|
HC PATH SURGERY CYTO ADDITIONAL
|
Facility
|
OP
|
$57.22
|
|
|
Service Code
|
CPT 88334
|
| Hospital Charge Code |
30000068
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.89 |
| Max. Negotiated Rate |
$51.50 |
| Rate for Payer: Aetna Commercial |
$48.64
|
| Rate for Payer: Aetna Medicare |
$28.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.19
|
| Rate for Payer: BCBS Complete |
$22.89
|
| Rate for Payer: Cash Price |
$45.78
|
| Rate for Payer: Cofinity Commercial |
$40.05
|
| Rate for Payer: Cofinity Commercial |
$49.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.78
|
| Rate for Payer: Healthscope Commercial |
$51.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.64
|
| Rate for Payer: PHP Commercial |
$48.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.19
|
| Rate for Payer: Priority Health SBD |
$36.05
|
|
|
HC PATH SURGERY CYTO INITIAL SITE
|
Facility
|
OP
|
$90.51
|
|
|
Service Code
|
CPT 88333
|
| Hospital Charge Code |
30000067
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.02 |
| Max. Negotiated Rate |
$2,242.66 |
| Rate for Payer: Aetna Commercial |
$76.93
|
| Rate for Payer: Aetna Medicare |
$828.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$995.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$995.89
|
| Rate for Payer: BCBS Complete |
$448.39
|
| Rate for Payer: BCBS MAPPO |
$796.71
|
| Rate for Payer: BCN Medicare Advantage |
$796.71
|
| Rate for Payer: Cash Price |
$72.41
|
| Rate for Payer: Cash Price |
$72.41
|
| Rate for Payer: Cofinity Commercial |
$77.84
|
| Rate for Payer: Cofinity Commercial |
$63.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$796.71
|
| Rate for Payer: Healthscope Commercial |
$81.46
|
| Rate for Payer: Mclaren Medicaid |
$427.04
|
| Rate for Payer: Mclaren Medicare |
$796.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$836.55
|
| Rate for Payer: Meridian Medicaid |
$448.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$916.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.93
|
| Rate for Payer: PACE Medicare |
$756.87
|
| Rate for Payer: PACE SWMI |
$796.71
|
| Rate for Payer: PHP Commercial |
$76.93
|
| Rate for Payer: PHP Medicare Advantage |
$796.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$427.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.83
|
| Rate for Payer: Priority Health Medicare |
$796.71
|
| Rate for Payer: Priority Health SBD |
$57.02
|
| Rate for Payer: Railroad Medicare Medicare |
$796.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,242.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$796.71
|
| Rate for Payer: UHC Medicare Advantage |
$796.71
|
| Rate for Payer: UHCCP Medicaid |
$448.55
|
| Rate for Payer: VA VA |
$796.71
|
|
|
HC PATH SURGERY CYTO INITIAL SITE
|
Facility
|
IP
|
$90.51
|
|
|
Service Code
|
CPT 88333
|
| Hospital Charge Code |
30000067
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.02 |
| Max. Negotiated Rate |
$81.46 |
| Rate for Payer: Aetna Commercial |
$76.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.83
|
| Rate for Payer: Cash Price |
$72.41
|
| Rate for Payer: Cofinity Commercial |
$63.36
|
| Rate for Payer: Cofinity Commercial |
$77.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.41
|
| Rate for Payer: Healthscope Commercial |
$81.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.93
|
| Rate for Payer: PHP Commercial |
$76.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.83
|
| Rate for Payer: Priority Health SBD |
$57.02
|
|
|
HC PCP SCREEN URIN
|
Facility
|
IP
|
$94.53
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000136
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.55 |
| Max. Negotiated Rate |
$85.08 |
| Rate for Payer: Aetna Commercial |
$80.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.44
|
| Rate for Payer: Cash Price |
$75.62
|
| Rate for Payer: Cofinity Commercial |
$66.17
|
| Rate for Payer: Cofinity Commercial |
$81.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.62
|
| Rate for Payer: Healthscope Commercial |
$85.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.35
|
| Rate for Payer: PHP Commercial |
$80.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.44
|
| Rate for Payer: Priority Health SBD |
$59.55
|
|
|
HC PCP SCREEN URIN
|
Facility
|
OP
|
$94.53
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000136
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$174.92 |
| Rate for Payer: Aetna Commercial |
$80.35
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: BCBS Complete |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$75.62
|
| Rate for Payer: Cash Price |
$75.62
|
| Rate for Payer: Cofinity Commercial |
$81.30
|
| Rate for Payer: Cofinity Commercial |
$66.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$85.08
|
| Rate for Payer: Mclaren Medicaid |
$33.31
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.35
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$80.35
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.44
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$59.55
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$34.98
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC PCP SCREEN URN.
