|
HC MAXIMUM VOLUNTARY VENTILATION
|
Facility
|
IP
|
$122.63
|
|
|
Service Code
|
CPT 94200
|
| Hospital Charge Code |
46000022
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$77.26 |
| Max. Negotiated Rate |
$110.37 |
| Rate for Payer: Aetna Commercial |
$104.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.71
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cofinity Commercial |
$105.46
|
| Rate for Payer: Cofinity Commercial |
$85.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.10
|
| Rate for Payer: Healthscope Commercial |
$110.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.24
|
| Rate for Payer: PHP Commercial |
$104.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.71
|
| Rate for Payer: Priority Health SBD |
$77.26
|
|
|
HC MAYO CHROMOGENIC FACTOR 8
|
Facility
|
OP
|
$338.23
|
|
|
Service Code
|
CPT 85130
|
| Hospital Charge Code |
30500105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$304.41 |
| Rate for Payer: Aetna Commercial |
$287.50
|
| Rate for Payer: Aetna Medicare |
$12.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.86
|
| Rate for Payer: BCBS Complete |
$6.69
|
| Rate for Payer: BCBS MAPPO |
$11.89
|
| Rate for Payer: BCBS Trust/PPO |
$10.53
|
| Rate for Payer: BCN Commercial |
$10.53
|
| Rate for Payer: BCN Medicare Advantage |
$11.89
|
| Rate for Payer: Cash Price |
$270.58
|
| Rate for Payer: Cash Price |
$270.58
|
| Rate for Payer: Cofinity Commercial |
$290.88
|
| Rate for Payer: Cofinity Commercial |
$236.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$236.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.89
|
| Rate for Payer: Healthscope Commercial |
$304.41
|
| Rate for Payer: Mclaren Medicaid |
$6.37
|
| Rate for Payer: Mclaren Medicare |
$11.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.48
|
| Rate for Payer: Meridian Medicaid |
$6.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.50
|
| Rate for Payer: Nomi Health Commercial |
$17.84
|
| Rate for Payer: PACE Medicare |
$11.30
|
| Rate for Payer: PACE SWMI |
$11.89
|
| Rate for Payer: PHP Commercial |
$287.50
|
| Rate for Payer: PHP Medicare Advantage |
$11.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.89
|
| Rate for Payer: Priority Health Medicare |
$11.89
|
| Rate for Payer: Priority Health Narrow Network |
$9.51
|
| Rate for Payer: Priority Health SBD |
$213.08
|
| Rate for Payer: Railroad Medicare Medicare |
$11.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.89
|
| Rate for Payer: UHC Medicare Advantage |
$11.89
|
| Rate for Payer: UHCCP Medicaid |
$6.69
|
| Rate for Payer: VA VA |
$11.89
|
|
|
HC MAYO CHROMOGENIC FACTOR 8
|
Facility
|
IP
|
$338.23
|
|
|
Service Code
|
CPT 85130
|
| Hospital Charge Code |
30500105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$213.08 |
| Max. Negotiated Rate |
$304.41 |
| Rate for Payer: Aetna Commercial |
$287.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.85
|
| Rate for Payer: Cash Price |
$270.58
|
| Rate for Payer: Cofinity Commercial |
$236.76
|
| Rate for Payer: Cofinity Commercial |
$290.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$236.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.58
|
| Rate for Payer: Healthscope Commercial |
$304.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.50
|
| Rate for Payer: PHP Commercial |
$287.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.85
|
| Rate for Payer: Priority Health SBD |
$213.08
|
|
|
HC MAYO CHROMOGENIC FACTOR 9
|
Facility
|
OP
|
$358.56
|
|
|
Service Code
|
CPT 85130
|
| Hospital Charge Code |
30500104
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$322.70 |
| Rate for Payer: Aetna Commercial |
$304.78
|
| Rate for Payer: Aetna Medicare |
$12.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.86
|
| Rate for Payer: BCBS Complete |
$6.69
|
| Rate for Payer: BCBS MAPPO |
$11.89
|
| Rate for Payer: BCBS Trust/PPO |
$10.53
|
| Rate for Payer: BCN Commercial |
$10.53
|
| Rate for Payer: BCN Medicare Advantage |
$11.89
|
| Rate for Payer: Cash Price |
$286.85
|
| Rate for Payer: Cash Price |
$286.85
|
| Rate for Payer: Cofinity Commercial |
$308.36
|
| Rate for Payer: Cofinity Commercial |
$250.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$250.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.89
|
| Rate for Payer: Healthscope Commercial |
$322.70
|
| Rate for Payer: Mclaren Medicaid |
$6.37
|
| Rate for Payer: Mclaren Medicare |
