|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 2
|
Facility
|
OP
|
$90.11
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200498
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$81.10 |
| Rate for Payer: Aetna Commercial |
$76.59
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$72.09
|
| Rate for Payer: Cash Price |
$72.09
|
| Rate for Payer: Cofinity Commercial |
$77.49
|
| Rate for Payer: Cofinity Commercial |
$63.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$81.10
|
| 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 |
$76.59
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$76.59
|
| 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 |
$58.57
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$56.77
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.78
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 2
|
Facility
|
IP
|
$90.11
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200498
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$56.77 |
| Max. Negotiated Rate |
$81.10 |
| Rate for Payer: Aetna Commercial |
$76.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.57
|
| Rate for Payer: Cash Price |
$72.09
|
| Rate for Payer: Cofinity Commercial |
$63.08
|
| Rate for Payer: Cofinity Commercial |
$77.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.09
|
| Rate for Payer: Healthscope Commercial |
$81.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.59
|
| Rate for Payer: PHP Commercial |
$76.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.57
|
| Rate for Payer: Priority Health SBD |
$56.77
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 3
|
Facility
|
IP
|
$269.08
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
30200499
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$169.52 |
| Max. Negotiated Rate |
$242.17 |
| Rate for Payer: Aetna Commercial |
$228.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.90
|
| Rate for Payer: Cash Price |
$215.26
|
| Rate for Payer: Cofinity Commercial |
$188.36
|
| Rate for Payer: Cofinity Commercial |
$231.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$188.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.26
|
| Rate for Payer: Healthscope Commercial |
$242.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.72
|
| Rate for Payer: PHP Commercial |
$228.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.90
|
| Rate for Payer: Priority Health SBD |
$169.52
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 3
|
Facility
|
OP
|
$269.08
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
30200499
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.22 |
| Max. Negotiated Rate |
$242.17 |
| Rate for Payer: Aetna Commercial |
$228.72
|
| Rate for Payer: Aetna Medicare |
$39.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.90
|
| 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 |
$21.23
|
| Rate for Payer: BCBS MAPPO |
$37.73
|
| Rate for Payer: BCN Medicare Advantage |
$37.73
|
| Rate for Payer: Cash Price |
$215.26
|
| Rate for Payer: Cash Price |
$215.26
|
| Rate for Payer: Cofinity Commercial |
$231.41
|
| Rate for Payer: Cofinity Commercial |
$188.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$188.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.73
|
| Rate for Payer: Healthscope Commercial |
$242.17
|
| Rate for Payer: Mclaren Medicaid |
$20.22
|
| 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 |
$21.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.72
|
| Rate for Payer: PACE Medicare |
$35.84
|
| Rate for Payer: PACE SWMI |
$37.73
|
| Rate for Payer: PHP Commercial |
$228.72
|
| Rate for Payer: PHP Medicare Advantage |
$37.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.90
|
| Rate for Payer: Priority Health Medicare |
$37.73
|
| Rate for Payer: Priority Health SBD |
$169.52
|
| Rate for Payer: Railroad Medicare Medicare |
$37.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.73
|
| Rate for Payer: UHC Medicare Advantage |
$37.73
|
| Rate for Payer: UHCCP Medicaid |
$21.24
|
| Rate for Payer: VA VA |
$37.73
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 4
|
Facility
|
IP
|
$269.08
|
|
|
Service Code
|
CPT 86363
|
| Hospital Charge Code |
30200500
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$169.52 |
| Max. Negotiated Rate |
$242.17 |
| Rate for Payer: Aetna Commercial |
$228.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.90
|
| Rate for Payer: Cash Price |
$215.26
|
| Rate for Payer: Cofinity Commercial |
$188.36
|
| Rate for Payer: Cofinity Commercial |
$231.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$188.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.26
|
| Rate for Payer: Healthscope Commercial |
$242.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.72
|
| Rate for Payer: PHP Commercial |
$228.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.90
|
| Rate for Payer: Priority Health SBD |
$169.52
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 4
|
Facility
|
OP
|
$269.08
|
|
|
Service Code
|
CPT 86363
|
| Hospital Charge Code |
30200500
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.22 |
| Max. Negotiated Rate |
$242.17 |
| Rate for Payer: Aetna Commercial |
$228.72
|
| Rate for Payer: Aetna Medicare |
$39.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.90
|
| 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 |
$21.23
|
| Rate for Payer: BCBS MAPPO |
$37.73
|
| Rate for Payer: BCN Medicare Advantage |
$37.73
|
| Rate for Payer: Cash Price |
$215.26
|
| Rate for Payer: Cash Price |
$215.26
|
| Rate for Payer: Cofinity Commercial |
$231.41
|
| Rate for Payer: Cofinity Commercial |
$188.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$188.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.73
|
| Rate for Payer: Healthscope Commercial |
$242.17
|
| Rate for Payer: Mclaren Medicaid |
$20.22
|
| 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 |
$21.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.72
|
| Rate for Payer: PACE Medicare |
$35.84
|
| Rate for Payer: PACE SWMI |
$37.73
|