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000120
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna Medicare |
$13.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.75
|
| Rate for Payer: BCBS Complete |
$7.09
|
| Rate for Payer: BCBS MAPPO |
$12.60
|
| Rate for Payer: BCN Medicare Advantage |
$12.60
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Cofinity Commercial |
$29.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Mclaren Medicaid |
$6.75
|
| Rate for Payer: Mclaren Medicare |
$12.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.23
|
| Rate for Payer: Meridian Medicaid |
$7.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: PACE Medicare |
$11.97
|
| Rate for Payer: PACE SWMI |
$12.60
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: PHP Medicare Advantage |
$12.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health Medicare |
$12.60
|
| Rate for Payer: Priority Health SBD |
$26.22
|
| Rate for Payer: Railroad Medicare Medicare |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.60
|
| Rate for Payer: UHC Medicare Advantage |
$12.60
|
| Rate for Payer: UHCCP Medicaid |
$7.09
|
| Rate for Payer: VA VA |
$12.60
|
|
|
HC PCP SCREEN URN.
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000120
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.22 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.05
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health SBD |
$26.22
|
|
|
HC PCV20 VACCINE FOR INTRAMUSCULAR USE
|
Facility
|
OP
|
$394.74
|
|
|
Service Code
|
CPT 90677
|
| Hospital Charge Code |
63600208
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$157.90 |
| Max. Negotiated Rate |
$355.27 |
| Rate for Payer: Aetna Commercial |
$335.53
|
| Rate for Payer: Aetna Medicare |
$197.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.58
|
| Rate for Payer: BCBS Complete |
$157.90
|
| Rate for Payer: Cash Price |
$315.79
|
| Rate for Payer: Cofinity Commercial |
$276.32
|
| Rate for Payer: Cofinity Commercial |
$339.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$276.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.79
|
| Rate for Payer: Healthscope Commercial |
$355.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.53
|
| Rate for Payer: PHP Commercial |
$335.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.58
|
| Rate for Payer: Priority Health SBD |
$248.69
|
|
|
HC PCV20 VACCINE FOR INTRAMUSCULAR USE
|
Facility
|
IP
|
$394.74
|
|
|
Service Code
|
CPT 90677
|
| Hospital Charge Code |
63600208
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$248.69 |
| Max. Negotiated Rate |
$355.27 |
| Rate for Payer: Aetna Commercial |
$335.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.58
|
| Rate for Payer: Cash Price |
$315.79
|
| Rate for Payer: Cofinity Commercial |
$276.32
|
| Rate for Payer: Cofinity Commercial |
$339.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$276.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.79
|
| Rate for Payer: Healthscope Commercial |
$355.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.53
|
| Rate for Payer: PHP Commercial |
$335.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.58
|
| Rate for Payer: Priority Health SBD |
$248.69
|
|
|
HC PEAK FLOW METER
|
Facility
|
OP
|
$29.15
|
|
| Hospital Charge Code |
27000132
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.66 |
| Max. Negotiated Rate |
$26.23 |
| Rate for Payer: Aetna Commercial |
$24.78
|
| Rate for Payer: Aetna Medicare |
$14.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.95
|
| Rate for Payer: BCBS Complete |
$11.66
|
| Rate for Payer: Cash Price |
$23.32
|
| Rate for Payer: Cofinity Commercial |
$20.41
|
| Rate for Payer: Cofinity Commercial |
$25.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.32
|
| Rate for Payer: Healthscope Commercial |
$26.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.78
|
| Rate for Payer: PHP Commercial |
$24.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.95
|
| Rate for Payer: Priority Health SBD |
$18.36
|
|
|
HC PEAK FLOW METER
|
Facility
|
IP
|
$29.15
|
|
| Hospital Charge Code |
27000132
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.36 |
| Max. Negotiated Rate |
$26.23 |
| Rate for Payer: Aetna Commercial |
$24.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.95
|
| Rate for Payer: Cash Price |
$23.32
|
| Rate for Payer: Cofinity Commercial |
$20.41
|
| Rate for Payer: Cofinity Commercial |
$25.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.32
|
| Rate for Payer: Healthscope Commercial |
$26.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.78
|
| Rate for Payer: PHP Commercial |
$24.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.95
|
| Rate for Payer: Priority Health SBD |
$18.36
|
|
|
HC PEANUT IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200054
|
|
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 PEANUT IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200054
