|
HC MECH VENT SUBS DAYS
|
Facility
|
OP
|
$1,312.60
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000003
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$62.02 |
| Max. Negotiated Rate |
$2,035.81 |
| Rate for Payer: Aetna Commercial |
$1,115.71
|
| Rate for Payer: Aetna Medicare |
$673.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$853.19
|
| 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 |
$62.02
|
| Rate for Payer: BCN Commercial |
$62.02
|
| Rate for Payer: BCN Medicare Advantage |
$647.73
|
| Rate for Payer: Cash Price |
$1,050.08
|
| Rate for Payer: Cash Price |
$1,050.08
|
| Rate for Payer: Cofinity Commercial |
$918.82
|
| Rate for Payer: Cofinity Commercial |
$1,128.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$918.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,050.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$647.73
|
| Rate for Payer: Healthscope Commercial |
$1,181.34
|
| 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 |
$1,115.71
|
| 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 |
$1,115.71
|
| 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 |
$853.19
|
| 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 |
$826.94
|
| Rate for Payer: Railroad Medicare Medicare |
$647.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$647.73
|
| Rate for Payer: UHC Exchange |
$971.32
|
| Rate for Payer: UHC Medicare Advantage |
$647.73
|
| Rate for Payer: UHCCP Medicaid |
$364.67
|
| Rate for Payer: VA VA |
$647.73
|
|
|
HC MECH VENT SUBS DAYS
|
Facility
|
IP
|
$1,312.60
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000003
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$826.94 |
| Max. Negotiated Rate |
$1,181.34 |
| Rate for Payer: Aetna Commercial |
$1,115.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$853.19
|
| Rate for Payer: Cash Price |
$1,050.08
|
| Rate for Payer: Cofinity Commercial |
$1,128.84
|
| Rate for Payer: Cofinity Commercial |
$918.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$918.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,050.08
|
| Rate for Payer: Healthscope Commercial |
$1,181.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,115.71
|
| Rate for Payer: PHP Commercial |
$1,115.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$853.19
|
| Rate for Payer: Priority Health SBD |
$826.94
|
|
|
HC MECONIUM AMPHETAMINE CONFIRM
|
Facility
|
IP
|
$117.30
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
30000099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.90 |
| Max. Negotiated Rate |
$105.57 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.24
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$100.88
|
| Rate for Payer: Cofinity Commercial |
$82.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Healthscope Commercial |
$105.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.70
|
| Rate for Payer: PHP Commercial |
$99.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.24
|
| Rate for Payer: Priority Health SBD |
$73.90
|
|
|
HC MECONIUM AMPHETAMINE CONFIRM
|
Facility
|
OP
|
$117.30
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
30000099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.92 |
| Max. Negotiated Rate |
$105.57 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: Aetna Medicare |
$58.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.24
|
| Rate for Payer: BCBS Complete |
$46.92
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$100.88
|
| Rate for Payer: Cofinity Commercial |
$82.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Healthscope Commercial |
$105.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.70
|
| Rate for Payer: PHP Commercial |
$99.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.24
|
| Rate for Payer: Priority Health SBD |
$73.90
|
|
|
HC MECONIUM BENZODIAZAPINE CONFIRMATION
|
Facility
|
IP
|
$117.30
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
30000102
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.90 |
| Max. Negotiated Rate |
$105.57 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.24
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$100.88
|
| Rate for Payer: Cofinity Commercial |
$82.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Healthscope Commercial |
$105.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.70
|
| Rate for Payer: PHP Commercial |
$99.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.24
|
| Rate for Payer: Priority Health SBD |
$73.90
|
|
|
HC MECONIUM BENZODIAZAPINE CONFIRMATION
|
Facility
|
OP
|
$117.30
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
30000102
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.37 |
| Max. Negotiated Rate |
$105.57 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: Aetna Medicare |
$58.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.24
|
| Rate for Payer: BCBS Complete |
$46.92
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$100.88
|
| Rate for Payer: Cofinity Commercial |
$82.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Healthscope Commercial |
$105.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.70
|
| Rate for Payer: PHP Commercial |
$99.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.24
|
| Rate for Payer: Priority Health SBD |
$73.90
|
| Rate for Payer: UHC Core |
$22.37
|
| Rate for Payer: UHC Exchange |
$22.37
|
|
|
HC MECONIUM BUPRENORPHINE CONFIRMATION
|
Facility
|
OP
|
$117.30
|
|
|
Service Code
|
CPT 80348
|
