|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 4
|
Facility
|
OP
|
$274.46
|
|
|
Service Code
|
CPT 86363
|
| Hospital Charge Code |
30200500
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$247.01 |
| Rate for Payer: Aetna Commercial |
$233.29
|
| Rate for Payer: Aetna Medicare |
$39.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.16
|
| Rate for Payer: BCBS Complete |
$20.72
|
| Rate for Payer: BCBS MAPPO |
$37.73
|
| Rate for Payer: BCBS Trust/PPO |
$40.23
|
| Rate for Payer: BCN Commercial |
$40.23
|
| Rate for Payer: BCN Medicare Advantage |
$37.73
|
| Rate for Payer: Cash Price |
$219.57
|
| Rate for Payer: Cash Price |
$219.57
|
| Rate for Payer: Cofinity Advantage |
$192.12
|
| Rate for Payer: Cofinity Commercial |
$236.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.73
|
| Rate for Payer: Healthscope Commercial |
$247.01
|
| Rate for Payer: Mclaren Medicaid |
$19.73
|
| Rate for Payer: Mclaren Medicare |
$37.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.62
|
| Rate for Payer: Meridian Medicaid |
$39.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$41.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.29
|
| Rate for Payer: Nomi Health Commercial |
$56.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.84
|
| Rate for Payer: PACE Medicare |
$35.84
|
| Rate for Payer: PACE SWMI |
$37.73
|
| Rate for Payer: PHP Commercial |
$233.29
|
| Rate for Payer: PHP Medicare Advantage |
$37.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$37.73
|
| Rate for Payer: Priority Health Medicare |
$37.73
|
| Rate for Payer: Priority Health SBD |
$172.91
|
| Rate for Payer: Priority Health Tiered Network |
$30.18
|
| Rate for Payer: Railroad Medicare Medicare |
$37.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.60
|
| Rate for Payer: UHC Core |
$56.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.73
|
| Rate for Payer: UHC Exchange |
$56.60
|
| Rate for Payer: UHC Medicaid |
$19.73
|
| Rate for Payer: UHCCP Medicaid |
$19.73
|
| Rate for Payer: VA VA |
$37.73
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 4
|
Facility
|
IP
|
$274.46
|
|
|
Service Code
|
CPT 86363
|
| Hospital Charge Code |
30200500
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$172.91 |
| Max. Negotiated Rate |
$247.01 |
| Rate for Payer: Aetna Commercial |
$233.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.40
|
| Rate for Payer: Cash Price |
$219.57
|
| Rate for Payer: Cofinity Advantage |
$192.12
|
| Rate for Payer: Cofinity Commercial |
$236.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.57
|
| Rate for Payer: Healthscope Commercial |
$247.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.84
|
| Rate for Payer: PHP Commercial |
$233.29
|
| Rate for Payer: Priority Health SBD |
$172.91
|
|
|
HC PEDS ECHO COMPLETE
|
Facility
|
IP
|
$2,048.55
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
48300005
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,290.59 |
| Max. Negotiated Rate |
$1,843.69 |
| Rate for Payer: Aetna Commercial |
$1,741.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,331.56
|
| Rate for Payer: Cash Price |
$1,638.84
|
| Rate for Payer: Cofinity Advantage |
$1,433.98
|
| Rate for Payer: Cofinity Commercial |
$1,761.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,638.84
|
| Rate for Payer: Healthscope Commercial |
$1,843.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,741.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,536.41
|
| Rate for Payer: PHP Commercial |
$1,741.27
|
| Rate for Payer: Priority Health SBD |
$1,290.59
|
|
|
HC PEDS ECHO COMPLETE
|
Facility
|
OP
|
$2,048.55
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
48300005
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$284.75 |
| Max. Negotiated Rate |
$1,843.69 |
| Rate for Payer: Aetna Commercial |
$1,741.27
|
| Rate for Payer: Aetna Medicare |
$566.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,331.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$680.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$680.56
|
| Rate for Payer: BCBS Complete |
$299.01
|
| Rate for Payer: BCBS MAPPO |
$544.45
|
| Rate for Payer: BCBS Trust/PPO |
$561.11
|
| Rate for Payer: BCN Commercial |
$561.11
|
| Rate for Payer: BCN Medicare Advantage |
$544.45
|
| Rate for Payer: Cash Price |
$1,638.84
|
| Rate for Payer: Cash Price |
$1,638.84
|
| Rate for Payer: Cofinity Advantage |
$1,433.98
|
| Rate for Payer: Cofinity Commercial |
$1,761.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,638.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$544.45
|
| Rate for Payer: Healthscope Commercial |
