|
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 2ND REFERRAL 30 MIN
|
Facility
|
OP
|
$51.60
|
|
|
Service Code
|
HCPCS G0271
|
| Hospital Charge Code |
94200009
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$5.16 |
| 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: BCBS Trust/PPO |
$35.43
|
| Rate for Payer: BCN Commercial |
$35.43
|
| Rate for Payer: Cash Price |
$41.28
|
| Rate for Payer: Cash Price |
$41.28
|
| Rate for Payer: Cofinity Commercial |
$44.38
|
| Rate for Payer: Cofinity Commercial |
$36.12
|
| 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 HMO/PPO/Tiered Network |
$6.45
|
| Rate for Payer: Priority Health Narrow Network |
$5.16
|
| Rate for Payer: Priority Health SBD |
$32.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.99
|
| Rate for Payer: UHC Exchange |
$38.18
|
|
|
HC MNT GROUP 30 MIN
|
Facility
|
OP
|
$60.53
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
94200004
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$54.48 |
| Rate for Payer: Aetna Commercial |
$51.45
|
| Rate for Payer: Aetna Medicare |
$30.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.34
|
| Rate for Payer: BCBS Complete |
$24.21
|
| Rate for Payer: BCBS Trust/PPO |
$35.43
|
| Rate for Payer: BCN Commercial |
$35.43
|
| Rate for Payer: Cash Price |
$48.42
|
| Rate for Payer: Cash Price |
$48.42
|
| Rate for Payer: Cofinity Commercial |
$52.06
|
| Rate for Payer: Cofinity Commercial |
$42.37
|
| 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 HMO/PPO/Tiered Network |
$15.00
|
| Rate for Payer: Priority Health Narrow Network |
$12.00
|
| Rate for Payer: Priority Health SBD |
$38.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.99
|
| 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
|
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 INITIAL 15 MIN
|
Facility
|
OP
|
$138.66
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
94200002
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$27.20 |
| 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: BCBS Trust/PPO |
$81.21
|
| Rate for Payer: BCN Commercial |
$81.21
|
| Rate for Payer: Cash Price |
$110.93
|
| Rate for Payer: Cash Price |
$110.93
|
| Rate for Payer: Cofinity Commercial |
$97.06
|
| Rate for Payer: Cofinity Commercial |
$119.25
|
| 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 HMO/PPO/Tiered Network |
$34.00
|
| Rate for Payer: Priority Health Narrow Network |
$27.20
|
| Rate for Payer: Priority Health SBD |
$87.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.97
|
| Rate for Payer: UHC Exchange |
$102.61
|
|
|
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 |
$23.20 |
| 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: BCBS Trust/PPO |
$72.36
|
| Rate for Payer: BCN Commercial |
$72.36
|
| Rate for Payer: Cash Price |
$98.05
|
| Rate for Payer: Cash Price |
$98.05
|
| Rate for Payer: Cofinity Commercial |
$85.79
|
| Rate for Payer: Cofinity Commercial |
$105.40
|
| 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 HMO/PPO/Tiered Network |
$29.00
|
| Rate for Payer: Priority Health Narrow Network |
$23.20
|
| Rate for Payer: Priority Health SBD |
$77.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.12
|
| 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
|
IP
|
$535.50
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200476
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$337.36 |
| Max. Negotiated Rate |
$481.95 |
| Rate for Payer: Aetna Commercial |
$455.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.08
|
| 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 |
$348.08
|
| Rate for Payer: Priority Health SBD |
$337.36
|
|
|
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) |
$348.08
|
| 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: BCBS Trust/PPO |
$8.00
|
| Rate for Payer: BCN Commercial |
$8.00
|
| 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: Nomi Health Commercial |
$18.08
|
| 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 |
$348.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.40
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$9.92
|
| Rate for Payer: Priority Health SBD |
$337.36
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.46
|
| 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 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 |
$65.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.72
|
| 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 |
$65.02
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.72
|
| 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 |
$65.02
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.72
|
| 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: BCBS Trust/PPO |
$8.00
|
| Rate for Payer: BCN Commercial |
$8.00
|
| 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 |
$65.02
|
| Rate for Payer: Nomi Health Commercial |
$18.08
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$65.02
|
| 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 |
