|
HC MENENCEPH CMPT 19
|
Facility
|
IP
|
$14.15
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200360
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$12.73 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.20
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Cofinity Commercial |
$9.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Healthscope Commercial |
$12.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: PHP Commercial |
$12.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health SBD |
$8.91
|
|
|
HC MENENCEPH CMPT 2
|
Facility
|
OP
|
$14.15
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
30200256
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$37.13 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: Aetna Medicare |
$13.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.49
|
| Rate for Payer: BCBS Complete |
$7.42
|
| Rate for Payer: BCBS MAPPO |
$13.19
|
| Rate for Payer: BCN Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$9.90
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.19
|
| Rate for Payer: Healthscope Commercial |
$12.73
|
| Rate for Payer: Mclaren Medicaid |
$7.07
|
| Rate for Payer: Mclaren Medicare |
$13.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.85
|
| Rate for Payer: Meridian Medicaid |
$7.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: PACE Medicare |
$12.53
|
| Rate for Payer: PACE SWMI |
$13.19
|
| Rate for Payer: PHP Commercial |
$12.03
|
| Rate for Payer: PHP Medicare Advantage |
$13.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health Medicare |
$13.19
|
| Rate for Payer: Priority Health SBD |
$8.91
|
| Rate for Payer: Railroad Medicare Medicare |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.19
|
| Rate for Payer: UHC Medicare Advantage |
$13.19
|
| Rate for Payer: UHCCP Medicaid |
$7.43
|
| Rate for Payer: VA VA |
$13.19
|
|
|
HC MENENCEPH CMPT 2
|
Facility
|
IP
|
$14.15
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
30200256
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$12.73 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.20
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Cofinity Commercial |
$9.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Healthscope Commercial |
$12.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: PHP Commercial |
$12.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health SBD |
$8.91
|
|
|
HC MENENCEPH CMPT 3
|
Facility
|
IP
|
$14.15
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
30200264
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$12.73 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.20
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Cofinity Commercial |
$9.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Healthscope Commercial |
$12.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: PHP Commercial |
$12.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health SBD |
$8.91
|
|
|
HC MENENCEPH CMPT 3
|
Facility
|
OP
|
$14.15
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
30200264
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$36.68 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: Aetna Medicare |
$13.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.29
|
| Rate for Payer: BCBS Complete |
$7.33
|
| Rate for Payer: BCBS MAPPO |
$13.03
|
| Rate for Payer: BCN Medicare Advantage |
$13.03
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$9.90
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.03
|
| Rate for Payer: Healthscope Commercial |
$12.73
|
| Rate for Payer: Mclaren Medicaid |
$6.98
|
| Rate for Payer: Mclaren Medicare |
$13.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.68
|
| Rate for Payer: Meridian Medicaid |
$7.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: PACE Medicare |
$12.38
|
| Rate for Payer: PACE SWMI |
$13.03
|
| Rate for Payer: PHP Commercial |
$12.03
|
| Rate for Payer: PHP Medicare Advantage |
$13.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health Medicare |
$13.03
|
| Rate for Payer: Priority Health SBD |
$8.91
|
| Rate for Payer: Railroad Medicare Medicare |
$13.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.03
|
| Rate for Payer: UHC Medicare Advantage |
$13.03
|
| Rate for Payer: UHCCP Medicaid |
$7.34
|
| Rate for Payer: VA VA |
$13.03
|
|
|
HC MENENCEPH CMPT 4
|
Facility
|
IP
|
$14.15
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
30200250
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$12.73 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.20
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Cofinity Commercial |
$9.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Healthscope Commercial |
