|
HC MEDTRONIC ICD DUAL
|
Facility
|
OP
|
$26,848.56
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27800019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,551.48 |
| Max. Negotiated Rate |
$24,163.70 |
| Rate for Payer: Aetna Commercial |
$22,821.28
|
| Rate for Payer: Aetna Medicare |
$13,424.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,451.56
|
| Rate for Payer: BCBS Complete |
$10,739.42
|
| Rate for Payer: Cash Price |
$21,478.85
|
| Rate for Payer: Cofinity Advantage |
$18,793.99
|
| Rate for Payer: Cofinity Commercial |
$23,089.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,478.85
|
| Rate for Payer: Healthscope Commercial |
$24,163.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,478.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,821.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20,136.42
|
| Rate for Payer: PHP Commercial |
$22,821.28
|
| Rate for Payer: Priority Health SBD |
$16,914.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,451.56
|
| Rate for Payer: UHC Core |
$13,988.10
|
| Rate for Payer: UHC Exchange |
$10,551.48
|
|
|
HC MEDTRONIC ICD DUAL
|
Facility
|
IP
|
$26,848.56
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27800019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16,914.59 |
| Max. Negotiated Rate |
$24,163.70 |
| Rate for Payer: Aetna Commercial |
$22,821.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,451.56
|
| Rate for Payer: Cash Price |
$21,478.85
|
| Rate for Payer: Cofinity Advantage |
$18,793.99
|
| Rate for Payer: Cofinity Commercial |
$23,089.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,478.85
|
| Rate for Payer: Healthscope Commercial |
$24,163.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,821.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20,136.42
|
| Rate for Payer: PHP Commercial |
$22,821.28
|
| Rate for Payer: Priority Health SBD |
$16,914.59
|
|
|
HC MEDTRONIC ICD SINGLE
|
Facility
|
IP
|
$24,301.66
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15,310.05 |
| Max. Negotiated Rate |
$21,871.49 |
| Rate for Payer: Aetna Commercial |
$20,656.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,796.08
|
| Rate for Payer: Cash Price |
$19,441.33
|
| Rate for Payer: Cofinity Advantage |
$17,011.16
|
| Rate for Payer: Cofinity Commercial |
$20,899.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,441.33
|
| Rate for Payer: Healthscope Commercial |
$21,871.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,656.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18,226.24
|
| Rate for Payer: PHP Commercial |
$20,656.41
|
| Rate for Payer: Priority Health SBD |
$15,310.05
|
|
|
HC MEDTRONIC ICD SINGLE
|
Facility
|
OP
|
$24,301.66
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,550.55 |
| Max. Negotiated Rate |
$21,871.49 |
| Rate for Payer: Aetna Commercial |
$20,656.41
|
| Rate for Payer: Aetna Medicare |
$12,150.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,796.08
|
| Rate for Payer: BCBS Complete |
$9,720.66
|
| Rate for Payer: Cash Price |
$19,441.33
|
| Rate for Payer: Cofinity Advantage |
$17,011.16
|
| Rate for Payer: Cofinity Commercial |
$20,899.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,441.33
|
| Rate for Payer: Healthscope Commercial |
$21,871.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,441.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,656.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18,226.24
|
| Rate for Payer: PHP Commercial |
$20,656.41
|
| Rate for Payer: Priority Health SBD |
$15,310.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,796.08
|
| Rate for Payer: UHC Core |
$12,661.16
|
| Rate for Payer: UHC Exchange |
$9,550.55
|
|
|
HC MEDTRONIC SINGLE PACEMAKER
|
Facility
|
IP
|
$13,480.45
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500008
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,492.68 |
| Max. Negotiated Rate |
$12,132.41 |
| Rate for Payer: Aetna Commercial |
$11,458.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,762.29
|
| Rate for Payer: Cash Price |
$10,784.36
|
| Rate for Payer: Cofinity Advantage |
$9,436.32
|
| Rate for Payer: Cofinity Commercial |
$11,593.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,784.36
|
| Rate for Payer: Healthscope Commercial |
$12,132.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,458.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,110.34
|
| Rate for Payer: PHP Commercial |
$11,458.38
|
| Rate for Payer: Priority Health SBD |
$8,492.68
|
|
|
HC MEDTRONIC SINGLE PACEMAKER
|
Facility
|
OP
|
$13,480.45
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500008
