|
HC MICU OBSERVATION PER HOUR
|
Facility
|
OP
|
$204.96
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200005
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$81.98 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: Aetna Commercial |
$174.22
|
| Rate for Payer: Aetna Medicare |
$102.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.22
|
| Rate for Payer: BCBS Complete |
$81.98
|
| Rate for Payer: BCBS Trust/PPO |
$112.58
|
| Rate for Payer: BCN Commercial |
$112.58
|
| Rate for Payer: Cash Price |
$163.97
|
| Rate for Payer: Cash Price |
$163.97
|
| Rate for Payer: Cash Price |
$163.97
|
| Rate for Payer: Cash Price |
$163.97
|
| Rate for Payer: Cofinity Advantage |
$143.47
|
| Rate for Payer: Cofinity Commercial |
$176.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.97
|
| Rate for Payer: Healthscope Commercial |
$184.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.72
|
| Rate for Payer: PHP Commercial |
$174.22
|
| Rate for Payer: Priority Health SBD |
$129.12
|
| Rate for Payer: UHC Medicaid |
$1,608.00
|
| Rate for Payer: UHCCP Medicaid |
$810.00
|
|
|
HC MILK IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200047
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
|
|
HC MILK IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200047
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC MINI BAL PROCEDURE
|
Facility
|
OP
|
$315.45
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
41000014
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$67.05 |
| Max. Negotiated Rate |
$434.91 |
| Rate for Payer: Aetna Commercial |
$268.13
|
| Rate for Payer: Aetna Medicare |
$133.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$160.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$160.26
|
| Rate for Payer: BCBS Complete |
$70.41
|
| Rate for Payer: BCBS MAPPO |
$128.21
|
| Rate for Payer: BCBS Trust/PPO |
$434.91
|
| Rate for Payer: BCN Commercial |
$434.91
|
| Rate for Payer: BCN Medicare Advantage |
$128.21
|
| Rate for Payer: Cash Price |
$252.36
|
| Rate for Payer: Cash Price |
$252.36
|
| Rate for Payer: Cofinity Advantage |
$220.81
|
| Rate for Payer: Cofinity Commercial |
$271.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.21
|
| Rate for Payer: Healthscope Commercial |
$283.90
|
| Rate for Payer: Mclaren Medicaid |
$67.05
|
| Rate for Payer: Mclaren Medicare |
$128.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.62
|
| Rate for Payer: Meridian Medicaid |
$134.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$147.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$141.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.13
|
| Rate for Payer: Nomi Health Commercial |
$384.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.59
|
| Rate for Payer: PACE Medicare |
$121.80
|
| Rate for Payer: PACE SWMI |
$128.21
|
| Rate for Payer: PHP Commercial |
$268.13
|
| Rate for Payer: PHP Medicare Advantage |
$128.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$414.63
|
| Rate for Payer: Priority Health Medicare |
$128.21
|
| Rate for Payer: Priority Health SBD |
$198.73
|
| Rate for Payer: Priority Health Tiered Network |
$331.70
|
| Rate for Payer: Railroad Medicare Medicare |
$128.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$205.04
|
| Rate for Payer: UHC Core |
$164.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$128.21
|
| Rate for Payer: UHC Exchange |
$123.97
|
| Rate for Payer: UHC Medicaid |
$67.05
|
| Rate for Payer: UHCCP Medicaid |
$67.05
|
| Rate for Payer: VA VA |
$128.21
|
|
|
HC MINI BAL PROCEDURE
|
Facility
|
IP
|
$315.45
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
41000014
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$198.73 |
| Max. Negotiated Rate |
$283.90 |
| Rate for Payer: Cash Price |
$252.36
|
| Rate for Payer: Aetna Commercial |
$268.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.04
|
| Rate for Payer: Cofinity Advantage |
$220.81
|
| Rate for Payer: Cofinity Commercial |
$271.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.36
|
| Rate for Payer: Healthscope Commercial |
$283.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.59
|
| Rate for Payer: PHP Commercial |
$268.13
|
| Rate for Payer: Priority Health SBD |
$198.73
|
|
|
HC MINIMUM BACTERICIDAL CONCENTRA
|
Facility
|
OP
|
$31.21
|
|
|
Service Code
|
CPT 87188
|
| Hospital Charge Code |
30600103
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: Aetna Medicare |
$6.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.30
|
| Rate for Payer: BCBS Complete |
$3.65
|
| Rate for Payer: BCBS MAPPO |
$6.64
|
| Rate for Payer: BCBS Trust/PPO |
$7.08
|
| Rate for Payer: BCN Commercial |
$7.08
|
| Rate for Payer: BCN Medicare Advantage |
$6.64