$1,843.69
|
| Rate for Payer: Mclaren Medicaid |
$284.75
|
| Rate for Payer: Mclaren Medicare |
$544.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$571.67
|
| Rate for Payer: Meridian Medicaid |
$571.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$626.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$598.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,741.27
|
| Rate for Payer: Nomi Health Commercial |
$1,633.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,536.41
|
| Rate for Payer: PACE Medicare |
$517.23
|
| Rate for Payer: PACE SWMI |
$544.45
|
| Rate for Payer: PHP Commercial |
$1,741.27
|
| Rate for Payer: PHP Medicare Advantage |
$544.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$284.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,760.71
|
| Rate for Payer: Priority Health Medicare |
$544.45
|
| Rate for Payer: Priority Health SBD |
$1,290.59
|
| Rate for Payer: Priority Health Tiered Network |
$1,408.57
|
| Rate for Payer: Railroad Medicare Medicare |
$544.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,331.56
|
| Rate for Payer: UHC Core |
$1,067.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$544.45
|
| Rate for Payer: UHC Exchange |
$805.08
|
| Rate for Payer: UHC Medicaid |
$284.75
|
| Rate for Payer: UHCCP Medicaid |
$284.75
|
| Rate for Payer: VA VA |
$544.45
|
|
|
HC PEDS ECHO LIMITED
|
Facility
|
OP
|
$842.06
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
48300006
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$768.83 |
| Rate for Payer: Aetna Commercial |
$715.75
|
| Rate for Payer: Aetna Medicare |
$247.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$547.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$324.22
|
| Rate for Payer: BCN Commercial |
$324.22
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$673.65
|
| Rate for Payer: Cash Price |
$673.65
|
| Rate for Payer: Cofinity Advantage |
$589.44
|
| Rate for Payer: Cofinity Commercial |
$724.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$757.85
|
| Rate for Payer: Mclaren Medicaid |
$124.34
|
| Rate for Payer: Mclaren Medicare |
$237.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.63
|
| Rate for Payer: Meridian Medicaid |
$249.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.75
|
| Rate for Payer: Nomi Health Commercial |
$713.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$631.54
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$715.75
|
| Rate for Payer: PHP Medicare Advantage |
$237.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$768.83
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health SBD |
$530.50
|
| Rate for Payer: Priority Health Tiered Network |
$615.06
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$547.34
|
| Rate for Payer: UHC Core |
$438.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$330.93
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC PEDS ECHO LIMITED
|
Facility
|
IP
|
$842.06
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
48300006
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$530.50 |
| Max. Negotiated Rate |
$757.85 |
| Rate for Payer: Aetna Commercial |
$715.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$547.34
|
| Rate for Payer: Cash Price |
$673.65
|
| Rate for Payer: Cofinity Advantage |
$589.44
|
| Rate for Payer: Cofinity Commercial |
$724.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.65
|
| Rate for Payer: Healthscope Commercial |
$757.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$631.54
|
| Rate for Payer: PHP Commercial |
$715.75
|
| Rate for Payer: Priority Health SBD |
$530.50
|
|
|
HC PEDS ECHO W/DEFINITY
|
Facility
|
IP
|
$1,697.12
|
|
|
Service Code
|
HCPCS C8921
|
| Hospital Charge Code |
48000028
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,069.19 |
| Max. Negotiated Rate |
$1,527.41 |
| Rate for Payer: Aetna Commercial |
$1,442.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,103.13
|
| Rate for Payer: Cash Price |
$1,357.70
|
| Rate for Payer: Cofinity Advantage |
$1,187.98
|
| Rate for Payer: Cofinity Commercial |
$1,459.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,357.70
|
| Rate for Payer: Healthscope Commercial |
$1,527.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,442.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,272.84
|
| Rate for Payer: PHP Commercial |
$1,442.55
|
| Rate for Payer: Priority Health SBD |
$1,069.19
|
|
|
HC PEDS ECHO W/DEFINITY
|
Facility
|
OP
|
$1,697.12
|
|
|
Service Code
|
HCPCS C8921
|
| Hospital Charge Code |
48000028
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$408.52 |