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,297.82 |
| Max. Negotiated Rate |
$12,132.41 |
| Rate for Payer: Aetna Commercial |
$11,458.38
|
| Rate for Payer: Aetna Medicare |
$6,740.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,762.29
|
| Rate for Payer: BCBS Complete |
$5,392.18
|
| Rate for Payer: Cash Price |
$10,784.36
|
| Rate for Payer: Cofinity Advantage |
$9,436.32
|
| Rate for Payer: Cofinity Commercial |
$11,593.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,784.36
|
| Rate for Payer: Healthscope Commercial |
$12,132.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,784.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,458.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,110.34
|
| Rate for Payer: PHP Commercial |
$11,458.38
|
| Rate for Payer: Priority Health SBD |
$8,492.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,762.29
|
| Rate for Payer: UHC Core |
$7,023.31
|
| Rate for Payer: UHC Exchange |
$5,297.82
|
|
|
HC MEDTRONIC TACHY (ICD) LEAD
|
Facility
|
OP
|
$15,909.43
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27800021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,252.41 |
| Max. Negotiated Rate |
$14,318.49 |
| Rate for Payer: Aetna Commercial |
$13,523.02
|
| Rate for Payer: Aetna Medicare |
$7,954.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,341.13
|
| Rate for Payer: BCBS Complete |
$6,363.77
|
| Rate for Payer: Cash Price |
$12,727.54
|
| Rate for Payer: Cofinity Advantage |
$11,136.60
|
| Rate for Payer: Cofinity Commercial |
$13,682.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,727.54
|
| Rate for Payer: Healthscope Commercial |
$14,318.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,727.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,523.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,932.07
|
| Rate for Payer: PHP Commercial |
$13,523.02
|
| Rate for Payer: Priority Health SBD |
$10,022.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,341.13
|
| Rate for Payer: UHC Core |
$8,288.81
|
| Rate for Payer: UHC Exchange |
$6,252.41
|
|
|
HC MEDTRONIC TACHY (ICD) LEAD
|
Facility
|
IP
|
$15,909.43
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27800021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,022.94 |
| Max. Negotiated Rate |
$14,318.49 |
| Rate for Payer: Aetna Commercial |
$13,523.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,341.13
|
| Rate for Payer: Cash Price |
$12,727.54
|
| Rate for Payer: Cofinity Advantage |
$11,136.60
|
| Rate for Payer: Cofinity Commercial |
$13,682.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,727.54
|
| Rate for Payer: Healthscope Commercial |
$14,318.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,523.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,932.07
|
| Rate for Payer: PHP Commercial |
$13,523.02
|
| Rate for Payer: Priority Health SBD |
$10,022.94
|
|
|
HC MENACWY-TT VACCINE IM
|
Facility
|
IP
|
$191.02
|
|
|
Service Code
|
CPT 90619
|
| Hospital Charge Code |
63600210
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$120.34 |
| Max. Negotiated Rate |
$171.92 |
| Rate for Payer: Aetna Commercial |
$162.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.16
|
| Rate for Payer: Cash Price |
$152.82
|
| Rate for Payer: Cofinity Advantage |
$133.71
|
| Rate for Payer: Cofinity Commercial |
$164.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.82
|
| Rate for Payer: Healthscope Commercial |
$171.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.26
|
| Rate for Payer: PHP Commercial |
$162.37
|
| Rate for Payer: Priority Health SBD |
$120.34
|
|
|
HC MENACWY-TT VACCINE IM
|
Facility
|
OP
|
$191.02
|
|
|
Service Code
|
CPT 90619
|
| Hospital Charge Code |
63600210
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.41 |
| Max. Negotiated Rate |
$436.12 |
| Rate for Payer: Aetna Commercial |
$162.37
|
| Rate for Payer: Aetna Medicare |
$95.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.16
|
| Rate for Payer: BCBS Complete |
$76.41
|
| Rate for Payer: BCBS Trust/PPO |
$436.12
|
| Rate for Payer: BCN Commercial |
$436.12
|
| Rate for Payer: Cash Price |
$152.82
|
| Rate for Payer: Cash Price |
$152.82
|
| Rate for Payer: Cofinity Advantage |
$133.71
|
| Rate for Payer: Cofinity Commercial |
$164.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.82
|
| Rate for Payer: Healthscope Commercial |
$171.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.26
|
| Rate for Payer: PHP Commercial |
$162.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$201.76
|
| Rate for Payer: Priority Health SBD |
$120.34
|
| Rate for Payer: Priority Health Tiered Network |