$12.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: PHP Commercial |
$12.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health SBD |
$8.91
|
|
|
HC MENENCEPH CMPT 4
|
Facility
|
OP
|
$14.15
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
30200250
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$40.51 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: Aetna Medicare |
$14.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.99
|
| Rate for Payer: BCBS Complete |
$8.10
|
| Rate for Payer: BCBS MAPPO |
$14.39
|
| Rate for Payer: BCN Medicare Advantage |
$14.39
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$9.90
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.39
|
| Rate for Payer: Healthscope Commercial |
$12.73
|
| Rate for Payer: Mclaren Medicaid |
$7.71
|
| Rate for Payer: Mclaren Medicare |
$14.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.11
|
| Rate for Payer: Meridian Medicaid |
$8.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: PACE Medicare |
$13.67
|
| Rate for Payer: PACE SWMI |
$14.39
|
| Rate for Payer: PHP Commercial |
$12.03
|
| Rate for Payer: PHP Medicare Advantage |
$14.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health Medicare |
$14.39
|
| Rate for Payer: Priority Health SBD |
$8.91
|
| Rate for Payer: Railroad Medicare Medicare |
$14.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.39
|
| Rate for Payer: UHC Medicare Advantage |
$14.39
|
| Rate for Payer: UHCCP Medicaid |
$8.10
|
| Rate for Payer: VA VA |
$14.39
|
|
|
HC MENENCEPH CMPT 5
|
Facility
|
IP
|
$14.15
|
|
|
Service Code
|
CPT 86645
|
| Hospital Charge Code |
30200253
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$12.73 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.20
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Cofinity Commercial |
$9.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Healthscope Commercial |
$12.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: PHP Commercial |
$12.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health SBD |
$8.91
|
|
|
HC MENENCEPH CMPT 5
|
Facility
|
OP
|
$14.15
|
|
|
Service Code
|
CPT 86645
|
| Hospital Charge Code |
30200253
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$47.43 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: Aetna Medicare |
$17.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.06
|
| Rate for Payer: BCBS Complete |
$9.48
|
| Rate for Payer: BCBS MAPPO |
$16.85
|
| Rate for Payer: BCN Medicare Advantage |
$16.85
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$9.90
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.85
|
| Rate for Payer: Healthscope Commercial |
$12.73
|
| Rate for Payer: Mclaren Medicaid |
$9.03
|
| Rate for Payer: Mclaren Medicare |
$16.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.69
|
| Rate for Payer: Meridian Medicaid |
$9.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: PACE Medicare |
$16.01
|
| Rate for Payer: PACE SWMI |
$16.85
|
| Rate for Payer: PHP Commercial |
$12.03
|
| Rate for Payer: PHP Medicare Advantage |
$16.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health Medicare |
$16.85
|
| Rate for Payer: Priority Health SBD |
$8.91
|
| Rate for Payer: Railroad Medicare Medicare |
$16.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.85
|
| Rate for Payer: UHC Medicare Advantage |
$16.85
|
| Rate for Payer: UHCCP Medicaid |
$9.49
|
| Rate for Payer: VA VA |
$16.85
|
|
|
HC MENENCEPH CMPT 6
|
Facility
|
OP
|
$14.15
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
30200257
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$37.13 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: Aetna Medicare |
$13.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.49
|
| Rate for Payer: BCBS Complete |
$7.42
|
| Rate for Payer: BCBS MAPPO |
$13.19
|
| Rate for Payer: BCN Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$9.90
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.19
|
| Rate for Payer: Healthscope Commercial |
$12.73
|
| Rate for Payer: Mclaren Medicaid |
$7.07
|
| Rate for Payer: Mclaren Medicare |
$13.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.85
|
| Rate for Payer: Meridian Medicaid |
$7.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: PACE Medicare |
$12.53
|
| Rate for Payer: PACE SWMI |
$13.19
|
| Rate for Payer: PHP Commercial |
$12.03
|
| Rate for Payer: PHP Medicare Advantage |
$13.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health Medicare |
$13.19
|
| Rate for Payer: Priority Health SBD |
$8.91
|
| Rate for Payer: Railroad Medicare Medicare |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.19
|
| Rate for Payer: UHC Medicare Advantage |
$13.19
|
| Rate for Payer: UHCCP Medicaid |
$7.43
|
| Rate for Payer: VA VA |