| Hospital Charge Code |
30000100
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$105.57 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: Aetna Medicare |
$58.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.24
|
| Rate for Payer: BCBS Complete |
$46.92
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$100.88
|
| Rate for Payer: Cofinity Commercial |
$82.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Healthscope Commercial |
$105.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.70
|
| Rate for Payer: PHP Commercial |
$99.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.24
|
| Rate for Payer: Priority Health SBD |
$73.90
|
| Rate for Payer: UHC Core |
$25.62
|
| Rate for Payer: UHC Exchange |
$25.62
|
|
|
HC MECONIUM BUPRENORPHINE CONFIRMATION
|
Facility
|
IP
|
$117.30
|
|
|
Service Code
|
CPT 80348
|
| Hospital Charge Code |
30000100
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.90 |
| Max. Negotiated Rate |
$105.57 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.24
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$100.88
|
| Rate for Payer: Cofinity Commercial |
$82.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Healthscope Commercial |
$105.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.70
|
| Rate for Payer: PHP Commercial |
$99.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.24
|
| Rate for Payer: Priority Health SBD |
$73.90
|
|
|
HC MECONIUM DRUG SCRN EA
|
Facility
|
OP
|
$94.53
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000144
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$93.21 |
| Rate for Payer: Aetna Commercial |
$80.35
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: BCBS Complete |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$55.01
|
| Rate for Payer: BCN Commercial |
$55.01
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$75.62
|
| Rate for Payer: Cash Price |
$75.62
|
| Rate for Payer: Cofinity Commercial |
$81.30
|
| Rate for Payer: Cofinity Commercial |
$66.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$85.08
|
| Rate for Payer: Mclaren Medicaid |
$33.31
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.35
|
| Rate for Payer: Nomi Health Commercial |
$93.21
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$80.35
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.14
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$49.71
|
| Rate for Payer: Priority Health SBD |
$59.55
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$34.98
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC MECONIUM DRUG SCRN EA
|
Facility
|
IP
|
$94.53
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000144
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.55 |
| Max. Negotiated Rate |
$85.08 |
| Rate for Payer: Aetna Commercial |
$80.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.44
|
| Rate for Payer: Cash Price |
$75.62
|
| Rate for Payer: Cofinity Commercial |
$66.17
|
| Rate for Payer: Cofinity Commercial |
$81.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.62
|
| Rate for Payer: Healthscope Commercial |
$85.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.35
|
| Rate for Payer: PHP Commercial |
$80.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.44
|
| Rate for Payer: Priority Health SBD |
$59.55
|
|
|
HC MECONIUM DRUG SCRN MULTI DRUGS.
|
Facility
|
OP
|
$104.04
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100653
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: BCBS Complete |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$55.01
|
| Rate for Payer: BCN Commercial |
$55.01
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Cofinity Commercial |
$72.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Mclaren Medicaid |
$33.31
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: Nomi Health Commercial |
$93.21
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.14
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$49.71
|
| Rate for Payer: Priority Health SBD |
$65.55
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$34.98
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC MECONIUM DRUG SCRN MULTI DRUGS.
|
Facility
|
IP
|
$104.04
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100653
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$65.55 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.63
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$72.83
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.63
|
| Rate for Payer: Priority Health SBD |
$65.55
|
|
|
HC MECONIUM OPIATES CONFIRMATION
|
Facility
|
OP
|
$117.30
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100577
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.78 |
| Max. Negotiated Rate |
$105.57 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: Aetna Medicare |
$58.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.24
|
| Rate for Payer: BCBS Complete |
$46.92
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$100.88
|
| Rate for Payer: Cofinity Commercial |
$82.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Healthscope Commercial |
$105.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.70
|
| Rate for Payer: PHP Commercial |
$99.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.24
|
| Rate for Payer: Priority Health SBD |
$73.90
|
| Rate for Payer: UHC Core |
$27.78
|
| Rate for Payer: UHC Exchange |
$27.78
|
|
|
HC MECONIUM OPIATES CONFIRMATION
|
Facility
|
IP
|
$117.30