$161.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$350.43
|
| Rate for Payer: UHC Core |
$350.43
|
| Rate for Payer: UHC Exchange |
$350.43
|
|
|
HC MENB-FHBP VACC 2/3 DOSE IM
|
Facility
|
OP
|
$537.45
|
|
|
Service Code
|
CPT 90621
|
| Hospital Charge Code |
63600187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$188.96 |
| Max. Negotiated Rate |
$556.28 |
| Rate for Payer: Aetna Commercial |
$456.83
|
| Rate for Payer: Aetna Medicare |
$268.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$349.34
|
| Rate for Payer: BCBS Complete |
$214.98
|
| Rate for Payer: BCBS Trust/PPO |
$556.28
|
| Rate for Payer: BCN Commercial |
$556.28
|
| Rate for Payer: Cash Price |
$429.96
|
| Rate for Payer: Cash Price |
$429.96
|
| Rate for Payer: Cofinity Advantage |
$376.21
|
| Rate for Payer: Cofinity Commercial |
$462.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$429.96
|
| Rate for Payer: Healthscope Commercial |
$483.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$429.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$456.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$403.09
|
| Rate for Payer: PHP Commercial |
$456.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$236.20
|
| Rate for Payer: Priority Health SBD |
$338.59
|
| Rate for Payer: Priority Health Tiered Network |
$188.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$447.05
|
| Rate for Payer: UHC Core |
$447.05
|
| Rate for Payer: UHC Exchange |
$447.05
|
|
|
HC MENB-FHBP VACC 2/3 DOSE IM
|
Facility
|
IP
|
$537.45
|
|
|
Service Code
|
CPT 90621
|
| Hospital Charge Code |
63600187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$338.59 |
| Max. Negotiated Rate |
$483.70 |
| Rate for Payer: Aetna Commercial |
$456.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$349.34
|
| Rate for Payer: Cash Price |
$429.96
|
| Rate for Payer: Cofinity Advantage |
$376.21
|
| Rate for Payer: Cofinity Commercial |
$462.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$429.96
|
| Rate for Payer: Healthscope Commercial |
$483.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$456.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$403.09
|
| Rate for Payer: PHP Commercial |
$456.83
|
| Rate for Payer: Priority Health SBD |
$338.59
|
|
|
HC MENB RECOMB PROT W/OUT MEMBR VESIC VACC IM
|
Facility
|
OP
|
$268.42
|
|
|
Service Code
|
CPT 90620
|
| Hospital Charge Code |
63600122
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$107.37 |
| Max. Negotiated Rate |
$583.91 |
| Rate for Payer: Aetna Commercial |
$228.16
|
| Rate for Payer: Aetna Medicare |
$134.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.47
|
| Rate for Payer: BCBS Complete |
$107.37
|
| Rate for Payer: BCBS Trust/PPO |
$583.91
|
| Rate for Payer: BCN Commercial |
$583.91
|
| Rate for Payer: Cash Price |
$214.74
|
| Rate for Payer: Cash Price |
$214.74
|
| Rate for Payer: Cofinity Advantage |
$187.89
|
| Rate for Payer: Cofinity Commercial |
$230.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.74
|
| Rate for Payer: Healthscope Commercial |
$241.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$214.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$201.31
|
| Rate for Payer: PHP Commercial |
$228.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$270.18
|
| Rate for Payer: Priority Health SBD |
$169.10
|
| Rate for Payer: Priority Health Tiered Network |
$216.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$497.34
|
| Rate for Payer: UHC Core |
$497.34
|
| Rate for Payer: UHC Exchange |
$497.34
|
|
|
HC MENB RECOMB PROT W/OUT MEMBR VESIC VACC IM
|
Facility
|
IP
|
$268.42
|
|
|
Service Code
|
CPT 90620
|
| Hospital Charge Code |
63600122
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$169.10 |
| Max. Negotiated Rate |
$241.58 |
| Rate for Payer: Aetna Commercial |
$228.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.47
|
| Rate for Payer: Cash Price |
$214.74
|
| Rate for Payer: Cofinity Advantage |
$187.89
|
| Rate for Payer: Cofinity Commercial |
$230.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.74
|
| Rate for Payer: Healthscope Commercial |
$241.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$201.31
|
| Rate for Payer: PHP Commercial |
$228.16
|
| Rate for Payer: Priority Health SBD |
$169.10
|
|
|
HC MENENCEPH CMPT 10
|
Facility
|
OP
|
$14.43
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
30200307
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: Aetna Commercial |
$12.27
|
| Rate for Payer: Aetna Medicare |
$13.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.31
|
| Rate for Payer: BCBS Complete |
$7.17
|