$13.19
|
|
|
HC MENENCEPH CMPT 6
|
Facility
|
IP
|
$14.15
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
30200257
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$12.73 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.20
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Cofinity Commercial |
$9.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Healthscope Commercial |
$12.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: PHP Commercial |
$12.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health SBD |
$8.91
|
|
|
HC MENENCEPH CMPT 7
|
Facility
|
OP
|
$14.15
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
30200282
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$37.13 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: Aetna Medicare |
$13.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.49
|
| Rate for Payer: BCBS Complete |
$7.42
|
| Rate for Payer: BCBS MAPPO |
$13.19
|
| Rate for Payer: BCN Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$9.90
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.19
|
| Rate for Payer: Healthscope Commercial |
$12.73
|
| Rate for Payer: Mclaren Medicaid |
$7.07
|
| Rate for Payer: Mclaren Medicare |
$13.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.85
|
| Rate for Payer: Meridian Medicaid |
$7.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: PACE Medicare |
$12.53
|
| Rate for Payer: PACE SWMI |
$13.19
|
| Rate for Payer: PHP Commercial |
$12.03
|
| Rate for Payer: PHP Medicare Advantage |
$13.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health Medicare |
$13.19
|
| Rate for Payer: Priority Health SBD |
$8.91
|
| Rate for Payer: Railroad Medicare Medicare |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.19
|
| Rate for Payer: UHC Medicare Advantage |
$13.19
|
| Rate for Payer: UHCCP Medicaid |
$7.43
|
| Rate for Payer: VA VA |
$13.19
|
|
|
HC MENENCEPH CMPT 7
|
Facility
|
IP
|
$14.15
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
30200282
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$12.73 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.20
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Cofinity Commercial |
$9.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Healthscope Commercial |
$12.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: PHP Commercial |
$12.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health SBD |
$8.91
|
|
|
HC MENENCEPH CMPT 8
|
Facility
|
IP
|
$14.15
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
30200284
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$12.73 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.20
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Cofinity Commercial |
$9.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Healthscope Commercial |
$12.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: PHP Commercial |
$12.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health SBD |
$8.91
|
|
|
HC MENENCEPH CMPT 8
|
Facility
|
OP
|
$14.15
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
30200284
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$54.47 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: Aetna Medicare |
$20.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.19
|
| Rate for Payer: BCBS Complete |
$10.89
|
| Rate for Payer: BCBS MAPPO |
$19.35
|
| Rate for Payer: BCN Medicare Advantage |
$19.35
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$9.90
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$12.73
|
| Rate for Payer: Mclaren Medicaid |
$10.37
|
| Rate for Payer: Mclaren Medicare |
$19.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.32
|
| Rate for Payer: Meridian Medicaid |
$10.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: PACE Medicare |
$18.38
|
| Rate for Payer: PACE SWMI |
$19.35
|
| Rate for Payer: PHP Commercial |
$12.03
|
| Rate for Payer: PHP Medicare Advantage |
$19.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health Medicare |
$19.35
|
| Rate for Payer: Priority Health SBD |
$8.91
|
| Rate for Payer: Railroad Medicare Medicare |
$19.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.35
|
| Rate for Payer: UHC Medicare Advantage |
$19.35
|
| Rate for Payer: UHCCP Medicaid |
$10.89
|
| Rate for Payer: VA VA |
$19.35
|
|
|
HC MENENCEPH CMPT 9
|
Facility
|
OP
|
$14.15
|
|
|
Service Code
|
CPT 86727
|
| Hospital Charge Code |
30200304
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$36.23 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: Aetna Medicare |
$13.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: BCBS Complete |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$9.90
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$12.73
|