$11.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.48
|
| Rate for Payer: Meridian Medicaid |
$6.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.78
|
| Rate for Payer: Nomi Health Commercial |
$17.84
|
| Rate for Payer: PACE Medicare |
$11.30
|
| Rate for Payer: PACE SWMI |
$11.89
|
| Rate for Payer: PHP Commercial |
$304.78
|
| Rate for Payer: PHP Medicare Advantage |
$11.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.89
|
| Rate for Payer: Priority Health Medicare |
$11.89
|
| Rate for Payer: Priority Health Narrow Network |
$9.51
|
| Rate for Payer: Priority Health SBD |
$225.89
|
| Rate for Payer: Railroad Medicare Medicare |
$11.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.89
|
| Rate for Payer: UHC Medicare Advantage |
$11.89
|
| Rate for Payer: UHCCP Medicaid |
$6.69
|
| Rate for Payer: VA VA |
$11.89
|
|
|
HC MAYO CHROMOGENIC FACTOR 9
|
Facility
|
IP
|
$358.56
|
|
|
Service Code
|
CPT 85130
|
| Hospital Charge Code |
30500104
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$225.89 |
| Max. Negotiated Rate |
$322.70 |
| Rate for Payer: Aetna Commercial |
$304.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.06
|
| Rate for Payer: Cash Price |
$286.85
|
| Rate for Payer: Cofinity Commercial |
$250.99
|
| Rate for Payer: Cofinity Commercial |
$308.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$250.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.85
|
| Rate for Payer: Healthscope Commercial |
$322.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.78
|
| Rate for Payer: PHP Commercial |
$304.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.06
|
| Rate for Payer: Priority Health SBD |
$225.89
|
|
|
HC MAYOCOMPLETE MYELOID NEOPLASMS, NGS
|
Facility
|
IP
|
$1,963.50
|
|
|
Service Code
|
CPT 81450
|
| Hospital Charge Code |
31000084
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,237.00 |
| Max. Negotiated Rate |
$1,767.15 |
| Rate for Payer: Aetna Commercial |
$1,668.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,276.28
|
| Rate for Payer: Cash Price |
$1,570.80
|
| Rate for Payer: Cofinity Commercial |
$1,374.45
|
| Rate for Payer: Cofinity Commercial |
$1,688.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,374.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,570.80
|
| Rate for Payer: Healthscope Commercial |
$1,767.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,668.98
|
| Rate for Payer: PHP Commercial |
$1,668.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,276.28
|
| Rate for Payer: Priority Health SBD |
$1,237.00
|
|
|
HC MAYOCOMPLETE MYELOID NEOPLASMS, NGS
|
Facility
|
OP
|
$1,963.50
|
|
|
Service Code
|
CPT 81450
|
| Hospital Charge Code |
31000084
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$2,278.59 |
| Rate for Payer: Aetna Commercial |
$1,668.98
|
| Rate for Payer: Aetna Medicare |
$789.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,276.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$949.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$949.41
|
| Rate for Payer: BCBS Complete |
$427.46
|
| Rate for Payer: BCBS MAPPO |
$759.53
|
| Rate for Payer: BCBS Trust/PPO |
$896.47
|
| Rate for Payer: BCN Commercial |
$896.47
|
| Rate for Payer: BCN Medicare Advantage |
$759.53
|
| Rate for Payer: Cash Price |
$1,570.80
|
| Rate for Payer: Cash Price |
$1,570.80
|
| Rate for Payer: Cofinity Commercial |
$1,688.61
|
| Rate for Payer: Cofinity Commercial |
$1,374.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,374.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,570.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$759.53
|
| Rate for Payer: Healthscope Commercial |
$1,767.15
|
| Rate for Payer: Mclaren Medicaid |
$407.11
|
| Rate for Payer: Mclaren Medicare |
$759.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$797.51
|
| Rate for Payer: Meridian Medicaid |
$427.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$873.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,668.98
|
| Rate for Payer: Nomi Health Commercial |
$2,278.59
|
| Rate for Payer: PACE Medicare |
$721.55
|
| Rate for Payer: PACE SWMI |
$759.53
|
| Rate for Payer: PHP Commercial |
$1,668.98
|
| Rate for Payer: PHP Medicare Advantage |
$759.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$407.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,276.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$759.53
|
| Rate for Payer: Priority Health Medicare |