| Max. Negotiated Rate |
$2,526.00 |
| Rate for Payer: Aetna Commercial |
$1,442.55
|
| Rate for Payer: Aetna Medicare |
$812.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,103.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$976.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$976.38
|
| Rate for Payer: BCBS Complete |
$428.98
|
| Rate for Payer: BCBS MAPPO |
$781.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,123.15
|
| Rate for Payer: BCN Commercial |
$1,123.15
|
| Rate for Payer: BCN Medicare Advantage |
$781.10
|
| Rate for Payer: Cash Price |
$1,357.70
|
| Rate for Payer: Cash Price |
$1,357.70
|
| Rate for Payer: Cofinity Advantage |
$1,187.98
|
| Rate for Payer: Cofinity Commercial |
$1,459.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,357.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$781.10
|
| Rate for Payer: Healthscope Commercial |
$1,527.41
|
| Rate for Payer: Mclaren Medicaid |
$408.52
|
| Rate for Payer: Mclaren Medicare |
$781.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$820.15
|
| Rate for Payer: Meridian Medicaid |
$820.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$898.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$859.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,442.55
|
| Rate for Payer: Nomi Health Commercial |
$2,343.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,272.84
|
| Rate for Payer: PACE Medicare |
$742.04
|
| Rate for Payer: PACE SWMI |
$781.10
|
| Rate for Payer: PHP Commercial |
$1,442.55
|
| Rate for Payer: PHP Medicare Advantage |
$781.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$408.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,526.00
|
| Rate for Payer: Priority Health Medicare |
$781.10
|
| Rate for Payer: Priority Health SBD |
$1,069.19
|
| Rate for Payer: Priority Health Tiered Network |
$2,020.80
|
| Rate for Payer: Railroad Medicare Medicare |
$781.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,103.13
|
| Rate for Payer: UHC Core |
$884.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$781.10
|
| Rate for Payer: UHC Exchange |
$666.97
|
| Rate for Payer: UHC Medicaid |
$408.52
|
| Rate for Payer: UHCCP Medicaid |
$408.52
|
| Rate for Payer: VA VA |
$781.10
|
|
|
HC PEDS OBS OVERFLOW PER HR
|
Facility
|
IP
|
$160.00
|
|
| Hospital Charge Code |
76900003
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Advantage |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health SBD |
$100.80
|
|
|
HC PEDS OBS OVERFLOW PER HR
|
Facility
|
OP
|
$160.00
|
|
| Hospital Charge Code |
76900003
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$62.88 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna Medicare |
$80.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.00
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Advantage |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health SBD |
$100.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.00
|
| Rate for Payer: UHC Core |
$83.36
|
| Rate for Payer: UHC Exchange |
$62.88
|
|
|
HC PEDS VENT INIT DAY
|
Facility
|
IP
|
$1,551.92
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000035
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$977.71 |
| Max. Negotiated Rate |
$1,396.73 |
| Rate for Payer: Aetna Commercial |
$1,319.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,008.75
|
| Rate for Payer: Cash Price |
$1,241.54
|
| Rate for Payer: Cofinity Advantage |
$1,086.34
|
| Rate for Payer: Cofinity Commercial |
$1,334.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,241.54
|
| Rate for Payer: Healthscope Commercial |
$1,396.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,319.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,163.94
|
| Rate for Payer: PHP Commercial |
$1,319.13
|
| Rate for Payer: Priority Health SBD |
$977.71
|
|
|
HC PEDS VENT INIT DAY
|
Facility
|
OP
|
$1,551.92
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000035
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$84.39 |
| Max. Negotiated Rate |
$1,990.71 |
| Rate for Payer: Aetna Commercial |
$1,319.13
|
| Rate for Payer: Aetna Medicare |
$640.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,008.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$769.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$769.46
|
| Rate for Payer: BCBS Complete |
$338.07
|
| Rate for Payer: BCBS MAPPO |
$615.57
|
| Rate for Payer: BCBS Trust/PPO |
$84.39
|
| Rate for Payer: BCN Commercial |
$84.39
|
| Rate for Payer: BCN Medicare Advantage |
$615.57
|
| Rate for Payer: Cash Price |
$1,241.54
|
| Rate for Payer: Cash Price |
$1,241.54
|