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Advantage |
$21.85
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.64
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Mclaren Medicaid |
$3.47
|
| Rate for Payer: Mclaren Medicare |
$6.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.97
|
| Rate for Payer: Meridian Medicaid |
$6.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$9.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.41
|
| Rate for Payer: PACE Medicare |
$6.31
|
| Rate for Payer: PACE SWMI |
$6.64
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: PHP Medicare Advantage |
$6.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6.64
|
| Rate for Payer: Priority Health Medicare |
$6.64
|
| Rate for Payer: Priority Health SBD |
$19.66
|
| Rate for Payer: Priority Health Tiered Network |
$5.31
|
| Rate for Payer: Railroad Medicare Medicare |
$6.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.96
|
| Rate for Payer: UHC Core |
$9.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.64
|
| Rate for Payer: UHC Exchange |
$9.96
|
| Rate for Payer: UHC Medicaid |
$3.47
|
| Rate for Payer: UHCCP Medicaid |
$3.47
|
| Rate for Payer: VA VA |
$6.64
|
|
|
HC MINIMUM BACTERICIDAL CONCENTRA
|
Facility
|
IP
|
$31.21
|
|
|
Service Code
|
CPT 87188
|
| Hospital Charge Code |
30600103
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.66 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.29
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Advantage |
$21.85
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.41
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: Priority Health SBD |
$19.66
|
|
|
HC MINIMUM LETHAL CONCENTRATION (MLC)
|
Facility
|
OP
|
$47.76
|
|
|
Service Code
|
CPT 87187
|
| Hospital Charge Code |
30600102
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.01 |
| Max. Negotiated Rate |
$60.26 |
| Rate for Payer: Aetna Commercial |
$40.60
|
| Rate for Payer: Aetna Medicare |
$41.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.21
|
| Rate for Payer: BCBS Complete |
$22.06
|
| Rate for Payer: BCBS MAPPO |
$40.17
|
| Rate for Payer: BCBS Trust/PPO |
$42.83
|
| Rate for Payer: BCN Commercial |
$42.83
|
| Rate for Payer: BCN Medicare Advantage |
$40.17
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cofinity Advantage |
$33.43
|
| Rate for Payer: Cofinity Commercial |
$41.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.17
|
| Rate for Payer: Healthscope Commercial |
$42.98
|
| Rate for Payer: Mclaren Medicaid |
$21.01
|
| Rate for Payer: Mclaren Medicare |
$40.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.18
|
| Rate for Payer: Meridian Medicaid |
$42.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$44.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.60
|
| Rate for Payer: Nomi Health Commercial |
$60.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.82
|
| Rate for Payer: PACE Medicare |
$38.16
|
| Rate for Payer: PACE SWMI |
$40.17
|
| Rate for Payer: PHP Commercial |
$40.60
|
| Rate for Payer: PHP Medicare Advantage |
$40.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$40.17
|
| Rate for Payer: Priority Health Medicare |
$40.17
|
| Rate for Payer: Priority Health SBD |
$30.09
|
| Rate for Payer: Priority Health Tiered Network |
$32.14
|
| Rate for Payer: Railroad Medicare Medicare |
$40.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.26
|
| Rate for Payer: UHC Core |
$60.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$40.17
|
| Rate for Payer: UHC Exchange |
$60.26
|
| Rate for Payer: UHC Medicaid |
$21.01
|
| Rate for Payer: UHCCP Medicaid |
$21.01
|
| Rate for Payer: VA VA |
$40.17
|
|
|
HC MINIMUM LETHAL CONCENTRATION (MLC)
|
Facility
|
IP
|
$47.76
|
|
|
Service Code
|
CPT 87187
|
| Hospital Charge Code |
30600102
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$30.09 |
| Max. Negotiated Rate |
$42.98 |
| Rate for Payer: Aetna Commercial |
$40.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.04
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cofinity Advantage |
$33.43
|
| Rate for Payer: Cofinity Commercial |
$41.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.21
|
| Rate for Payer: Healthscope Commercial |
$42.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.82
|
| Rate for Payer: PHP Commercial |
$40.60
|
| Rate for Payer: Priority Health SBD |
$30.09
|
|
|
HC MINOR PROCEDURE WO SEDATION
|
Facility
|
OP
|
$542.17
|
|
| Hospital Charge Code |
36000076
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$216.87 |
| Max. Negotiated Rate |
$487.95 |
| Rate for Payer: Aetna Commercial |
$460.84
|
| Rate for Payer: Aetna Medicare |
$271.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.41
|
| Rate for Payer: BCBS Complete |
$216.87
|
| Rate for Payer: Cash Price |