$49.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.40
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$9.92
|
| Rate for Payer: Priority Health SBD |
$48.20
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.46
|
| 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
|
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 MONITOR DOWNLOAD
|
Facility
|
OP
|
$755.95
|
|
|
Service Code
|
CPT 94776
|
| Hospital Charge Code |
41000013
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$680.36 |
| Rate for Payer: Aetna Commercial |
$642.56
|
| Rate for Payer: Aetna Medicare |
$159.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$491.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.62
|
| Rate for Payer: BCBS Complete |
$86.28
|
| Rate for Payer: BCBS MAPPO |
$153.30
|
| Rate for Payer: BCBS Trust/PPO |
$412.63
|
| Rate for Payer: BCN Commercial |
$412.63
|
| Rate for Payer: BCN Medicare Advantage |
$153.30
|
| 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 |
$153.30
|
| Rate for Payer: Healthscope Commercial |
$680.36
|
| Rate for Payer: Mclaren Medicaid |
$82.17
|
| Rate for Payer: Mclaren Medicare |
$153.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.96
|
| Rate for Payer: Meridian Medicaid |
$86.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$642.56
|
| Rate for Payer: Nomi Health Commercial |
$459.90
|
| Rate for Payer: PACE Medicare |
$145.64
|
| Rate for Payer: PACE SWMI |
$153.30
|
| Rate for Payer: PHP Commercial |
$642.56
|
| Rate for Payer: PHP Medicare Advantage |
$153.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$491.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$481.80
|
| Rate for Payer: Priority Health Medicare |
$153.30
|
| Rate for Payer: Priority Health Narrow Network |
$385.44
|
| Rate for Payer: Priority Health SBD |
$476.25
|
| Rate for Payer: Railroad Medicare Medicare |
$153.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$431.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.30
|
| Rate for Payer: UHC Exchange |
$559.40
|
| Rate for Payer: UHC Medicare Advantage |
$153.30
|
| Rate for Payer: UHCCP Medicaid |
$86.31
|
| Rate for Payer: VA VA |
$153.30
|
|
|
HC MONITORED EXERCISE
|
Facility
|
OP
|
$244.93
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
94300001
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$14.21 |
| Max. Negotiated Rate |
$387.72 |
| Rate for Payer: Aetna Commercial |
$208.19
|
| Rate for Payer: Aetna Medicare |
$128.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$154.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$154.20
|
| Rate for Payer: BCBS Complete |
$69.43
|
| Rate for Payer: BCBS MAPPO |
$123.36
|
| Rate for Payer: BCBS Trust/PPO |
$69.40
|
| Rate for Payer: BCN Commercial |
$69.40
|
| Rate for Payer: BCN Medicare Advantage |
$123.36
|
| Rate for Payer: Cash Price |
$195.94
|
| Rate for Payer: Cash Price |
$195.94
|
| Rate for Payer: Cofinity Commercial |
$210.64
|
| Rate for Payer: Cofinity Commercial |
$171.45
|
| 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 |
$123.36
|
| Rate for Payer: Healthscope Commercial |
$220.44
|
| Rate for Payer: Mclaren Medicaid |
$66.12
|
| Rate for Payer: Mclaren Medicare |
$123.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.53
|
| Rate for Payer: Meridian Medicaid |
$69.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.19
|
| Rate for Payer: Nomi Health Commercial |
$370.08
|
| Rate for Payer: PACE Medicare |
$117.19
|
| Rate for Payer: PACE SWMI |
$123.36
|
| Rate for Payer: PHP Commercial |
$208.19
|
| Rate for Payer: PHP Medicare Advantage |
$123.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$387.72
|
| Rate for Payer: Priority Health Medicare |
$123.36
|
| Rate for Payer: Priority Health Narrow Network |
$310.18
|
| Rate for Payer: Priority Health SBD |
$154.31
|
| Rate for Payer: Railroad Medicare Medicare |
$123.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.36
|
| Rate for Payer: UHC Exchange |
$181.25
|
| Rate for Payer: UHC Medicare Advantage |
$123.36
|
| Rate for Payer: UHCCP Medicaid |
$69.45
|
| Rate for Payer: VA VA |
$123.36
|
|
|
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
|
|
|
HC MONITOR SET QUICK PRESSURE
|
Facility
|
OP
|
$437.50
|
|
| Hospital Charge Code |
27000707
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$393.75 |
| Rate for Payer: Aetna Commercial |
$371.88
|
| Rate for Payer: Aetna Medicare |
$218.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.38
|
| Rate for Payer: BCBS Complete |
$175.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cofinity Commercial |
$306.25
|
| Rate for Payer: Cofinity Commercial |
$376.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$306.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.00
|
| Rate for Payer: Healthscope Commercial |
$393.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.88
|
| Rate for Payer: PHP Commercial |
$371.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.38
|
| Rate for Payer: Priority Health SBD |
$275.62
|
|
|
HC MONITOR SET QUICK PRESSURE