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100577
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.90 |
| Max. Negotiated Rate |
$105.57 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.24
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$100.88
|
| Rate for Payer: Cofinity Commercial |
$82.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Healthscope Commercial |
$105.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.70
|
| Rate for Payer: PHP Commercial |
$99.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.24
|
| Rate for Payer: Priority Health SBD |
$73.90
|
|
|
HC MECONIUM OXYCODONE CONFIRMATION
|
Facility
|
IP
|
$117.30
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30000104
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.90 |
| Max. Negotiated Rate |
$105.57 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.24
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$100.88
|
| Rate for Payer: Cofinity Commercial |
$82.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Healthscope Commercial |
$105.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.70
|
| Rate for Payer: PHP Commercial |
$99.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.24
|
| Rate for Payer: Priority Health SBD |
$73.90
|
|
|
HC MECONIUM OXYCODONE CONFIRMATION
|
Facility
|
OP
|
$117.30
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30000104
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.74 |
| Max. Negotiated Rate |
$105.57 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: Aetna Medicare |
$58.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.24
|
| Rate for Payer: BCBS Complete |
$46.92
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$100.88
|
| Rate for Payer: Cofinity Commercial |
$82.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Healthscope Commercial |
$105.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.70
|
| Rate for Payer: PHP Commercial |
$99.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.24
|
| Rate for Payer: Priority Health SBD |
$73.90
|
| Rate for Payer: UHC Core |
$24.74
|
| Rate for Payer: UHC Exchange |
$24.74
|
|
|
HC MECONIUM THC CONFIRMATION
|
Facility
|
OP
|
$117.30
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
30100567
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.37 |
| Max. Negotiated Rate |
$105.57 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: Aetna Medicare |
$58.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.24
|
| Rate for Payer: BCBS Complete |
$46.92
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$100.88
|
| Rate for Payer: Cofinity Commercial |
$82.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Healthscope Commercial |
$105.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.70
|
| Rate for Payer: PHP Commercial |
$99.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.24
|
| Rate for Payer: Priority Health SBD |
$73.90
|
| Rate for Payer: UHC Core |
$22.37
|
| Rate for Payer: UHC Exchange |
$22.37
|
|
|
HC MECONIUM THC CONFIRMATION
|
Facility
|
IP
|
$117.30
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
30100567
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.90 |
| Max. Negotiated Rate |
$105.57 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.24
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$100.88
|
| Rate for Payer: Cofinity Commercial |
$82.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Healthscope Commercial |
$105.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.70
|
| Rate for Payer: PHP Commercial |
$99.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.24
|
| Rate for Payer: Priority Health SBD |
$73.90
|
|
|
HC MECONIUM TRAMADOL CONFIRMATION
|
Facility
|
IP
|
$117.30
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
30000101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.90 |
| Max. Negotiated Rate |
$105.57 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.24
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$100.88
|
| Rate for Payer: Cofinity Commercial |
$82.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Healthscope Commercial |
$105.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.70
|
| Rate for Payer: PHP Commercial |
$99.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.24
|
| Rate for Payer: Priority Health SBD |
$73.90
|
|
|
HC MECONIUM TRAMADOL CONFIRMATION
|
Facility
|
OP
|
$117.30
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
30000101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.71 |
| Max. Negotiated Rate |
$105.57 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: Aetna Medicare |
$58.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.24
|
| Rate for Payer: BCBS Complete |
$46.92
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$100.88
|
| Rate for Payer: Cofinity Commercial |
$82.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Healthscope Commercial |
$105.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.70
|
| Rate for Payer: PHP Commercial |
$99.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.24
|
| Rate for Payer: Priority Health SBD |
$73.90
|
| Rate for Payer: UHC Core |
$21.71
|
| Rate for Payer: UHC Exchange |
$21.71
|
|
|
HC MEDICAL NUTRITION TX EACH 15"
|
Facility
|
OP
|
$65.14
|
|
|
Service Code
|
HCPCS G0270
|
| Hospital Charge Code |
94200008
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$10.89 |
| Max. Negotiated Rate |
$72.36 |
| Rate for Payer: Aetna Commercial |
