|
HC MINIMUM LETHAL CONCENTRATION (MLC)
|
Facility
|
OP
|
$46.82
|
|
|
Service Code
|
CPT 87187
|
| Hospital Charge Code |
30600102
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.53 |
| Max. Negotiated Rate |
$113.07 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna Medicare |
$41.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.21
|
| Rate for Payer: BCBS Complete |
$22.61
|
| Rate for Payer: BCBS MAPPO |
$40.17
|
| Rate for Payer: BCN Medicare Advantage |
$40.17
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Cofinity Commercial |
$32.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.17
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Mclaren Medicaid |
$21.53
|
| Rate for Payer: Mclaren Medicare |
$40.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.18
|
| Rate for Payer: Meridian Medicaid |
$22.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: PACE Medicare |
$38.16
|
| Rate for Payer: PACE SWMI |
$40.17
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: PHP Medicare Advantage |
$40.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health Medicare |
$40.17
|
| Rate for Payer: Priority Health SBD |
$29.50
|
| Rate for Payer: Railroad Medicare Medicare |
$40.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.17
|
| Rate for Payer: UHC Medicare Advantage |
$40.17
|
| Rate for Payer: UHCCP Medicaid |
$22.62
|
| Rate for Payer: VA VA |
$40.17
|
|
|
HC MINOR PROCEDURE WO SEDATION
|
Facility
|
OP
|
$531.54
|
|
| Hospital Charge Code |
36000076
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$212.62 |
| Max. Negotiated Rate |
$478.39 |
| Rate for Payer: Aetna Commercial |
$451.81
|
| Rate for Payer: Aetna Medicare |
$265.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.50
|
| Rate for Payer: BCBS Complete |
$212.62
|
| Rate for Payer: Cash Price |
$425.23
|
| Rate for Payer: Cofinity Commercial |
$372.08
|
| Rate for Payer: Cofinity Commercial |
$457.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$372.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.23
|
| Rate for Payer: Healthscope Commercial |
$478.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$451.81
|
| Rate for Payer: PHP Commercial |
$451.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.50
|
| Rate for Payer: Priority Health SBD |
$334.87
|
|
|
HC MINOR PROCEDURE WO SEDATION
|
Facility
|
IP
|
$531.54
|
|
| Hospital Charge Code |
36000076
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$334.87 |
| Max. Negotiated Rate |
$478.39 |
| Rate for Payer: Aetna Commercial |
$451.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.50
|
| Rate for Payer: Cash Price |
$425.23
|
| Rate for Payer: Cofinity Commercial |
$372.08
|
| Rate for Payer: Cofinity Commercial |
$457.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$372.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.23
|
| Rate for Payer: Healthscope Commercial |
$478.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$451.81
|
| Rate for Payer: PHP Commercial |
$451.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.50
|
| Rate for Payer: Priority Health SBD |
$334.87
|
|
|
HC MINOR PROCEDURE W SEDATION
|
Facility
|
IP
|
$615.92
|
|
| Hospital Charge Code |
36000075
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$388.03 |
| Max. Negotiated Rate |
$554.33 |
| Rate for Payer: Aetna Commercial |
$523.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.35
|
| Rate for Payer: Cash Price |
$492.74
|
| Rate for Payer: Cofinity Commercial |
$431.14
|
| Rate for Payer: Cofinity Commercial |
$529.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$431.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.74
|
| Rate for Payer: Healthscope Commercial |
$554.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.53
|
| Rate for Payer: PHP Commercial |
$523.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.35
|
| Rate for Payer: Priority Health SBD |
$388.03
|
|
|
HC MINOR PROCEDURE W SEDATION
|
Facility
|
OP
|
$615.92
|
|
| Hospital Charge Code |
36000075
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$246.37 |
| Max. Negotiated Rate |
$554.33 |
| Rate for Payer: Aetna Commercial |
$523.53
|
| Rate for Payer: Aetna Medicare |
$307.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.35
|
| Rate for Payer: BCBS Complete |
$246.37
|
| Rate for Payer: Cash Price |
$492.74
|
| Rate for Payer: Cofinity Commercial |
$431.14
|
| Rate for Payer: Cofinity Commercial |
$529.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$431.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.74