$759.53
|
| Rate for Payer: Priority Health Narrow Network |
$607.62
|
| Rate for Payer: Priority Health SBD |
$1,237.00
|
| Rate for Payer: Railroad Medicare Medicare |
$759.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$911.44
|
| Rate for Payer: UHC Core |
$56.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$759.53
|
| Rate for Payer: UHC Exchange |
$56.40
|
| Rate for Payer: UHC Medicare Advantage |
$759.53
|
| Rate for Payer: UHCCP Medicaid |
$427.62
|
| Rate for Payer: VA VA |
$759.53
|
|
|
HC MAYO CREATININE, URINE CMPT
|
Facility
|
OP
|
$10.78
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
30100734
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$109.48 |
| Rate for Payer: Aetna Commercial |
$9.16
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.48
|
| Rate for Payer: BCBS Complete |
$2.92
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCBS Trust/PPO |
$4.59
|
| Rate for Payer: BCN Commercial |
$4.59
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$8.62
|
| Rate for Payer: Cash Price |
$8.62
|
| Rate for Payer: Cofinity Commercial |
$9.27
|
| Rate for Payer: Cofinity Commercial |
$7.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$9.70
|
| Rate for Payer: Mclaren Medicaid |
$2.78
|
| Rate for Payer: Mclaren Medicare |
$5.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: Meridian Medicaid |
$2.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.16
|
| Rate for Payer: Nomi Health Commercial |
$7.77
|
| Rate for Payer: PACE Medicare |
$4.92
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$9.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.18
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: Priority Health Narrow Network |
$4.14
|
| Rate for Payer: Priority Health SBD |
$6.79
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.22
|
| Rate for Payer: UHC Core |
$109.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.18
|
| Rate for Payer: UHC Exchange |
$109.48
|
| Rate for Payer: UHC Medicare Advantage |
$5.18
|
| Rate for Payer: UHCCP Medicaid |
$2.92
|
| Rate for Payer: VA VA |
$5.18
|
|
|
HC MAYO CREATININE, URINE CMPT
|
Facility
|
IP
|
$10.78
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
30100734
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$9.70 |
| Rate for Payer: Aetna Commercial |
$9.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.01
|
| Rate for Payer: Cash Price |
$8.62
|
| Rate for Payer: Cofinity Commercial |
$7.55
|
| Rate for Payer: Cofinity Commercial |
$9.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.62
|
| Rate for Payer: Healthscope Commercial |
$9.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.16
|
| Rate for Payer: PHP Commercial |
$9.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.01
|
| Rate for Payer: Priority Health SBD |
$6.79
|
|
|
HC MDI TREATMENT
|
Facility
|
OP
|
$149.67
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
41000004
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$626.34 |
| Rate for Payer: Aetna Commercial |
$127.22
|
| Rate for Payer: Aetna Medicare |
$207.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.10
|
| Rate for Payer: BCBS Complete |
$112.15
|
| Rate for Payer: BCBS MAPPO |
$199.28
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: BCN Commercial |
$33.96
|
| Rate for Payer: BCN Medicare Advantage |
$199.28
|
| Rate for Payer: Cash Price |
$119.74
|
| Rate for Payer: Cash Price |
$119.74
|
| Rate for Payer: Cofinity Commercial |
$128.72
|
| Rate for Payer: Cofinity Commercial |
$104.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.28
|
| Rate for Payer: Healthscope Commercial |
$134.70
|
| Rate for Payer: Mclaren Medicaid |
$106.81
|
| Rate for Payer: Mclaren Medicare |
$199.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.24
|
| Rate for Payer: Meridian Medicaid |
$112.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.22
|
| Rate for Payer: Nomi Health Commercial |
$597.84
|
| Rate for Payer: PACE Medicare |
$189.32
|
| Rate for Payer: PACE SWMI |
$199.28
|
| Rate for Payer: PHP Commercial |
$127.22
|
| Rate for Payer: PHP Medicare Advantage |
$199.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$626.34
|
| Rate for Payer: Priority Health Medicare |
$199.28
|
| Rate for Payer: Priority Health Narrow Network |
$501.07
|
| Rate for Payer: Priority Health SBD |
$94.29
|
| Rate for Payer: Railroad Medicare Medicare |
