
$2,209.97
|
| Rate for Payer: Healthscope Commercial |
$2,312.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,184.27
|
| Rate for Payer: PHP Commercial |
$2,184.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,798.81
|
| Rate for Payer: Priority Health SBD |
$1,618.93
|
|
|
HC SIGMOIDOSCOPY W EUS EXAM
|
Facility
|
IP
|
$2,569.73
|
|
| Hospital Charge Code |
36000082
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,618.93 |
| Max. Negotiated Rate |
$2,312.76 |
| Rate for Payer: Aetna Commercial |
$2,184.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,670.32
|
| Rate for Payer: Cash Price |
$2,055.78
|
| Rate for Payer: Cofinity Commercial |
$1,798.81
|
| Rate for Payer: Cofinity Commercial |
$2,209.97
|
| Rate for Payer: Healthscope Commercial |
$2,312.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,184.27
|
| Rate for Payer: PHP Commercial |
$2,184.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,798.81
|
| Rate for Payer: Priority Health SBD |
$1,618.93
|
|
|
HC SIGMOIDOSCOPY WITH BIOPSY
|
Facility
|
IP
|
$1,240.03
|
|
|
Service Code
|
CPT 45331
|
| Hospital Charge Code |
36000111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$781.22 |
| Max. Negotiated Rate |
$1,116.03 |
| Rate for Payer: Aetna Commercial |
$1,054.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$806.02
|
| Rate for Payer: Cash Price |
$992.02
|
| Rate for Payer: Cofinity Commercial |
$1,066.43
|
| Rate for Payer: Cofinity Commercial |
$868.02
|
| Rate for Payer: Healthscope Commercial |
$1,116.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,054.03
|
| Rate for Payer: PHP Commercial |
$1,054.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$868.02
|
| Rate for Payer: Priority Health SBD |
$781.22
|
|