| Rate for Payer: Cofinity Advantage |
$1,086.34
|
| Rate for Payer: Cofinity Commercial |
$1,334.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,241.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.57
|
| Rate for Payer: Healthscope Commercial |
$1,396.73
|
| Rate for Payer: Mclaren Medicaid |
$321.94
|
| Rate for Payer: Mclaren Medicare |
$615.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$646.35
|
| Rate for Payer: Meridian Medicaid |
$646.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$707.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$677.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,319.13
|
| Rate for Payer: Nomi Health Commercial |
$1,846.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,163.94
|
| Rate for Payer: PACE Medicare |
$584.79
|
| Rate for Payer: PACE SWMI |
$615.57
|
| Rate for Payer: PHP Commercial |
$1,319.13
|
| Rate for Payer: PHP Medicare Advantage |
$615.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,990.71
|
| Rate for Payer: Priority Health Medicare |
$615.57
|
| Rate for Payer: Priority Health SBD |
$977.71
|
| Rate for Payer: Priority Health Tiered Network |
$1,592.57
|
| Rate for Payer: Railroad Medicare Medicare |
$615.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,008.75
|
| Rate for Payer: UHC Core |
$808.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$615.57
|
| Rate for Payer: UHC Exchange |
$609.90
|
| Rate for Payer: UHC Medicaid |
$321.94
|
| Rate for Payer: UHCCP Medicaid |
$321.94
|
| Rate for Payer: VA VA |
$615.57
|
|
|
HC PEDS VENT SUB DAY
|
Facility
|
OP
|
$1,341.51
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000036
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$62.18 |
| Max. Negotiated Rate |
$1,990.71 |
| Rate for Payer: Aetna Commercial |
$1,140.28
|
| Rate for Payer: Aetna Medicare |
$640.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$871.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$769.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$769.46
|
| Rate for Payer: BCBS Complete |
$338.07
|
| Rate for Payer: BCBS MAPPO |
$615.57
|
| Rate for Payer: BCBS Trust/PPO |
$62.18
|
| Rate for Payer: BCN Commercial |
$62.18
|
| Rate for Payer: BCN Medicare Advantage |
$615.57
|
| Rate for Payer: Cash Price |
$1,073.21
|
| Rate for Payer: Cash Price |
$1,073.21
|
| Rate for Payer: Cofinity Advantage |
$939.06
|
| Rate for Payer: Cofinity Commercial |
$1,153.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,073.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.57
|
| Rate for Payer: Healthscope Commercial |
$1,207.36
|
| Rate for Payer: Mclaren Medicaid |
$321.94
|
| Rate for Payer: Mclaren Medicare |
$615.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$646.35
|
| Rate for Payer: Meridian Medicaid |
$646.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$707.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$677.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,140.28
|
| Rate for Payer: Nomi Health Commercial |
$1,846.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,006.13
|
| Rate for Payer: PACE Medicare |
$584.79
|
| Rate for Payer: PACE SWMI |
$615.57
|
| Rate for Payer: PHP Commercial |
$1,140.28
|
| Rate for Payer: PHP Medicare Advantage |
$615.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,990.71
|
| Rate for Payer: Priority Health Medicare |
$615.57
|
| Rate for Payer: Priority Health SBD |
$845.15
|
| Rate for Payer: Priority Health Tiered Network |
$1,592.57
|
| Rate for Payer: Railroad Medicare Medicare |
$615.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$871.98
|
| Rate for Payer: UHC Core |
$698.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$615.57
|
| Rate for Payer: UHC Exchange |
$527.21
|
| Rate for Payer: UHC Medicaid |
$321.94
|
| Rate for Payer: UHCCP Medicaid |
$321.94
|
| Rate for Payer: VA VA |
$615.57
|
|
|
HC PEDS VENT SUB DAY
|
Facility
|
IP
|
$1,341.51
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000036
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$845.15 |
| Max. Negotiated Rate |
$1,207.36 |
| Rate for Payer: Aetna Commercial |
$1,140.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$871.98
|
| Rate for Payer: Cash Price |
$1,073.21
|
| Rate for Payer: Cofinity Advantage |
$939.06
|
| Rate for Payer: Cofinity Commercial |
$1,153.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,073.21
|
| Rate for Payer: Healthscope Commercial |
$1,207.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,140.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,006.13
|
| Rate for Payer: PHP Commercial |
$1,140.28
|