$433.74
|
| Rate for Payer: Cofinity Advantage |
$379.52
|
| Rate for Payer: Cofinity Commercial |
$466.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.74
|
| Rate for Payer: Healthscope Commercial |
$487.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$433.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$460.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$406.63
|
| Rate for Payer: PHP Commercial |
$460.84
|
| Rate for Payer: Priority Health SBD |
$341.57
|
|
|
HC MINOR PROCEDURE WO SEDATION
|
Facility
|
IP
|
$542.17
|
|
| Hospital Charge Code |
36000076
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$341.57 |
| Max. Negotiated Rate |
$487.95 |
| Rate for Payer: Aetna Commercial |
$460.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.41
|
| Rate for Payer: Cash Price |
$433.74
|
| Rate for Payer: Cofinity Advantage |
$379.52
|
| Rate for Payer: Cofinity Commercial |
$466.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.74
|
| Rate for Payer: Healthscope Commercial |
$487.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$460.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$406.63
|
| Rate for Payer: PHP Commercial |
$460.84
|
| Rate for Payer: Priority Health SBD |
$341.57
|
|
|
HC MINOR PROCEDURE W SEDATION
|
Facility
|
OP
|
$628.24
|
|
| Hospital Charge Code |
36000075
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$251.30 |
| Max. Negotiated Rate |
$565.42 |
| Rate for Payer: Aetna Commercial |
$534.00
|
| Rate for Payer: Aetna Medicare |
$314.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$408.36
|
| Rate for Payer: BCBS Complete |
$251.30
|
| Rate for Payer: Cash Price |
$502.59
|
| Rate for Payer: Cofinity Advantage |
$439.77
|
| Rate for Payer: Cofinity Commercial |
$540.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$502.59
|
| Rate for Payer: Healthscope Commercial |
$565.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$502.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$534.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$471.18
|
| Rate for Payer: PHP Commercial |
$534.00
|
| Rate for Payer: Priority Health SBD |
$395.79
|
|
|
HC MINOR PROCEDURE W SEDATION
|
Facility
|
IP
|
$628.24
|
|
| Hospital Charge Code |
36000075
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$395.79 |
| Max. Negotiated Rate |
$565.42 |
| Rate for Payer: Aetna Commercial |
$534.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$408.36
|
| Rate for Payer: Cash Price |
$502.59
|
| Rate for Payer: Cofinity Advantage |
$439.77
|
| Rate for Payer: Cofinity Commercial |
$540.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$502.59
|
| Rate for Payer: Healthscope Commercial |
$565.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$534.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$471.18
|
| Rate for Payer: PHP Commercial |
$534.00
|
| Rate for Payer: Priority Health SBD |
$395.79
|
|
|
HC MITOTANE (LYSODREN)
|
Facility
|
OP
|
$119.87
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100731
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$107.88 |
| Rate for Payer: Aetna Commercial |
$101.89
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: BCBS Complete |
$10.24
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$19.87
|
| Rate for Payer: BCN Commercial |
$19.87
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$95.90
|
| Rate for Payer: Cash Price |
$95.90
|
| Rate for Payer: Cofinity Advantage |
$83.91
|
| Rate for Payer: Cofinity Commercial |
$103.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$107.88
|
| Rate for Payer: Mclaren Medicaid |
$9.75
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$19.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.89
|
| Rate for Payer: Nomi Health Commercial |
$27.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.90
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$101.89
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.75
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health SBD |
$75.52
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.96
|
| Rate for Payer: UHC Core |
$27.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.64
|
| Rate for Payer: UHC Exchange |
$27.96
|
| Rate for Payer: UHC Medicaid |
$9.75
|
| Rate for Payer: UHCCP Medicaid |
$9.75
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC MITOTANE (LYSODREN)
|
Facility
|
IP
|
$119.87
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100731
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$75.52 |
| Max. Negotiated Rate |
$107.88 |
| Rate for Payer: Aetna Commercial |
$101.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.92
|
| Rate for Payer: Cash Price |
$95.90
|
| Rate for Payer: Cofinity Advantage |