| Rate for Payer: BCBS MAPPO |
$13.05
|
| Rate for Payer: BCBS Trust/PPO |
$13.92
|
| Rate for Payer: BCN Commercial |
$13.92
|
| Rate for Payer: BCN Medicare Advantage |
$13.05
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cofinity Advantage |
$10.10
|
| Rate for Payer: Cofinity Commercial |
$12.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.05
|
| Rate for Payer: Healthscope Commercial |
$12.99
|
| Rate for Payer: Mclaren Medicaid |
$6.83
|
| Rate for Payer: Mclaren Medicare |
$13.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.70
|
| Rate for Payer: Meridian Medicaid |
$13.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: Nomi Health Commercial |
$19.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.82
|
| Rate for Payer: PACE Medicare |
$12.40
|
| Rate for Payer: PACE SWMI |
$13.05
|
| Rate for Payer: PHP Commercial |
$12.27
|
| Rate for Payer: PHP Medicare Advantage |
$13.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.05
|
| Rate for Payer: Priority Health Medicare |
$13.05
|
| Rate for Payer: Priority Health SBD |
$9.09
|
| Rate for Payer: Priority Health Tiered Network |
$10.44
|
| Rate for Payer: Railroad Medicare Medicare |
$13.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.58
|
| Rate for Payer: UHC Core |
$19.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.05
|
| Rate for Payer: UHC Exchange |
$19.58
|
| Rate for Payer: UHC Medicaid |
$6.83
|
| Rate for Payer: UHCCP Medicaid |
$6.83
|
| Rate for Payer: VA VA |
$13.05
|
|
|
HC MENENCEPH CMPT 10
|
Facility
|
IP
|
$14.43
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
30200307
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$12.99 |
| Rate for Payer: Aetna Commercial |
$12.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.38
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cofinity Advantage |
$10.10
|
| Rate for Payer: Cofinity Commercial |
$12.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Healthscope Commercial |
$12.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.82
|
| Rate for Payer: PHP Commercial |
$12.27
|
| Rate for Payer: Priority Health SBD |
$9.09
|
|
|
HC MENENCEPH CMPT 11
|
Facility
|
IP
|
$14.43
|
|
|
Service Code
|
CPT 86653
|
| Hospital Charge Code |
30200258
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$12.99 |
| Rate for Payer: Aetna Commercial |
$12.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.38
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cofinity Advantage |
$10.10
|
| Rate for Payer: Cofinity Commercial |
$12.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Healthscope Commercial |
$12.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.82
|
| Rate for Payer: PHP Commercial |
$12.27
|
| Rate for Payer: Priority Health SBD |
$9.09
|
|
|
HC MENENCEPH CMPT 11
|
Facility
|
OP
|
$14.43
|
|
|
Service Code
|
CPT 86653
|
| Hospital Charge Code |
30200258
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$19.79 |
| Rate for Payer: Aetna Commercial |
$12.27
|
| Rate for Payer: Aetna Medicare |
$13.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.49
|
| Rate for Payer: BCBS Complete |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$13.19
|
| Rate for Payer: BCBS Trust/PPO |
$14.06
|
| Rate for Payer: BCN Commercial |
$14.06
|
| Rate for Payer: BCN Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cofinity Advantage |
$10.10
|
| Rate for Payer: Cofinity Commercial |
$12.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.19
|
| Rate for Payer: Healthscope Commercial |
$12.99
|
| Rate for Payer: Mclaren Medicaid |
$6.90
|
| Rate for Payer: Mclaren Medicare |
$13.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.85
|
| Rate for Payer: Meridian Medicaid |
$13.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: Nomi Health Commercial |
$19.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.82
|
| Rate for Payer: PACE Medicare |
$12.53
|
| Rate for Payer: PACE SWMI |
$13.19
|
| Rate for Payer: PHP Commercial |
$12.27
|
| Rate for Payer: PHP Medicare Advantage |
$13.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.19
|
| Rate for Payer: Priority Health Medicare |
$13.19
|
| Rate for Payer: Priority Health SBD |
$9.09
|
| Rate for Payer: Priority Health Tiered Network |
$10.55
|
| Rate for Payer: Railroad Medicare Medicare |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.79
|
| Rate for Payer: UHC Core |
$19.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.19
|
| Rate for Payer: UHC Exchange |
$19.79
|
| Rate for Payer: UHC Medicaid |
$6.90
|
| Rate for Payer: UHCCP Medicaid |
$6.90
|
| Rate for Payer: VA VA |
$13.19
|
|
|
HC MENENCEPH CMPT 12