| Rate for Payer: Mclaren Medicaid |
$6.90
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: Meridian Medicaid |
$7.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$12.03
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health SBD |
$8.91
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.87
|
| Rate for Payer: UHC Medicare Advantage |
$12.87
|
| Rate for Payer: UHCCP Medicaid |
$7.25
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC MENENCEPH CMPT 9
|
Facility
|
IP
|
$14.15
|
|
|
Service Code
|
CPT 86727
|
| Hospital Charge Code |
30200304
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$12.73 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.20
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Cofinity Commercial |
$9.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Healthscope Commercial |
$12.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: PHP Commercial |
$12.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health SBD |
$8.91
|
|
|
HC MENIGOCOCCAL, QUADRIVALENT (MCV4 OR MENACWY) IM
|
Facility
|
IP
|
$160.22
|
|
|
Service Code
|
CPT 90734
|
| Hospital Charge Code |
63600085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.94 |
| Max. Negotiated Rate |
$144.20 |
| Rate for Payer: Aetna Commercial |
$136.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.14
|
| Rate for Payer: Cash Price |
$128.18
|
| Rate for Payer: Cofinity Commercial |
$112.15
|
| Rate for Payer: Cofinity Commercial |
$137.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$112.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.18
|
| Rate for Payer: Healthscope Commercial |
$144.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.19
|
| Rate for Payer: PHP Commercial |
$136.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.14
|
| Rate for Payer: Priority Health SBD |
$100.94
|
|
|
HC MENIGOCOCCAL, QUADRIVALENT (MCV4 OR MENACWY) IM
|
Facility
|
OP
|
$160.22
|
|
|
Service Code
|
CPT 90734
|
| Hospital Charge Code |
63600085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.09 |
| Max. Negotiated Rate |
$144.20 |
| Rate for Payer: Aetna Commercial |
$136.19
|
| Rate for Payer: Aetna Medicare |
$80.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.14
|
| Rate for Payer: BCBS Complete |
$64.09
|
| Rate for Payer: Cash Price |
$128.18
|
| Rate for Payer: Cofinity Commercial |
$112.15
|
| Rate for Payer: Cofinity Commercial |
$137.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$112.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.18
|
| Rate for Payer: Healthscope Commercial |
$144.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.19
|
| Rate for Payer: PHP Commercial |
$136.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.14
|
| Rate for Payer: Priority Health SBD |
$100.94
|
|
|
HC MENINGITIS/ENCEPHALITIS PANEL
|
Facility
|
OP
|
$728.28
|
|
|
Service Code
|
CPT 87483
|
| Hospital Charge Code |
30600287
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$223.39 |
| Max. Negotiated Rate |
$1,173.19 |
| Rate for Payer: Aetna Commercial |
$619.04
|
| Rate for Payer: Aetna Medicare |
$433.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$473.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$520.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$520.98
|
| Rate for Payer: BCBS Complete |
$234.56
|
| Rate for Payer: BCBS MAPPO |
$416.78
|
| Rate for Payer: BCN Medicare Advantage |
$416.78
|
| Rate for Payer: Cash Price |
$582.62
|
| Rate for Payer: Cash Price |
$582.62
|
| Rate for Payer: Cofinity Commercial |
$626.32
|
| Rate for Payer: Cofinity Commercial |
$509.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$509.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$582.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$416.78
|
| Rate for Payer: Healthscope Commercial |
$655.45
|
| Rate for Payer: Mclaren Medicaid |
$223.39
|
| Rate for Payer: Mclaren Medicare |
$416.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$437.62
|
| Rate for Payer: Meridian Medicaid |
$234.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$479.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$619.04
|
| Rate for Payer: PACE Medicare |
$395.94
|
| Rate for Payer: PACE SWMI |
$416.78
|
| Rate for Payer: PHP Commercial |
$619.04
|
| Rate for Payer: PHP Medicare Advantage |
$416.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$223.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.38
|
| Rate for Payer: Priority Health Medicare |
$416.78
|
| Rate for Payer: Priority Health SBD |
$458.82
|
| Rate for Payer: Railroad Medicare Medicare |
$416.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,173.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$416.78
|
| Rate for Payer: UHC Medicare Advantage |