$55.37
|
| Rate for Payer: Aetna Medicare |
$32.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.34
|
| Rate for Payer: BCBS Complete |
$26.06
|
| Rate for Payer: BCBS Trust/PPO |
$72.36
|
| Rate for Payer: BCN Commercial |
$72.36
|
| Rate for Payer: Cash Price |
$52.11
|
| Rate for Payer: Cash Price |
$52.11
|
| Rate for Payer: Cofinity Commercial |
$56.02
|
| Rate for Payer: Cofinity Commercial |
$45.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.11
|
| Rate for Payer: Healthscope Commercial |
$58.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.37
|
| Rate for Payer: PHP Commercial |
$55.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.61
|
| Rate for Payer: Priority Health Narrow Network |
$10.89
|
| Rate for Payer: Priority Health SBD |
$41.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.12
|
| Rate for Payer: UHC Exchange |
$48.20
|
|
|
HC MEDICAL NUTRITION TX EACH 15"
|
Facility
|
IP
|
$65.14
|
|
|
Service Code
|
HCPCS G0270
|
| Hospital Charge Code |
94200008
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$41.04 |
| Max. Negotiated Rate |
$58.63 |
| Rate for Payer: Aetna Commercial |
$55.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.34
|
| Rate for Payer: Cash Price |
$52.11
|
| Rate for Payer: Cofinity Commercial |
$45.60
|
| Rate for Payer: Cofinity Commercial |
$56.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.11
|
| Rate for Payer: Healthscope Commercial |
$58.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.37
|
| Rate for Payer: PHP Commercial |
$55.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.34
|
| Rate for Payer: Priority Health SBD |
$41.04
|
|
|
HC MED PHYSIC DOS EVAL RAD EXPS
|
Facility
|
OP
|
$263.99
|
|
|
Service Code
|
CPT 76145
|
| Hospital Charge Code |
32000333
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$166.31 |
| Max. Negotiated Rate |
$1,709.87 |
| Rate for Payer: Aetna Commercial |
$224.39
|
| Rate for Payer: Aetna Medicare |
$540.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$649.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$649.84
|
| Rate for Payer: BCBS Complete |
$292.58
|
| Rate for Payer: BCBS MAPPO |
$519.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,709.87
|
| Rate for Payer: BCN Commercial |
$1,709.87
|
| Rate for Payer: BCN Medicare Advantage |
$519.87
|
| Rate for Payer: Cash Price |
$211.19
|
| Rate for Payer: Cash Price |
$211.19
|
| Rate for Payer: Cofinity Commercial |
$227.03
|
| Rate for Payer: Cofinity Commercial |
$184.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$184.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$519.87
|
| Rate for Payer: Healthscope Commercial |
$237.59
|
| Rate for Payer: Mclaren Medicaid |
$278.65
|
| Rate for Payer: Mclaren Medicare |
$519.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$545.86
|
| Rate for Payer: Meridian Medicaid |
$292.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$597.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.39
|
| Rate for Payer: Nomi Health Commercial |
$1,559.61
|
| Rate for Payer: PACE Medicare |
$493.88
|
| Rate for Payer: PACE SWMI |
$519.87
|
| Rate for Payer: PHP Commercial |
$224.39
|
| Rate for Payer: PHP Medicare Advantage |
$519.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,633.95
|
| Rate for Payer: Priority Health Medicare |
$519.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,307.16
|
| Rate for Payer: Priority Health SBD |
$166.31
|
| Rate for Payer: Railroad Medicare Medicare |
$519.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$900.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$519.87
|
| Rate for Payer: UHC Exchange |
$195.35
|
| Rate for Payer: UHC Medicare Advantage |
$519.87
|
| Rate for Payer: UHCCP Medicaid |
$292.69
|
| Rate for Payer: VA VA |
$519.87
|
|
|
HC MED PHYSIC DOS EVAL RAD EXPS
|
Facility
|
IP
|
$263.99
|
|
|
Service Code
|
CPT 76145
|
| Hospital Charge Code |
32000333
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$166.31 |
| Max. Negotiated Rate |
$237.59 |
| Rate for Payer: Aetna Commercial |
$224.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.59
|
| Rate for Payer: Cash Price |
$211.19
|
| Rate for Payer: Cofinity Commercial |
$184.79
|
| Rate for Payer: Cofinity Commercial |
$227.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$184.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.19
|
| Rate for Payer: Healthscope Commercial |
$237.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.39
|
| Rate for Payer: PHP Commercial |
$224.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.59
|
| Rate for Payer: Priority Health SBD |
$166.31
|
|
|
HC MED SURG ROOM & BOARD
|
Facility
|
IP
|
$3,356.84
|
|
| Hospital Charge Code |
11000001
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$2,114.81 |
| Max. Negotiated Rate |
$3,021.16 |
| Rate for Payer: Aetna Commercial |
$2,853.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,181.95
|
| Rate for Payer: Cash Price |
$2,685.47
|
| Rate for Payer: Cofinity Commercial |
$2,349.79
|
| Rate for Payer: Cofinity Commercial |
$2,886.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,349.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,685.47
|
| Rate for Payer: Healthscope Commercial |
$3,021.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,853.31
|
| Rate for Payer: PHP Commercial |
$2,853.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,181.95
|
| Rate for Payer: Priority Health SBD |
$2,114.81
|
|