$199.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$199.28
|
| Rate for Payer: UHC Exchange |
$110.76
|
| Rate for Payer: UHC Medicare Advantage |
$199.28
|
| Rate for Payer: UHCCP Medicaid |
$112.19
|
| Rate for Payer: VA VA |
$199.28
|
|
|
HC MDI TREATMENT
|
Facility
|
IP
|
$149.67
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
41000004
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$94.29 |
| Max. Negotiated Rate |
$134.70 |
| Rate for Payer: Aetna Commercial |
$127.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.29
|
| Rate for Payer: Cash Price |
$119.74
|
| Rate for Payer: Cofinity Commercial |
$104.77
|
| Rate for Payer: Cofinity Commercial |
$128.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.74
|
| Rate for Payer: Healthscope Commercial |
$134.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.22
|
| Rate for Payer: PHP Commercial |
$127.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.29
|
| Rate for Payer: Priority Health SBD |
$94.29
|
|
|
HC MEADOW FESCUE IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200092
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| 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 |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.63
|
| Rate for Payer: BCN Commercial |
$4.63
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| 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 |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.37
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$4.30
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC MEADOW FESCUE IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200092
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
|
|
HC MEASLES PCR THROAT
|
Facility
|
IP
|
$491.10
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600347
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$309.39 |
| Max. Negotiated Rate |
$441.99 |
| Rate for Payer: Aetna Commercial |
$417.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.22
|
| Rate for Payer: Cash Price |
$392.88
|
| Rate for Payer: Cofinity Commercial |
$343.77
|
| Rate for Payer: Cofinity Commercial |
$422.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$343.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.88
|
| Rate for Payer: Healthscope Commercial |
$441.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$417.44
|
| Rate for Payer: PHP Commercial |
$417.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.22
|
| Rate for Payer: Priority Health SBD |
$309.39
|
|
|
HC MEASLES PCR THROAT
|
Facility
|
OP
|
$491.10
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600347
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$441.99 |
| Rate for Payer: Aetna Commercial |
$417.44
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$31.07
|
| Rate for Payer: BCN Commercial |
$31.07
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$392.88
|
| Rate for Payer: Cash Price |
$392.88
|
| Rate for Payer: Cofinity Commercial |
$343.77
|
| Rate for Payer: Cofinity Commercial |
$422.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$343.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$441.99
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$417.44
|
| Rate for Payer: Nomi Health Commercial |
$52.64
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$417.44
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.22
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$309.39
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$19.76
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC MEASLES (RUBEOLA) IGM
|
Facility
|
OP
|
$50.98
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
30200398
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$45.88 |
| Rate for Payer: Aetna Commercial |
$43.33
|
| Rate for Payer: Aetna Medicare |
$13.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.14
|
| 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 |
$7.25
|
| Rate for Payer: BCBS MAPPO |
$12.88
|
| Rate for Payer: BCBS Trust/PPO |
$11.40
|
| Rate for Payer: BCN Commercial |
$11.40
|
| Rate for Payer: BCN Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$43.84
|
| Rate for Payer: Cofinity Commercial |
$35.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.88
|
| Rate for Payer: Healthscope Commercial |
$45.88
|
| Rate for Payer: Mclaren Medicaid |
$6.90
|
| 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 |