$83.91
|
| Rate for Payer: Cofinity Commercial |
$103.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.90
|
| Rate for Payer: Healthscope Commercial |
$107.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.90
|
| Rate for Payer: PHP Commercial |
$101.89
|
| Rate for Payer: Priority Health SBD |
$75.52
|
|
|
HC MMR VACCINE
|
Facility
|
OP
|
$111.42
|
|
|
Service Code
|
CPT 90707
|
| Hospital Charge Code |
63600027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.57 |
| Max. Negotiated Rate |
$234.42 |
| Rate for Payer: Aetna Commercial |
$94.71
|
| Rate for Payer: Aetna Medicare |
$55.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.42
|
| Rate for Payer: BCBS Complete |
$44.57
|
| Rate for Payer: BCBS Trust/PPO |
$234.42
|
| Rate for Payer: BCN Commercial |
$234.42
|
| Rate for Payer: Cash Price |
$89.14
|
| Rate for Payer: Cash Price |
$89.14
|
| Rate for Payer: Cofinity Advantage |
$77.99
|
| Rate for Payer: Cofinity Commercial |
$95.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.14
|
| Rate for Payer: Healthscope Commercial |
$100.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.56
|
| Rate for Payer: PHP Commercial |
$94.71
|
| Rate for Payer: Priority Health SBD |
$70.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.28
|
| Rate for Payer: UHC Core |
$193.28
|
| Rate for Payer: UHC Exchange |
$193.28
|
|
|
HC MMR VACCINE
|
Facility
|
IP
|
$111.42
|
|
|
Service Code
|
CPT 90707
|
| Hospital Charge Code |
63600027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.19 |
| Max. Negotiated Rate |
$100.28 |
| Rate for Payer: Aetna Commercial |
$94.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.42
|
| Rate for Payer: Cash Price |
$89.14
|
| Rate for Payer: Cofinity Advantage |
$77.99
|
| Rate for Payer: Cofinity Commercial |
$95.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.14
|
| Rate for Payer: Healthscope Commercial |
$100.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.56
|
| Rate for Payer: PHP Commercial |
$94.71
|
| Rate for Payer: Priority Health SBD |
$70.19
|
|
|
HC MNT GROUP 2ND REFERRAL 30 MIN
|
Facility
|
IP
|
$52.63
|
|
|
Service Code
|
HCPCS G0271
|
| Hospital Charge Code |
94200009
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$33.16 |
| Max. Negotiated Rate |
$47.37 |
| Rate for Payer: Aetna Commercial |
$44.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.21
|
| Rate for Payer: Cash Price |
$42.10
|
| Rate for Payer: Cofinity Advantage |
$36.84
|
| Rate for Payer: Cofinity Commercial |
$45.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.10
|
| Rate for Payer: Healthscope Commercial |
$47.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.47
|
| Rate for Payer: PHP Commercial |
$44.74
|
| Rate for Payer: Priority Health SBD |
$33.16
|
|
|
HC MNT GROUP 2ND REFERRAL 30 MIN
|
Facility
|
OP
|
$52.63
|
|
|
Service Code
|
HCPCS G0271
|
| Hospital Charge Code |
94200009
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$47.37 |
| Rate for Payer: Aetna Commercial |
$44.74
|
| Rate for Payer: Aetna Medicare |
$26.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.21
|
| Rate for Payer: BCBS Complete |
$21.05
|
| Rate for Payer: BCBS Trust/PPO |
$37.03
|
| Rate for Payer: BCN Commercial |
$37.03
|
| Rate for Payer: Cash Price |
$42.10
|
| Rate for Payer: Cash Price |
$42.10
|
| Rate for Payer: Cofinity Advantage |
$36.84
|
| Rate for Payer: Cofinity Commercial |
$45.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.10
|
| Rate for Payer: Healthscope Commercial |
$47.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.47
|
| Rate for Payer: PHP Commercial |
$44.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6.45
|
| Rate for Payer: Priority Health SBD |
$33.16
|
| Rate for Payer: Priority Health Tiered Network |
$5.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.21
|
| Rate for Payer: UHC Core |
$27.42
|
| Rate for Payer: UHC Exchange |
$20.68
|
|
|
HC MNT GROUP 30 MIN
|
Facility
|
OP
|
$61.74
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
94200004
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$55.57 |
| Rate for Payer: Aetna Commercial |
$52.48
|
| Rate for Payer: Aetna Medicare |
$30.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.13
|
| Rate for Payer: BCBS Complete |
$24.70
|
| Rate for Payer: BCBS Trust/PPO |
$37.03
|
| Rate for Payer: BCN Commercial |
$37.03
|
| Rate for Payer: Cash Price |
$49.39
|
| Rate for Payer: Cash Price |
$49.39
|
| Rate for Payer: Cofinity Advantage |
$43.22
|
| Rate for Payer: Cofinity Commercial |
$53.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.39
|
| Rate for Payer: Healthscope Commercial |
$55.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.30
|
| Rate for Payer: PHP Commercial |