|
| Rate for Payer: Healthscope Commercial |
$554.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.53
|
| Rate for Payer: PHP Commercial |
$523.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.35
|
| Rate for Payer: Priority Health SBD |
$388.03
|
|
|
HC MITOTANE (LYSODREN)
|
Facility
|
IP
|
$117.52
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100731
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$74.04 |
| Max. Negotiated Rate |
$105.77 |
| Rate for Payer: Aetna Commercial |
$99.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.39
|
| Rate for Payer: Cash Price |
$94.02
|
| Rate for Payer: Cofinity Commercial |
$101.07
|
| Rate for Payer: Cofinity Commercial |
$82.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.02
|
| Rate for Payer: Healthscope Commercial |
$105.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.89
|
| Rate for Payer: PHP Commercial |
$99.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.39
|
| Rate for Payer: Priority Health SBD |
$74.04
|
|
|
HC MITOTANE (LYSODREN)
|
Facility
|
OP
|
$117.52
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100731
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$105.77 |
| Rate for Payer: Aetna Commercial |
$99.89
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: BCBS Complete |
$10.49
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$94.02
|
| Rate for Payer: Cash Price |
$94.02
|
| Rate for Payer: Cofinity Commercial |
$82.26
|
| Rate for Payer: Cofinity Commercial |
$101.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$105.77
|
| Rate for Payer: Mclaren Medicaid |
$9.99
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$10.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.89
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$99.89
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.39
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health SBD |
$74.04
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Medicare Advantage |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$10.49
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC MMR VACCINE
|
Facility
|
IP
|
$109.24
|
|
|
Service Code
|
CPT 90707
|
| Hospital Charge Code |
63600027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.82 |
| Max. Negotiated Rate |
$98.32 |
| Rate for Payer: Aetna Commercial |
$92.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.01
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Commercial |
$76.47
|
| Rate for Payer: Cofinity Commercial |
$93.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Healthscope Commercial |
$98.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: PHP Commercial |
$92.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.01
|
| Rate for Payer: Priority Health SBD |
$68.82
|
|
|
HC MMR VACCINE
|
Facility
|
OP
|
$109.24
|
|
|
Service Code
|
CPT 90707
|
| Hospital Charge Code |
63600027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.70 |
| Max. Negotiated Rate |
$98.32 |
| Rate for Payer: Aetna Commercial |
$92.85
|
| Rate for Payer: Aetna Medicare |
$54.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.01
|
| Rate for Payer: BCBS Complete |
$43.70
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Commercial |
$76.47
|
| Rate for Payer: Cofinity Commercial |
$93.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Healthscope Commercial |
$98.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: PHP Commercial |
$92.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.01
|
| Rate for Payer: Priority Health SBD |
$68.82
|
|
|
HC MNT GROUP 2ND REFERRAL 30 MIN
|
Facility
|
OP
|
$51.60
|
|
|
Service Code
|
HCPCS G0271
|
| Hospital Charge Code |
94200009
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$20.64 |
| Max. Negotiated Rate |
$46.44 |
| Rate for Payer: Aetna Commercial |
$43.86
|
| Rate for Payer: Aetna Medicare |
$25.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.54
|
| Rate for Payer: BCBS Complete |
$20.64
|
| Rate for Payer: Cash Price |
$41.28
|
| Rate for Payer: Cofinity Commercial |
$36.12
|
| Rate for Payer: Cofinity Commercial |
$44.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.28
|
| Rate for Payer: Healthscope Commercial |
$46.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.86
|
| Rate for Payer: PHP Commercial |
$43.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.54
|
| Rate for Payer: Priority Health SBD |
$32.51
|
| Rate for Payer: UHC Core |
$38.18
|
| Rate for Payer: UHC Exchange |
$38.18
|