|
|
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 |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| 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: 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 Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| 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 PECAN NUT IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200117
|
|
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 PECAN NUT IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200117
|
|
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 |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| 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: 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 Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| 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 PED MINOR TREATMENT RM
|
Facility
|
OP
|
$129.02
|
|
| Hospital Charge Code |
51000044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.61 |
| Max. Negotiated Rate |
$116.12 |
| Rate for Payer: Aetna Commercial |
$109.67
|
| Rate for Payer: Aetna Medicare |
$64.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.86
|
| Rate for Payer: BCBS Complete |
$51.61
|
| Rate for Payer: Cash Price |
$103.22
|
| Rate for Payer: Cofinity Commercial |
$110.96
|
| Rate for Payer: Cofinity Commercial |
$90.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.22
|
| Rate for Payer: Healthscope Commercial |
$116.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.67
|
| Rate for Payer: PHP Commercial |
$109.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.86
|
| Rate for Payer: Priority Health SBD |
$81.28
|
|
|
HC PED MINOR TREATMENT RM
|
Facility
|
IP
|
$129.02
|
|
| Hospital Charge Code |
51000044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.28 |
| Max. Negotiated Rate |
$116.12 |
| Rate for Payer: Aetna Commercial |
$109.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.86
|
| Rate for Payer: Cash Price |
$103.22
|
| Rate for Payer: Cofinity Commercial |
$110.96
|
| Rate for Payer: Cofinity Commercial |
$90.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.22
|
| Rate for Payer: Healthscope Commercial |
$116.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.67
|
| Rate for Payer: PHP Commercial |
$109.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.86
|
| Rate for Payer: Priority Health SBD |
$81.28
|
|
|
HC PED OBSERVATION PER HOUR
|
Facility
|
IP
|
$165.57
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200014
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$104.31 |
| Max. Negotiated Rate |
$149.01 |
| Rate for Payer: Aetna Commercial |
$140.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.62
|
| Rate for Payer: Cash Price |
$132.46
|
| Rate for Payer: Cofinity Commercial |
$115.90
|
| Rate for Payer: Cofinity Commercial |
$142.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.46
|
| Rate for Payer: Healthscope Commercial |
$149.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.73
|
| Rate for Payer: PHP Commercial |
$140.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.62
|
| Rate for Payer: Priority Health SBD |
$104.31
|
|
|
HC PED OBSERVATION PER HOUR
|
Facility
|
OP
|
$165.57
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200014
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$66.23 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$140.73
|
| Rate for Payer: Aetna Medicare |
$82.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.62
|
| Rate for Payer: BCBS Complete |
$66.23
|
| Rate for Payer: Cash Price |
$132.46
|
| Rate for Payer: Cash Price |
$132.46
|
| Rate for Payer: Cofinity Commercial |
$115.90
|
| Rate for Payer: Cofinity Commercial |
$142.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.46
|
| Rate for Payer: Healthscope Commercial |
$149.01
|
| Rate for Payer: Meridian Medicaid |
$1,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.73
|
| Rate for Payer: PHP Commercial |
$140.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.62
|
| Rate for Payer: Priority Health SBD |
$104.31
|
| Rate for Payer: UHC Core |
$122.52
|
| Rate for Payer: UHC Exchange |
$122.52
|
|
|
HC PED OR PICU MED SURG R&B
|
Facility
|
IP
|
$5,325.60
|
|
| Hospital Charge Code |
11300001
|
|
Hospital Revenue Code
|
113
|
| Min. Negotiated Rate |
$3,355.13 |
| Max. Negotiated Rate |
$4,793.04 |
| Rate for Payer: Aetna Commercial |
$4,526.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,461.64
|
| Rate for Payer: Cash Price |
$4,260.48
|
| Rate for Payer: Cofinity Commercial |
$3,727.92
|
| Rate for Payer: Cofinity Commercial |
$4,580.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,727.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,260.48
|
| Rate for Payer: Healthscope Commercial |
$4,793.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,526.76
|
| Rate for Payer: PHP Commercial |