$52.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15.00
|
| Rate for Payer: Priority Health SBD |
$38.90
|
| Rate for Payer: Priority Health Tiered Network |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.13
|
| Rate for Payer: UHC Core |
$32.17
|
| Rate for Payer: UHC Exchange |
$24.26
|
|
|
HC MNT GROUP 30 MIN
|
Facility
|
IP
|
$61.74
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
94200004
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$38.90 |
| Max. Negotiated Rate |
$55.57 |
| Rate for Payer: Aetna Commercial |
$52.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.13
|
| Rate for Payer: Cash Price |
$49.39
|
| Rate for Payer: Cofinity Advantage |
$43.22
|
| Rate for Payer: Cofinity Commercial |
$53.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.39
|
| Rate for Payer: Healthscope Commercial |
$55.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.30
|
| Rate for Payer: PHP Commercial |
$52.48
|
| Rate for Payer: Priority Health SBD |
$38.90
|
|
|
HC MNT INITIAL 15 MIN
|
Facility
|
OP
|
$141.43
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
94200002
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$127.29 |
| Rate for Payer: Aetna Commercial |
$120.22
|
| Rate for Payer: Aetna Medicare |
$70.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.93
|
| Rate for Payer: BCBS Complete |
$56.57
|
| Rate for Payer: BCBS Trust/PPO |
$82.92
|
| Rate for Payer: BCN Commercial |
$82.92
|
| Rate for Payer: Cash Price |
$113.14
|
| Rate for Payer: Cash Price |
$113.14
|
| Rate for Payer: Cofinity Advantage |
$99.00
|
| Rate for Payer: Cofinity Commercial |
$121.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.14
|
| Rate for Payer: Healthscope Commercial |
$127.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$113.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$106.07
|
| Rate for Payer: PHP Commercial |
$120.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$34.00
|
| Rate for Payer: Priority Health SBD |
$89.10
|
| Rate for Payer: Priority Health Tiered Network |
$27.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.93
|
| Rate for Payer: UHC Core |
$73.69
|
| Rate for Payer: UHC Exchange |
$55.58
|
|
|
HC MNT INITIAL 15 MIN
|
Facility
|
IP
|
$141.43
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
94200002
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$89.10 |
| Max. Negotiated Rate |
$127.29 |
| Rate for Payer: Aetna Commercial |
$120.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.93
|
| Rate for Payer: Cash Price |
$113.14
|
| Rate for Payer: Cofinity Advantage |
$99.00
|
| Rate for Payer: Cofinity Commercial |
$121.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.14
|
| Rate for Payer: Healthscope Commercial |
$127.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$106.07
|
| Rate for Payer: PHP Commercial |
$120.22
|
| Rate for Payer: Priority Health SBD |
$89.10
|
|
|
HC MNT REASSESS & INTERVENT 15 MIN
|
Facility
|
IP
|
$125.01
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
94200003
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$78.76 |
| Max. Negotiated Rate |
$112.51 |
| Rate for Payer: Aetna Commercial |
$106.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.26
|
| Rate for Payer: Cash Price |
$100.01
|
| Rate for Payer: Cofinity Advantage |
$87.51
|
| Rate for Payer: Cofinity Commercial |
$107.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.01
|
| Rate for Payer: Healthscope Commercial |
$112.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.76
|
| Rate for Payer: PHP Commercial |
$106.26
|
| Rate for Payer: Priority Health SBD |
$78.76
|
|
|
HC MNT REASSESS & INTERVENT 15 MIN
|
Facility
|
OP
|
$125.01
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
94200003
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$112.51 |
| Rate for Payer: Aetna Commercial |
$106.26
|
| Rate for Payer: Aetna Medicare |
$62.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.26
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS Trust/PPO |
$74.02
|
| Rate for Payer: BCN Commercial |
$74.02
|
| Rate for Payer: Cash Price |
$100.01
|
| Rate for Payer: Cash Price |
$100.01
|
| Rate for Payer: Cofinity Advantage |
$87.51
|
| Rate for Payer: Cofinity Commercial |
$107.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.01
|
| Rate for Payer: Healthscope Commercial |
$112.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.76
|
| Rate for Payer: PHP Commercial |
$106.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$29.00
|
| Rate for Payer: Priority Health SBD |
$78.76
|
| Rate for Payer: Priority Health Tiered Network |
$23.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.26
|
| Rate for Payer: UHC Core |
$65.13
|
| Rate for Payer: UHC Exchange |
$49.13
|
|