|
|
HC MNT GROUP 2ND REFERRAL 30 MIN
|
Facility
|
IP
|
$51.60
|
|
|
Service Code
|
HCPCS G0271
|
| Hospital Charge Code |
94200009
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$32.51 |
| Max. Negotiated Rate |
$46.44 |
| Rate for Payer: Aetna Commercial |
$43.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.54
|
| Rate for Payer: Cash Price |
$41.28
|
| Rate for Payer: Cofinity Commercial |
$36.12
|
| Rate for Payer: Cofinity Commercial |
$44.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.28
|
| Rate for Payer: Healthscope Commercial |
$46.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.86
|
| Rate for Payer: PHP Commercial |
$43.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.54
|
| Rate for Payer: Priority Health SBD |
$32.51
|
|
|
HC MNT GROUP 30 MIN
|
Facility
|
OP
|
$60.53
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
94200004
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$24.21 |
| Max. Negotiated Rate |
$54.48 |
| Rate for Payer: Aetna Commercial |
$51.45
|
| Rate for Payer: Aetna Medicare |
$30.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.34
|
| Rate for Payer: BCBS Complete |
$24.21
|
| Rate for Payer: Cash Price |
$48.42
|
| Rate for Payer: Cofinity Commercial |
$42.37
|
| Rate for Payer: Cofinity Commercial |
$52.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.42
|
| Rate for Payer: Healthscope Commercial |
$54.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.45
|
| Rate for Payer: PHP Commercial |
$51.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.34
|
| Rate for Payer: Priority Health SBD |
$38.13
|
| Rate for Payer: UHC Core |
$44.79
|
| Rate for Payer: UHC Exchange |
$44.79
|
|
|
HC MNT GROUP 30 MIN
|
Facility
|
IP
|
$60.53
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
94200004
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$38.13 |
| Max. Negotiated Rate |
$54.48 |
| Rate for Payer: Aetna Commercial |
$51.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.34
|
| Rate for Payer: Cash Price |
$48.42
|
| Rate for Payer: Cofinity Commercial |
$42.37
|
| Rate for Payer: Cofinity Commercial |
$52.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.42
|
| Rate for Payer: Healthscope Commercial |
$54.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.45
|
| Rate for Payer: PHP Commercial |
$51.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.34
|
| Rate for Payer: Priority Health SBD |
$38.13
|
|
|
HC MNT INITIAL 15 MIN
|
Facility
|
OP
|
$138.66
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
94200002
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$55.46 |
| Max. Negotiated Rate |
$124.79 |
| Rate for Payer: Aetna Commercial |
$117.86
|
| Rate for Payer: Aetna Medicare |
$69.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.13
|
| Rate for Payer: BCBS Complete |
$55.46
|
| Rate for Payer: Cash Price |
$110.93
|
| Rate for Payer: Cofinity Commercial |
$119.25
|
| Rate for Payer: Cofinity Commercial |
$97.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.93
|
| Rate for Payer: Healthscope Commercial |
$124.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.86
|
| Rate for Payer: PHP Commercial |
$117.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.13
|
| Rate for Payer: Priority Health SBD |
$87.36
|
| Rate for Payer: UHC Core |
$102.61
|
| Rate for Payer: UHC Exchange |
$102.61
|
|
|
HC MNT INITIAL 15 MIN
|
Facility
|
IP
|
$138.66
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
94200002
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$87.36 |
| Max. Negotiated Rate |
$124.79 |
| Rate for Payer: Aetna Commercial |
$117.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.13
|
| Rate for Payer: Cash Price |
$110.93
|
| Rate for Payer: Cofinity Commercial |
$119.25
|
| Rate for Payer: Cofinity Commercial |
$97.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.93
|
| Rate for Payer: Healthscope Commercial |
$124.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.86
|
| Rate for Payer: PHP Commercial |
$117.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.13
|
| Rate for Payer: Priority Health SBD |
$87.36
|
|
|
HC MNT REASSESS & INTERVENT 15 MIN
|
Facility
|
OP
|
$122.56
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
94200003
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$49.02 |
| Max. Negotiated Rate |
$110.30 |
| Rate for Payer: Aetna Commercial |
$104.18
|
| Rate for Payer: Aetna Medicare |
$61.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.66
|
| Rate for Payer: BCBS Complete |