$416.78
|
| Rate for Payer: UHCCP Medicaid |
$234.65
|
| Rate for Payer: VA VA |
$416.78
|
|
|
HC MENINGITIS/ENCEPHALITIS PANEL
|
Facility
|
IP
|
$728.28
|
|
|
Service Code
|
CPT 87483
|
| Hospital Charge Code |
30600287
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$458.82 |
| Max. Negotiated Rate |
$655.45 |
| Rate for Payer: Aetna Commercial |
$619.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$473.38
|
| Rate for Payer: Cash Price |
$582.62
|
| Rate for Payer: Cofinity Commercial |
$509.80
|
| Rate for Payer: Cofinity Commercial |
$626.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$509.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$582.62
|
| Rate for Payer: Healthscope Commercial |
$655.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$619.04
|
| Rate for Payer: PHP Commercial |
$619.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.38
|
| Rate for Payer: Priority Health SBD |
$458.82
|
|
|
HC MENINGOENCEPHALITIS PANEL CSF
|
Facility
|
OP
|
$9.36
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200218
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$36.23 |
| Rate for Payer: Aetna Commercial |
$7.96
|
| Rate for Payer: Aetna Medicare |
$13.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: BCBS Complete |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$7.49
|
| Rate for Payer: Cash Price |
$7.49
|
| Rate for Payer: Cofinity Commercial |
$8.05
|
| Rate for Payer: Cofinity Commercial |
$6.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$8.42
|
| Rate for Payer: Mclaren Medicaid |
$6.90
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: Meridian Medicaid |
$7.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.96
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$7.96
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.08
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health SBD |
$5.90
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.87
|
| Rate for Payer: UHC Medicare Advantage |
$12.87
|
| Rate for Payer: UHCCP Medicaid |
$7.25
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC MENINGOENCEPHALITIS PANEL CSF
|
Facility
|
OP
|
$14.15
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
30200356
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$47.43 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: Aetna Medicare |
$17.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.06
|
| Rate for Payer: BCBS Complete |
$9.48
|
| Rate for Payer: BCBS MAPPO |
$16.85
|
| Rate for Payer: BCN Medicare Advantage |
$16.85
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$9.90
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.85
|
| Rate for Payer: Healthscope Commercial |
$12.73
|
| Rate for Payer: Mclaren Medicaid |
$9.03
|
| Rate for Payer: Mclaren Medicare |
$16.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.69
|
| Rate for Payer: Meridian Medicaid |
$9.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: PACE Medicare |
$16.01
|
| Rate for Payer: PACE SWMI |
$16.85
|
| Rate for Payer: PHP Commercial |
$12.03
|
| Rate for Payer: PHP Medicare Advantage |
$16.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health Medicare |
$16.85
|
| Rate for Payer: Priority Health SBD |
$8.91
|
| Rate for Payer: Railroad Medicare Medicare |
$16.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.85
|
| Rate for Payer: UHC Medicare Advantage |
$16.85
|
| Rate for Payer: UHCCP Medicaid |
$9.49
|
| Rate for Payer: VA VA |
$16.85
|
|
|
HC MENINGOENCEPHALITIS PANEL CSF
|
Facility
|
IP
|
$14.15
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
30200356
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$12.73 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.20
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Cofinity Commercial |
$9.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Healthscope Commercial |
$12.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: PHP Commercial |
$12.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health SBD |
$8.91
|
|
|
HC MENINGOENCEPHALITIS PANEL CSF
|
Facility
|
IP
|
$9.36
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200218
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Aetna Commercial |
$7.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.08
|
| Rate for Payer: Cash Price |
$7.49
|
| Rate for Payer: Cofinity Commercial |
$6.55
|
| Rate for Payer: Cofinity Commercial |
$8.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.49
|
| Rate for Payer: Healthscope Commercial |
$8.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.96
|
| Rate for Payer: PHP Commercial |
$7.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.08
|
| Rate for Payer: Priority Health SBD |
$5.90
|
|