$7.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.33
|
| Rate for Payer: Nomi Health Commercial |
$19.32
|
| Rate for Payer: PACE Medicare |
$12.24
|
| Rate for Payer: PACE SWMI |
$12.88
|
| Rate for Payer: PHP Commercial |
$43.33
|
| Rate for Payer: PHP Medicare Advantage |
$12.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.25
|
| Rate for Payer: Priority Health Medicare |
$12.88
|
| Rate for Payer: Priority Health Narrow Network |
$10.60
|
| Rate for Payer: Priority Health SBD |
$32.12
|
| Rate for Payer: Railroad Medicare Medicare |
$12.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.88
|
| Rate for Payer: UHC Medicare Advantage |
$12.88
|
| Rate for Payer: UHCCP Medicaid |
$7.25
|
| Rate for Payer: VA VA |
$12.88
|
|
|
HC MEASLES (RUBEOLA) IGM
|
Facility
|
IP
|
$50.98
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
30200398
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.12 |
| Max. Negotiated Rate |
$45.88 |
| Rate for Payer: Aetna Commercial |
$43.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.14
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$35.69
|
| Rate for Payer: Cofinity Commercial |
$43.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.78
|
| Rate for Payer: Healthscope Commercial |
$45.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.33
|
| Rate for Payer: PHP Commercial |
$43.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.14
|
| Rate for Payer: Priority Health SBD |
$32.12
|
|
|
HC MECHANICAL REMOVAL OBSTRC CVD
|
Facility
|
OP
|
$1,568.04
|
|
|
Service Code
|
CPT 36596
|
| Hospital Charge Code |
36100143
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$47.08 |
| Max. Negotiated Rate |
$4,783.71 |
| Rate for Payer: Aetna Commercial |
$1,332.83
|
| Rate for Payer: Aetna Medicare |
$1,582.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,019.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,902.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,902.54
|
| Rate for Payer: BCBS Complete |
$856.60
|
| Rate for Payer: BCBS MAPPO |
$1,522.03
|
| Rate for Payer: BCBS Trust/PPO |
$466.80
|
| Rate for Payer: BCN Commercial |
$466.80
|
| Rate for Payer: BCN Medicare Advantage |
$1,522.03
|
| Rate for Payer: Cash Price |
$1,254.43
|
| Rate for Payer: Cash Price |
$1,254.43
|
| Rate for Payer: Cash Price |
$1,254.43
|
| Rate for Payer: Cofinity Commercial |
$1,097.63
|
| Rate for Payer: Cofinity Commercial |
$1,348.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,097.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,254.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,522.03
|
| Rate for Payer: Healthscope Commercial |
$1,411.24
|
| Rate for Payer: Mclaren Medicaid |
$815.81
|
| Rate for Payer: Mclaren Medicare |
$1,522.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,598.13
|
| Rate for Payer: Meridian Medicaid |
$856.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,750.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,332.83
|
| Rate for Payer: Nomi Health Commercial |
$3,196.26
|
| Rate for Payer: PACE Medicare |
$1,445.93
|
| Rate for Payer: PACE SWMI |
$1,522.03
|
| Rate for Payer: PHP Commercial |
$1,332.83
|
| Rate for Payer: PHP Medicare Advantage |
$1,522.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$815.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,019.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,783.71
|
| Rate for Payer: Priority Health Medicare |
$1,522.03
|
| Rate for Payer: Priority Health Narrow Network |
$3,826.97
|
| Rate for Payer: Priority Health SBD |
$987.87
|
| Rate for Payer: Railroad Medicare Medicare |
$1,522.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.08
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,522.03
|
| Rate for Payer: UHC Exchange |
$1,566.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,522.03
|
| Rate for Payer: UHCCP Medicaid |
$856.90
|
| Rate for Payer: VA VA |
$1,522.03
|
|
|
HC MECHANICAL REMOVAL OBSTRC CVD
|
Facility
|
IP
|
$1,568.04
|
|
|
Service Code
|
CPT 36596
|
| Hospital Charge Code |
36100143
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$987.87 |
| Max. Negotiated Rate |
$1,411.24 |
| Rate for Payer: Aetna Commercial |
$1,332.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,019.23
|
| Rate for Payer: Cash Price |
$1,254.43
|
| Rate for Payer: Cofinity Commercial |
$1,097.63
|
| Rate for Payer: Cofinity Commercial |