| Rate for Payer: Priority Health SBD |
$845.15
|
|
|
HC PEG TUBE INSERTION/TRAY
|
Facility
|
IP
|
$1,235.07
|
|
| Hospital Charge Code |
36000079
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$778.09 |
| Max. Negotiated Rate |
$1,111.56 |
| Rate for Payer: Aetna Commercial |
$1,049.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$802.80
|
| Rate for Payer: Cash Price |
$988.06
|
| Rate for Payer: Cofinity Advantage |
$864.55
|
| Rate for Payer: Cofinity Commercial |
$1,062.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$988.06
|
| Rate for Payer: Healthscope Commercial |
$1,111.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,049.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$926.30
|
| Rate for Payer: PHP Commercial |
$1,049.81
|
| Rate for Payer: Priority Health SBD |
$778.09
|
|
|
HC PEG TUBE INSERTION/TRAY
|
Facility
|
OP
|
$1,235.07
|
|
| Hospital Charge Code |
36000079
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$494.03 |
| Max. Negotiated Rate |
$1,111.56 |
| Rate for Payer: Aetna Commercial |
$1,049.81
|
| Rate for Payer: Aetna Medicare |
$617.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$802.80
|
| Rate for Payer: BCBS Complete |
$494.03
|
| Rate for Payer: Cash Price |
$988.06
|
| Rate for Payer: Cofinity Advantage |
$864.55
|
| Rate for Payer: Cofinity Commercial |
$1,062.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$988.06
|
| Rate for Payer: Healthscope Commercial |
$1,111.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$988.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,049.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$926.30
|
| Rate for Payer: PHP Commercial |
$1,049.81
|
| Rate for Payer: Priority Health SBD |
$778.09
|
|
|
HC PEJ FDG TUBE INSERTION/REPLACE
|
Facility
|
IP
|
$1,555.53
|
|
| Hospital Charge Code |
36000059
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$979.98 |
| Max. Negotiated Rate |
$1,399.98 |
| Rate for Payer: Aetna Commercial |
$1,322.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,011.09
|
| Rate for Payer: Cash Price |
$1,244.42
|
| Rate for Payer: Cofinity Advantage |
$1,088.87
|
| Rate for Payer: Cofinity Commercial |
$1,337.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,244.42
|
| Rate for Payer: Healthscope Commercial |
$1,399.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,322.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,166.65
|
| Rate for Payer: PHP Commercial |
$1,322.20
|
| Rate for Payer: Priority Health SBD |
$979.98
|
|
|
HC PEJ FDG TUBE INSERTION/REPLACE
|
Facility
|
OP
|
$1,555.53
|
|
| Hospital Charge Code |
36000059
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$622.21 |
| Max. Negotiated Rate |
$1,399.98 |
| Rate for Payer: Aetna Commercial |
$1,322.20
|
| Rate for Payer: Aetna Medicare |
$777.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,011.09
|
| Rate for Payer: BCBS Complete |
$622.21
|
| Rate for Payer: Cash Price |
$1,244.42
|
| Rate for Payer: Cofinity Advantage |
$1,088.87
|
| Rate for Payer: Cofinity Commercial |
$1,337.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,244.42
|
| Rate for Payer: Healthscope Commercial |
$1,399.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,244.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,322.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,166.65
|
| Rate for Payer: PHP Commercial |
$1,322.20
|
| Rate for Payer: Priority Health SBD |
$979.98
|
|
|
HC PELVIC EXAMINATION
|
Facility
|
OP
|
$47.94
|
|
|
Service Code
|
CPT 99459
|
| Hospital Charge Code |
51000129
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.76 |
| Max. Negotiated Rate |
$94.76 |
| Rate for Payer: Aetna Commercial |
$40.75
|
| Rate for Payer: Aetna Medicare |
$23.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.16
|
| Rate for Payer: BCBS Complete |
$19.18
|
| Rate for Payer: BCBS Trust/PPO |
$94.76
|
| Rate for Payer: BCCCP Commercial |
$16.76
|
| Rate for Payer: BCN Commercial |
$94.76
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cofinity Advantage |
$33.56
|
| Rate for Payer: Cofinity Commercial |
$41.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.35
|
| Rate for Payer: Healthscope Commercial |
$43.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.95
|
| Rate for Payer: PHP Commercial |
$40.75
|
| Rate for Payer: Priority Health SBD |
$30.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.16
|
| Rate for Payer: UHC Core |
$24.98
|
| Rate for Payer: UHC Exchange |
$18.84
|
|
|
HC PELVIC EXAMINATION
|
Facility
|
IP
|
$47.94
|
|
|
Service Code
|
CPT 99459
|
| Hospital Charge Code |
51000129
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.20 |