|
Facility
|
OP
|
$14.43
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
30200328
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$19.32 |
| Rate for Payer: Aetna Commercial |
$12.27
|
| Rate for Payer: Aetna Medicare |
$13.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.10
|
| Rate for Payer: BCBS Complete |
$7.07
|
| Rate for Payer: BCBS MAPPO |
$12.88
|
| Rate for Payer: BCBS Trust/PPO |
$13.73
|
| Rate for Payer: BCN Commercial |
$13.73
|
| Rate for Payer: BCN Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cofinity Advantage |
$10.10
|
| Rate for Payer: Cofinity Commercial |
$12.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.88
|
| Rate for Payer: Healthscope Commercial |
$12.99
|
| Rate for Payer: Mclaren Medicaid |
$6.74
|
| Rate for Payer: Mclaren Medicare |
$12.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.52
|
| Rate for Payer: Meridian Medicaid |
$13.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: Nomi Health Commercial |
$19.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.82
|
| Rate for Payer: PACE Medicare |
$12.24
|
| Rate for Payer: PACE SWMI |
$12.88
|
| Rate for Payer: PHP Commercial |
$12.27
|
| Rate for Payer: PHP Medicare Advantage |
$12.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.88
|
| Rate for Payer: Priority Health Medicare |
$12.88
|
| Rate for Payer: Priority Health SBD |
$9.09
|
| Rate for Payer: Priority Health Tiered Network |
$10.30
|
| Rate for Payer: Railroad Medicare Medicare |
$12.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.32
|
| Rate for Payer: UHC Core |
$19.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.88
|
| Rate for Payer: UHC Exchange |
$19.32
|
| Rate for Payer: UHC Medicaid |
$6.74
|
| Rate for Payer: UHCCP Medicaid |
$6.74
|
| Rate for Payer: VA VA |
$12.88
|
|
|
HC MENENCEPH CMPT 12
|
Facility
|
IP
|
$14.43
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
30200328
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$12.99 |
| Rate for Payer: Aetna Commercial |
$12.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.38
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cofinity Advantage |
$10.10
|
| Rate for Payer: Cofinity Commercial |
$12.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Healthscope Commercial |
$12.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.82
|
| Rate for Payer: PHP Commercial |
$12.27
|
| Rate for Payer: Priority Health SBD |
$9.09
|
|
|
HC MENENCEPH CMPT 13
|
Facility
|
OP
|
$14.43
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
30200259
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$19.79 |
| Rate for Payer: Aetna Commercial |
$12.27
|
| Rate for Payer: Aetna Medicare |
$13.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.49
|
| Rate for Payer: BCBS Complete |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$13.19
|
| Rate for Payer: BCBS Trust/PPO |
$14.06
|
| Rate for Payer: BCN Commercial |
$14.06
|
| Rate for Payer: BCN Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cofinity Advantage |
$10.10
|
| Rate for Payer: Cofinity Commercial |
$12.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.19
|
| Rate for Payer: Healthscope Commercial |
$12.99
|
| Rate for Payer: Mclaren Medicaid |
$6.90
|
| Rate for Payer: Mclaren Medicare |
$13.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.85
|
| Rate for Payer: Meridian Medicaid |
$13.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: Nomi Health Commercial |
$19.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.82
|
| Rate for Payer: PACE Medicare |
$12.53
|
| Rate for Payer: PACE SWMI |
$13.19
|
| Rate for Payer: PHP Commercial |
$12.27
|
| Rate for Payer: PHP Medicare Advantage |
$13.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.19
|
| Rate for Payer: Priority Health Medicare |
$13.19
|
| Rate for Payer: Priority Health SBD |
$9.09
|
| Rate for Payer: Priority Health Tiered Network |
$10.55
|
| Rate for Payer: Railroad Medicare Medicare |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.79
|
| Rate for Payer: UHC Core |
$19.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.19
|
| Rate for Payer: UHC Exchange |
$19.79
|
| Rate for Payer: UHC Medicaid |
$6.90
|
| Rate for Payer: UHCCP Medicaid |
$6.90
|
| Rate for Payer: VA VA |
$13.19
|
|
|
HC MENENCEPH CMPT 13
|
Facility
|
IP
|
$14.43
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
30200259
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$12.99 |
| Rate for Payer: Aetna Commercial |
$12.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.38
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cofinity Advantage |
$10.10
|