$4,526.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,461.64
|
| Rate for Payer: Priority Health SBD |
$3,355.13
|
|
|
HC PED OR PICU ROOM & BOARD
|
Facility
|
IP
|
$5,325.60
|
|
| Hospital Charge Code |
12300001
|
|
Hospital Revenue Code
|
123
|
| Min. Negotiated Rate |
$3,355.13 |
| Max. Negotiated Rate |
$4,793.04 |
| Rate for Payer: Aetna Commercial |
$4,526.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,461.64
|
| Rate for Payer: Cash Price |
$4,260.48
|
| Rate for Payer: Cofinity Commercial |
$3,727.92
|
| Rate for Payer: Cofinity Commercial |
$4,580.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,727.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,260.48
|
| Rate for Payer: Healthscope Commercial |
$4,793.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,526.76
|
| Rate for Payer: PHP Commercial |
$4,526.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,461.64
|
| Rate for Payer: Priority Health SBD |
$3,355.13
|
|
|
HC PED POUCH W/WAFER
|
Facility
|
IP
|
$22.45
|
|
| Hospital Charge Code |
27000133
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.14 |
| Max. Negotiated Rate |
$20.20 |
| Rate for Payer: Aetna Commercial |
$19.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.59
|
| Rate for Payer: Cash Price |
$17.96
|
| Rate for Payer: Cofinity Commercial |
$15.71
|
| Rate for Payer: Cofinity Commercial |
$19.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.96
|
| Rate for Payer: Healthscope Commercial |
$20.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.08
|
| Rate for Payer: PHP Commercial |
$19.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.59
|
| Rate for Payer: Priority Health SBD |
$14.14
|
|
|
HC PED POUCH W/WAFER
|
Facility
|
OP
|
$22.45
|
|
| Hospital Charge Code |
27000133
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.98 |
| Max. Negotiated Rate |
$20.20 |
| Rate for Payer: Aetna Commercial |
$19.08
|
| Rate for Payer: Aetna Medicare |
$11.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.59
|
| Rate for Payer: BCBS Complete |
$8.98
|
| Rate for Payer: Cash Price |
$17.96
|
| Rate for Payer: Cofinity Commercial |
$15.71
|
| Rate for Payer: Cofinity Commercial |
$19.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.96
|
| Rate for Payer: Healthscope Commercial |
$20.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.08
|
| Rate for Payer: PHP Commercial |
$19.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.59
|
| Rate for Payer: Priority Health SBD |
$14.14
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 1
|
Facility
|
IP
|
$165.29
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200497
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$104.13 |
| Max. Negotiated Rate |
$148.76 |
| Rate for Payer: Aetna Commercial |
$140.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.44
|
| Rate for Payer: Cash Price |
$132.23
|
| Rate for Payer: Cofinity Commercial |
$115.70
|
| Rate for Payer: Cofinity Commercial |
$142.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.23
|
| Rate for Payer: Healthscope Commercial |
$148.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.50
|
| Rate for Payer: PHP Commercial |
$140.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.44
|
| Rate for Payer: Priority Health SBD |
$104.13
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 1
|
Facility
|
OP
|
$165.29
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200497
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.63 |
| Max. Negotiated Rate |
$148.76 |
| Rate for Payer: Aetna Commercial |
$140.50
|
| Rate for Payer: Aetna Medicare |
$24.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.46
|
| Rate for Payer: BCBS Complete |
$13.27
|
| Rate for Payer: BCBS MAPPO |
$23.57
|
| Rate for Payer: BCN Medicare Advantage |
$23.57
|
| Rate for Payer: Cash Price |
$132.23
|
| Rate for Payer: Cash Price |
$132.23
|
| Rate for Payer: Cofinity Commercial |
$142.15
|
| Rate for Payer: Cofinity Commercial |
$115.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.57
|
| Rate for Payer: Healthscope Commercial |
$148.76
|
| Rate for Payer: Mclaren Medicaid |
$12.63
|
| Rate for Payer: Mclaren Medicare |
$23.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.75
|
| Rate for Payer: Meridian Medicaid |
$13.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.50
|
| Rate for Payer: PACE Medicare |
$22.39
|
| Rate for Payer: PACE SWMI |
$23.57
|
| Rate for Payer: PHP Commercial |
$140.50
|
| Rate for Payer: PHP Medicare Advantage |
$23.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.44
|
| Rate for Payer: Priority Health Medicare |
$23.57
|
| Rate for Payer: Priority Health SBD |
$104.13
|
| Rate for Payer: Railroad Medicare Medicare |
$23.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.57
|
| Rate for Payer: UHC Medicare Advantage |
$23.57
|
| Rate for Payer: UHCCP Medicaid |
$13.27
|
| Rate for Payer: VA VA |
$23.57
|
|