$49.02
|
| Rate for Payer: Cash Price |
$98.05
|
| Rate for Payer: Cofinity Commercial |
$105.40
|
| Rate for Payer: Cofinity Commercial |
$85.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.05
|
| Rate for Payer: Healthscope Commercial |
$110.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.18
|
| Rate for Payer: PHP Commercial |
$104.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.66
|
| Rate for Payer: Priority Health SBD |
$77.21
|
| Rate for Payer: UHC Core |
$90.69
|
| Rate for Payer: UHC Exchange |
$90.69
|
|
|
HC MNT REASSESS & INTERVENT 15 MIN
|
Facility
|
IP
|
$122.56
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
94200003
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$77.21 |
| Max. Negotiated Rate |
$110.30 |
| Rate for Payer: Aetna Commercial |
$104.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.66
|
| Rate for Payer: Cash Price |
$98.05
|
| Rate for Payer: Cofinity Commercial |
$105.40
|
| Rate for Payer: Cofinity Commercial |
$85.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.05
|
| Rate for Payer: Healthscope Commercial |
$110.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.18
|
| Rate for Payer: PHP Commercial |
$104.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.66
|
| Rate for Payer: Priority Health SBD |
$77.21
|
|
|
HC MOG FACS, S
|
Facility
|
OP
|
$535.50
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200476
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$481.95 |
| Rate for Payer: Aetna Commercial |
$455.18
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cofinity Commercial |
$460.53
|
| Rate for Payer: Cofinity Commercial |
$374.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$374.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$481.95
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.18
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$455.18
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.07
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$337.37
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.78
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC MOG FACS, S
|
Facility
|
IP
|
$535.50
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200476
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$337.37 |
| Max. Negotiated Rate |
$481.95 |
| Rate for Payer: Aetna Commercial |
$455.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.07
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cofinity Commercial |
$374.85
|
| Rate for Payer: Cofinity Commercial |
$460.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$374.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.40
|
| Rate for Payer: Healthscope Commercial |
$481.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.18
|
| Rate for Payer: PHP Commercial |
$455.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.07
|
| Rate for Payer: Priority Health SBD |
$337.37
|
|
|
HC MOG FACS TITER, S
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200477
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$48.20 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.73
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.03
|
| Rate for Payer: PHP Commercial |
$65.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.73
|
| Rate for Payer: Priority Health SBD |
$48.20
|
|
|
HC MOG FACS TITER, S
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200477
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.03
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.03
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$65.03
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.73
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$48.20
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.78
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC MONITOR DOWNLOAD
|
Facility
|
OP
|
$755.95
|
|
|
Service Code
|
CPT 94776
|
| Hospital Charge Code |
41000013
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$680.36 |
| Rate for Payer: Aetna Commercial |
$642.56
|
| Rate for Payer: Aetna Medicare |
$158.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$491.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.74
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$152.59
|
| Rate for Payer: BCN Medicare Advantage |
$152.59
|
| Rate for Payer: Cash Price |
$604.76
|
| Rate for Payer: Cash Price |
$604.76
|
| Rate for Payer: Cofinity Commercial |
$650.12
|
| Rate for Payer: Cofinity Commercial |