| Rate for Payer: Cofinity Commercial |
$12.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Healthscope Commercial |
$12.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.82
|
| Rate for Payer: PHP Commercial |
$12.27
|
| Rate for Payer: Priority Health SBD |
$9.09
|
|
|
HC MENENCEPH CMPT 14
|
Facility
|
IP
|
$14.43
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
30200300
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$12.99 |
| Rate for Payer: Aetna Commercial |
$12.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.38
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cofinity Advantage |
$10.10
|
| Rate for Payer: Cofinity Commercial |
$12.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Healthscope Commercial |
$12.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.82
|
| Rate for Payer: PHP Commercial |
$12.27
|
| Rate for Payer: Priority Health SBD |
$9.09
|
|
|
HC MENENCEPH CMPT 14
|
Facility
|
OP
|
$14.43
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
30200300
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.09 |
| Max. Negotiated Rate |
$20.33 |
| Rate for Payer: Aetna Commercial |
$12.27
|
| Rate for Payer: Aetna Medicare |
$14.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.94
|
| Rate for Payer: BCBS Complete |
$7.44
|
| Rate for Payer: BCBS MAPPO |
$13.55
|
| Rate for Payer: BCBS Trust/PPO |
$14.44
|
| Rate for Payer: BCN Commercial |
$14.44
|
| Rate for Payer: BCN Medicare Advantage |
$13.55
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cofinity Advantage |
$10.10
|
| Rate for Payer: Cofinity Commercial |
$12.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.55
|
| Rate for Payer: Healthscope Commercial |
$12.99
|
| Rate for Payer: Mclaren Medicaid |
$7.09
|
| Rate for Payer: Mclaren Medicare |
$13.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.23
|
| Rate for Payer: Meridian Medicaid |
$14.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: Nomi Health Commercial |
$20.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.82
|
| Rate for Payer: PACE Medicare |
$12.87
|
| Rate for Payer: PACE SWMI |
$13.55
|
| Rate for Payer: PHP Commercial |
$12.27
|
| Rate for Payer: PHP Medicare Advantage |
$13.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.55
|
| Rate for Payer: Priority Health Medicare |
$13.55
|
| Rate for Payer: Priority Health SBD |
$9.09
|
| Rate for Payer: Priority Health Tiered Network |
$10.84
|
| Rate for Payer: Railroad Medicare Medicare |
$13.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.33
|
| Rate for Payer: UHC Core |
$20.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.55
|
| Rate for Payer: UHC Exchange |
$20.33
|
| Rate for Payer: UHC Medicaid |
$7.09
|
| Rate for Payer: UHCCP Medicaid |
$7.09
|
| Rate for Payer: VA VA |
$13.55
|
|
|
HC MENENCEPH CMPT 15
|
Facility
|
OP
|
$14.43
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
30200319
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$19.32 |
| Rate for Payer: Aetna Commercial |
$12.27
|
| Rate for Payer: Aetna Medicare |
$13.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.10
|
| Rate for Payer: BCBS Complete |
$7.07
|
| Rate for Payer: BCBS MAPPO |
$12.88
|
| Rate for Payer: BCBS Trust/PPO |
$13.73
|
| Rate for Payer: BCN Commercial |
$13.73
|
| Rate for Payer: BCN Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cofinity Advantage |
$10.10
|
| Rate for Payer: Cofinity Commercial |
$12.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.88
|
| Rate for Payer: Healthscope Commercial |
$12.99
|
| Rate for Payer: Mclaren Medicaid |
$6.74
|
| Rate for Payer: Mclaren Medicare |
$12.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.52
|
| Rate for Payer: Meridian Medicaid |
$13.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: Nomi Health Commercial |
$19.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.82
|
| Rate for Payer: PACE Medicare |
$12.24
|
| Rate for Payer: PACE SWMI |
$12.88
|
| Rate for Payer: PHP Commercial |
$12.27
|
| Rate for Payer: PHP Medicare Advantage |
$12.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.88
|
| Rate for Payer: Priority Health Medicare |
$12.88
|
| Rate for Payer: Priority Health SBD |
$9.09
|
| Rate for Payer: Priority Health Tiered Network |
$10.30
|
| Rate for Payer: Railroad Medicare Medicare |
$12.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.32
|
| Rate for Payer: UHC Core |
$19.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.88
|
| Rate for Payer: UHC Exchange |
$19.32
|
| Rate for Payer: UHC Medicaid |
$6.74
|
| Rate for Payer: UHCCP Medicaid |
$6.74
|
| Rate for Payer: VA VA |
$12.88
|
|