$1,348.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,097.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,254.43
|
| Rate for Payer: Healthscope Commercial |
$1,411.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,332.83
|
| Rate for Payer: PHP Commercial |
$1,332.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,019.23
|
| Rate for Payer: Priority Health SBD |
$987.87
|
|
|
HC MECHANICAL REMOVAL OF PERICATHETER OBSTRUCTION
|
Facility
|
OP
|
$2,962.57
|
|
|
Service Code
|
CPT 36595
|
| Hospital Charge Code |
36100142
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$189.06 |
| Max. Negotiated Rate |
$9,692.51 |
| Rate for Payer: Aetna Commercial |
$2,518.18
|
| Rate for Payer: Aetna Medicare |
$3,207.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,925.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$344.75
|
| Rate for Payer: BCN Commercial |
$344.75
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Cash Price |
$2,370.06
|
| Rate for Payer: Cash Price |
$2,370.06
|
| Rate for Payer: Cash Price |
$2,370.06
|
| Rate for Payer: Cofinity Commercial |
$2,073.80
|
| Rate for Payer: Cofinity Commercial |
$2,547.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,073.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,370.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Healthscope Commercial |
$2,666.31
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,518.18
|
| Rate for Payer: Nomi Health Commercial |
$6,476.11
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Commercial |
$2,518.18
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,925.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,692.51
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$7,754.01
|
| Rate for Payer: Priority Health SBD |
$1,866.42
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.06
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$5,811.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,736.21
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
HC MECHANICAL REMOVAL OF PERICATHETER OBSTRUCTION
|
Facility
|
IP
|
$2,962.57
|
|
|
Service Code
|
CPT 36595
|
| Hospital Charge Code |
36100142
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,866.42 |
| Max. Negotiated Rate |
$2,666.31 |
| Rate for Payer: Aetna Commercial |
$2,518.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,925.67
|
| Rate for Payer: Cash Price |
$2,370.06
|
| Rate for Payer: Cofinity Commercial |
$2,073.80
|
| Rate for Payer: Cofinity Commercial |
$2,547.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,073.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,370.06
|
| Rate for Payer: Healthscope Commercial |
$2,666.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,518.18
|
| Rate for Payer: PHP Commercial |
$2,518.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,925.67
|
| Rate for Payer: Priority Health SBD |
$1,866.42
|
|
|
HC MECH CHEST WALL OSCILLATION
|
Facility
|
IP
|
$320.61
|
|
|
Service Code
|
CPT 94669
|
| Hospital Charge Code |
41000043
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$201.98 |
| Max. Negotiated Rate |
$288.55 |
| Rate for Payer: Aetna Commercial |
$272.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.40
|
| Rate for Payer: Cash Price |
$256.49
|
| Rate for Payer: Cofinity Commercial |
$224.43
|
| Rate for Payer: Cofinity Commercial |
$275.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$224.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.49
|
| Rate for Payer: Healthscope Commercial |
$288.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.52
|
| Rate for Payer: PHP Commercial |
$272.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.40
|
| Rate for Payer: Priority Health SBD |
$201.98
|
|
|
HC MECH CHEST WALL OSCILLATION
|
Facility
|
OP
|
$320.61
|
|
|
Service Code
|
CPT 94669
|
| Hospital Charge Code |
41000043
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$20.54 |
| Max. Negotiated Rate |
$626.34 |
| Rate for Payer: Aetna Commercial |
$272.52
|
| Rate for Payer: Aetna Medicare |
$207.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.10
|
| Rate for Payer: BCBS Complete |
$112.15
|
| Rate for Payer: BCBS MAPPO |
$199.28
|
| Rate for Payer: BCBS Trust/PPO |
$86.88
|
| Rate for Payer: BCN Commercial |
$86.88
|
| Rate for Payer: BCN Medicare Advantage |
$199.28
|
| Rate for Payer: Cash Price |
$256.49
|
| Rate for Payer: Cash Price |
$256.49
|