$529.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$529.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$604.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$680.36
|
| Rate for Payer: Mclaren Medicaid |
$81.79
|
| Rate for Payer: Mclaren Medicare |
$152.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.22
|
| Rate for Payer: Meridian Medicaid |
$85.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$642.56
|
| Rate for Payer: PACE Medicare |
$144.96
|
| Rate for Payer: PACE SWMI |
$152.59
|
| Rate for Payer: PHP Commercial |
$642.56
|
| Rate for Payer: PHP Medicare Advantage |
$152.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$491.37
|
| Rate for Payer: Priority Health Medicare |
$152.59
|
| Rate for Payer: Priority Health SBD |
$476.25
|
| Rate for Payer: Railroad Medicare Medicare |
$152.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.53
|
| Rate for Payer: UHC Core |
$559.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.59
|
| Rate for Payer: UHC Exchange |
$559.40
|
| Rate for Payer: UHC Medicare Advantage |
$152.59
|
| Rate for Payer: UHCCP Medicaid |
$85.91
|
| Rate for Payer: VA VA |
$152.59
|
|
|
HC MONITOR DOWNLOAD
|
Facility
|
IP
|
$755.95
|
|
|
Service Code
|
CPT 94776
|
| Hospital Charge Code |
41000013
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$476.25 |
| Max. Negotiated Rate |
$680.36 |
| Rate for Payer: Aetna Commercial |
$642.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$491.37
|
| Rate for Payer: Cash Price |
$604.76
|
| Rate for Payer: Cofinity Commercial |
$529.16
|
| Rate for Payer: Cofinity Commercial |
$650.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$529.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$604.76
|
| Rate for Payer: Healthscope Commercial |
$680.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$642.56
|
| Rate for Payer: PHP Commercial |
$642.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$491.37
|
| Rate for Payer: Priority Health SBD |
$476.25
|
|
|
HC MONITORED EXERCISE
|
Facility
|
OP
|
$244.93
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
94300001
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$65.82 |
| Max. Negotiated Rate |
$345.67 |
| Rate for Payer: Aetna Commercial |
$208.19
|
| Rate for Payer: Aetna Medicare |
$127.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$153.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$153.50
|
| Rate for Payer: BCBS Complete |
$69.11
|
| Rate for Payer: BCBS MAPPO |
$122.80
|
| Rate for Payer: BCN Medicare Advantage |
$122.80
|
| Rate for Payer: Cash Price |
$195.94
|
| Rate for Payer: Cash Price |
$195.94
|
| Rate for Payer: Cofinity Commercial |
$171.45
|
| Rate for Payer: Cofinity Commercial |
$210.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.80
|
| Rate for Payer: Healthscope Commercial |
$220.44
|
| Rate for Payer: Mclaren Medicaid |
$65.82
|
| Rate for Payer: Mclaren Medicare |
$122.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.94
|
| Rate for Payer: Meridian Medicaid |
$69.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.19
|
| Rate for Payer: PACE Medicare |
$116.66
|
| Rate for Payer: PACE SWMI |
$122.80
|
| Rate for Payer: PHP Commercial |
$208.19
|
| Rate for Payer: PHP Medicare Advantage |
$122.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.20
|
| Rate for Payer: Priority Health Medicare |
$122.80
|
| Rate for Payer: Priority Health SBD |
$154.31
|
| Rate for Payer: Railroad Medicare Medicare |
$122.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$345.67
|
| Rate for Payer: UHC Core |
$181.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.80
|
| Rate for Payer: UHC Exchange |
$181.25
|
| Rate for Payer: UHC Medicare Advantage |
$122.80
|
| Rate for Payer: UHCCP Medicaid |
$69.14
|
| Rate for Payer: VA VA |
$122.80
|
|
|
HC MONITORED EXERCISE
|
Facility
|
IP
|
$244.93
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
94300001
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$154.31 |
| Max. Negotiated Rate |
$220.44 |
| Rate for Payer: Aetna Commercial |
$208.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.20
|
| Rate for Payer: Cash Price |
$195.94
|
| Rate for Payer: Cofinity Commercial |
$171.45
|
| Rate for Payer: Cofinity Commercial |
$210.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.94
|
| Rate for Payer: Healthscope Commercial |
$220.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.19
|
| Rate for Payer: PHP Commercial |
$208.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.20
|
| Rate for Payer: Priority Health SBD |
$154.31
|
|