| Max. Negotiated Rate |
$43.15 |
| Rate for Payer: Aetna Commercial |
$40.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.16
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cofinity Advantage |
$33.56
|
| Rate for Payer: Cofinity Commercial |
$41.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.35
|
| Rate for Payer: Healthscope Commercial |
$43.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.95
|
| Rate for Payer: PHP Commercial |
$40.75
|
| Rate for Payer: Priority Health SBD |
$30.20
|
|
|
HC PENICILLIUM IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200055
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| 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 |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC PENICILLIUM IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200055
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
|
|
HC PENTAMIDINE THERAPY
|
Facility
|
IP
|
$1,054.22
|
|
|
Service Code
|
CPT 94642
|
| Hospital Charge Code |
41000005
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$664.16 |
| Max. Negotiated Rate |
$948.80 |
| Rate for Payer: Aetna Commercial |
$896.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$685.24
|
| Rate for Payer: Cash Price |
$843.38
|
| Rate for Payer: Cofinity Advantage |
$737.95
|
| Rate for Payer: Cofinity Commercial |
$906.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$843.38
|
| Rate for Payer: Healthscope Commercial |
$948.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$896.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$790.66
|
| Rate for Payer: PHP Commercial |
$896.09
|
| Rate for Payer: Priority Health SBD |
$664.16
|
|
|
HC PENTAMIDINE THERAPY
|
Facility
|
OP
|
$1,054.22
|
|
|
Service Code
|
CPT 94642
|
| Hospital Charge Code |
41000005
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$114.11 |
| Max. Negotiated Rate |
$948.80 |
| Rate for Payer: Aetna Commercial |
$896.09
|
| Rate for Payer: Aetna Medicare |
$226.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$685.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.74
|
| Rate for Payer: BCBS Complete |
$119.83
|
| Rate for Payer: BCBS MAPPO |
$218.19
|
| Rate for Payer: BCBS Trust/PPO |
$565.36
|
| Rate for Payer: BCN Commercial |
$565.36
|
| Rate for Payer: BCN Medicare Advantage |
$218.19
|
| Rate for Payer: Cash Price |
$843.38
|
| Rate for Payer: Cash Price |
$843.38
|
| Rate for Payer: Cofinity Advantage |
$737.95
|
| Rate for Payer: Cofinity Commercial |
$906.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$843.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.19
|
| Rate for Payer: Healthscope Commercial |
$948.80
|
| Rate for Payer: Mclaren Medicaid |
$114.11
|
| Rate for Payer: Mclaren Medicare |
$218.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$229.10
|
| Rate for Payer: Meridian Medicaid |
$229.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$240.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$896.09
|
| Rate for Payer: Nomi Health Commercial |
$654.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$790.66
|
| Rate for Payer: PACE Medicare |
$207.28
|
| Rate for Payer: PACE SWMI |
$218.19
|
| Rate for Payer: PHP Commercial |
$896.09
|
| Rate for Payer: PHP Medicare Advantage |
$218.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$705.61
|
| Rate for Payer: Priority Health Medicare |
$218.19
|
| Rate for Payer: Priority Health SBD |
$664.16
|
| Rate for Payer: Priority Health Tiered Network |
$564.49
|
| Rate for Payer: Railroad Medicare Medicare |
$218.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$685.24
|
| Rate for Payer: UHC Core |
$549.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$218.19
|
| Rate for Payer: UHC Exchange |
$414.31
|
| Rate for Payer: UHC Medicaid |
$114.11
|
| Rate for Payer: UHCCP Medicaid |
$114.11
|
| Rate for Payer: VA VA |
$218.19
|
|
|
HC PENTOBARBITOL NEMBUTAL LVL
|
Facility
|
IP
|
$182.07
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
30100572
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$114.70 |
| Max. Negotiated Rate |
$163.86 |
| Rate for Payer: Aetna Commercial |
$154.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.35
|
| Rate for Payer: Cash Price |
$145.66
|
| Rate for Payer: Cofinity Advantage |
$127.45
|
| Rate for Payer: Cofinity Commercial |
$156.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.66
|
| Rate for Payer: Healthscope Commercial |
$163.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.55
|
| Rate for Payer: PHP Commercial |
$154.76
|
| Rate for Payer: Priority Health SBD |
$114.70
|
|