| Rate for Payer: Cofinity Commercial |
$275.72
|
| Rate for Payer: Cofinity Commercial |
$224.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$224.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.28
|
| Rate for Payer: Healthscope Commercial |
$288.55
|
| Rate for Payer: Mclaren Medicaid |
$106.81
|
| Rate for Payer: Mclaren Medicare |
$199.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.24
|
| Rate for Payer: Meridian Medicaid |
$112.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.52
|
| Rate for Payer: Nomi Health Commercial |
$597.84
|
| Rate for Payer: PACE Medicare |
$189.32
|
| Rate for Payer: PACE SWMI |
$199.28
|
| Rate for Payer: PHP Commercial |
$272.52
|
| Rate for Payer: PHP Medicare Advantage |
$199.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$626.34
|
| Rate for Payer: Priority Health Medicare |
$199.28
|
| Rate for Payer: Priority Health Narrow Network |
$501.07
|
| Rate for Payer: Priority Health SBD |
$201.98
|
| Rate for Payer: Railroad Medicare Medicare |
$199.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$199.28
|
| Rate for Payer: UHC Exchange |
$237.25
|
| Rate for Payer: UHC Medicare Advantage |
$199.28
|
| Rate for Payer: UHCCP Medicaid |
$112.19
|
| Rate for Payer: VA VA |
$199.28
|
|
|
HC MECH VENT INITIAL DAY
|
Facility
|
IP
|
$1,506.76
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000002
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$949.26 |
| Max. Negotiated Rate |
$1,356.08 |
| Rate for Payer: Aetna Commercial |
$1,280.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$979.39
|
| Rate for Payer: Cash Price |
$1,205.41
|
| Rate for Payer: Cofinity Commercial |
$1,054.73
|
| Rate for Payer: Cofinity Commercial |
$1,295.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,054.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,205.41
|
| Rate for Payer: Healthscope Commercial |
$1,356.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,280.75
|
| Rate for Payer: PHP Commercial |
$1,280.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$979.39
|
| Rate for Payer: Priority Health SBD |
$949.26
|
|
|
HC MECH VENT INITIAL DAY
|
Facility
|
OP
|
$1,506.76
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000002
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$81.21 |
| Max. Negotiated Rate |
$2,035.81 |
| Rate for Payer: Aetna Commercial |
$1,280.75
|
| Rate for Payer: Aetna Medicare |
$673.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$979.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$809.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$809.66
|
| Rate for Payer: BCBS Complete |
$364.54
|
| Rate for Payer: BCBS MAPPO |
$647.73
|
| Rate for Payer: BCBS Trust/PPO |
$81.21
|
| Rate for Payer: BCN Commercial |
$81.21
|
| Rate for Payer: BCN Medicare Advantage |
$647.73
|
| Rate for Payer: Cash Price |
$1,205.41
|
| Rate for Payer: Cash Price |
$1,205.41
|
| Rate for Payer: Cofinity Commercial |
$1,295.81
|
| Rate for Payer: Cofinity Commercial |
$1,054.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,054.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,205.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$647.73
|
| Rate for Payer: Healthscope Commercial |
$1,356.08
|
| Rate for Payer: Mclaren Medicaid |
$347.18
|
| Rate for Payer: Mclaren Medicare |
$647.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$680.12
|
| Rate for Payer: Meridian Medicaid |
$364.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$744.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,280.75
|
| Rate for Payer: Nomi Health Commercial |
$1,943.19
|
| Rate for Payer: PACE Medicare |
$615.34
|
| Rate for Payer: PACE SWMI |
$647.73
|
| Rate for Payer: PHP Commercial |
$1,280.75
|
| Rate for Payer: PHP Medicare Advantage |
$647.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$347.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$979.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,035.81
|
| Rate for Payer: Priority Health Medicare |
$647.73
|
| Rate for Payer: Priority Health Narrow Network |
$1,628.65
|
| Rate for Payer: Priority Health SBD |
$949.26
|
| Rate for Payer: Railroad Medicare Medicare |
$647.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$647.73
|
| Rate for Payer: UHC Exchange |
$1,115.00
|
| Rate for Payer: UHC Medicare Advantage |
$647.73
|
| Rate for Payer: UHCCP Medicaid |
$364.67
|
| Rate for Payer: VA VA |
$647.73
|
|