|
Facility
|
IP
|
$437.50
|
|
| Hospital Charge Code |
27000707
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$275.62 |
| Max. Negotiated Rate |
$393.75 |
| Rate for Payer: Aetna Commercial |
$371.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.38
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cofinity Commercial |
$306.25
|
| Rate for Payer: Cofinity Commercial |
$376.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$306.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.00
|
| Rate for Payer: Healthscope Commercial |
$393.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.88
|
| Rate for Payer: PHP Commercial |
$371.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.38
|
| Rate for Payer: Priority Health SBD |
$275.62
|
|
|
HC MONO SCREENING MONOSPOT
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
30200186
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.48
|
| Rate for Payer: BCBS Complete |
$2.92
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCBS Trust/PPO |
$4.59
|
| Rate for Payer: BCN Commercial |
$4.59
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Mclaren Medicaid |
$2.78
|
| Rate for Payer: Mclaren Medicare |
$5.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: Meridian Medicaid |
$2.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$7.77
|
| Rate for Payer: PACE Medicare |
$4.92
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.33
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: Priority Health Narrow Network |
$4.26
|
| Rate for Payer: Priority Health SBD |
$16.39
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.18
|
| Rate for Payer: UHC Medicare Advantage |
$5.18
|
| Rate for Payer: UHCCP Medicaid |
$2.92
|
| Rate for Payer: VA VA |
$5.18
|
|
|
HC MONO SCREENING MONOSPOT
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
30200186
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health SBD |
$16.39
|
|
|
HC MORPHINE LVL
|
Facility
|
OP
|
$119.34
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100578
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.78 |
| Max. Negotiated Rate |
$107.41 |
| Rate for Payer: Aetna Commercial |
$101.44
|
| Rate for Payer: Aetna Medicare |
$59.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.57
|
| Rate for Payer: BCBS Complete |
$47.74
|
| Rate for Payer: Cash Price |
$95.47
|
| Rate for Payer: Cash Price |
$95.47
|
| Rate for Payer: Cofinity Commercial |
$102.63
|
| Rate for Payer: Cofinity Commercial |
$83.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$83.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.47
|
| Rate for Payer: Healthscope Commercial |
$107.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.44
|
| Rate for Payer: PHP Commercial |
$101.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.57
|
| Rate for Payer: Priority Health SBD |
$75.18
|
| Rate for Payer: UHC Core |
$27.78
|
| Rate for Payer: UHC Exchange |
$27.78
|
|
|
HC MORPHINE LVL
|
Facility
|
IP
|
$119.34
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100578
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$75.18 |
| Max. Negotiated Rate |
$107.41 |
| Rate for Payer: Aetna Commercial |
$101.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.57
|
| Rate for Payer: Cash Price |
$95.47
|
| Rate for Payer: Cofinity Commercial |
$102.63
|
| Rate for Payer: Cofinity Commercial |
$83.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$83.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.47
|
| Rate for Payer: Healthscope Commercial |
$107.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.44
|
| Rate for Payer: PHP Commercial |
$101.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.57
|
| Rate for Payer: Priority Health SBD |
$75.18
|
|
|
HC MOUSE IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200048
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.63
|
| Rate for Payer: BCN Commercial |
$4.63
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.37
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$4.30
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC MOUSE IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200048
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
|
|
HC MPCDS CELL SORTING BM
|
Facility
|
IP
|
$170.78
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31100048
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$107.59 |
| Max. Negotiated Rate |
$153.70 |
| Rate for Payer: Aetna Commercial |
$145.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.01
|
| Rate for Payer: Cash Price |
$136.62
|
| Rate for Payer: Cofinity Commercial |
$119.55
|
| Rate for Payer: Cofinity Commercial |
$146.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$119.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.62
|
| Rate for Payer: Healthscope Commercial |
$153.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.16
|
| Rate for Payer: PHP Commercial |
$145.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.01
|
| Rate for Payer: Priority Health SBD |
$107.59
|
|