| Rate for Payer: PHP Commercial |
$228.72
|
| Rate for Payer: PHP Medicare Advantage |
$37.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.90
|
| Rate for Payer: Priority Health Medicare |
$37.73
|
| Rate for Payer: Priority Health SBD |
$169.52
|
| Rate for Payer: Railroad Medicare Medicare |
$37.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.73
|
| Rate for Payer: UHC Medicare Advantage |
$37.73
|
| Rate for Payer: UHCCP Medicaid |
$21.24
|
| Rate for Payer: VA VA |
$37.73
|
|
|
HC PEDS ECHO COMPLETE
|
Facility
|
OP
|
$2,008.38
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
48300005
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$286.63 |
| Max. Negotiated Rate |
$1,807.54 |
| Rate for Payer: Aetna Commercial |
$1,707.12
|
| Rate for Payer: Aetna Medicare |
$556.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,305.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$668.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$668.44
|
| Rate for Payer: BCBS Complete |
$300.96
|
| Rate for Payer: BCBS MAPPO |
$534.75
|
| Rate for Payer: BCN Medicare Advantage |
$534.75
|
| Rate for Payer: Cash Price |
$1,606.70
|
| Rate for Payer: Cash Price |
$1,606.70
|
| Rate for Payer: Cofinity Commercial |
$1,727.21
|
| Rate for Payer: Cofinity Commercial |
$1,405.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,405.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,606.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$534.75
|
| Rate for Payer: Healthscope Commercial |
$1,807.54
|
| Rate for Payer: Mclaren Medicaid |
$286.63
|
| Rate for Payer: Mclaren Medicare |
$534.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$561.49
|
| Rate for Payer: Meridian Medicaid |
$300.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$614.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,707.12
|
| Rate for Payer: PACE Medicare |
$508.01
|
| Rate for Payer: PACE SWMI |
$534.75
|
| Rate for Payer: PHP Commercial |
$1,707.12
|
| Rate for Payer: PHP Medicare Advantage |
$534.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,305.45
|
| Rate for Payer: Priority Health Medicare |
$534.75
|
| Rate for Payer: Priority Health SBD |
$1,265.28
|
| Rate for Payer: Railroad Medicare Medicare |
$534.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,505.27
|
| Rate for Payer: UHC Core |
$1,486.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$534.75
|
| Rate for Payer: UHC Exchange |
$1,486.20
|
| Rate for Payer: UHC Medicare Advantage |
$534.75
|
| Rate for Payer: UHCCP Medicaid |
$301.06
|
| Rate for Payer: VA VA |
$534.75
|
|
|
HC PEDS ECHO COMPLETE
|
Facility
|
IP
|
$2,008.38
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
48300005
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,265.28 |
| Max. Negotiated Rate |
$1,807.54 |
| Rate for Payer: Aetna Commercial |
$1,707.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,305.45
|
| Rate for Payer: Cash Price |
$1,606.70
|
| Rate for Payer: Cofinity Commercial |
$1,405.87
|
| Rate for Payer: Cofinity Commercial |
$1,727.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,405.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,606.70
|
| Rate for Payer: Healthscope Commercial |
$1,807.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,707.12
|
| Rate for Payer: PHP Commercial |
$1,707.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,305.45
|
| Rate for Payer: Priority Health SBD |
$1,265.28
|
|
|
HC PEDS ECHO LIMITED
|
Facility
|
OP
|
$825.55
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
48300006
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$743.00 |
| Rate for Payer: Aetna Commercial |
$701.72
|
| Rate for Payer: Aetna Medicare |
$245.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$536.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| Rate for Payer: Cash Price |
$660.44
|
| Rate for Payer: Cash Price |
$660.44
|
| Rate for Payer: Cofinity Commercial |
$709.97
|
| Rate for Payer: Cofinity Commercial |
$577.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$577.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$743.00
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$701.72
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$701.72
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.61
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health SBD |
$520.10
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$663.58
|
| Rate for Payer: UHC Core |
$610.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Exchange |
$610.91
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$132.72
|
| Rate for Payer: VA VA |
$235.74
|
|
|
HC PEDS ECHO LIMITED
|
Facility
|
IP
|
$825.55
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
48300006
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$520.10 |
| Max. Negotiated Rate |
$743.00 |
| Rate for Payer: Aetna Commercial |
$701.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$536.61
|
| Rate for Payer: Cash Price |
$660.44
|
| Rate for Payer: Cofinity Commercial |
$577.88
|
| Rate for Payer: Cofinity Commercial |
$709.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$577.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.44
|
| Rate for Payer: Healthscope Commercial |
$743.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$701.72
|
| Rate for Payer: PHP Commercial |
$701.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.61
|
| Rate for Payer: Priority Health SBD |
$520.10
|
|
|
HC PEDS ECHO W/DEFINITY
|
Facility
|
IP
|
$1,663.84
|
|
|
Service Code
|
HCPCS C8921
|
| Hospital Charge Code |
48000028
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,048.22 |
| Max. Negotiated Rate |
$1,497.46 |
| Rate for Payer: Aetna Commercial |
$1,414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,081.50
|
| Rate for Payer: Cash Price |
$1,331.07
|
| Rate for Payer: Cofinity Commercial |
$1,164.69
|
| Rate for Payer: Cofinity Commercial |
$1,430.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,164.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,331.07
|
| Rate for Payer: Healthscope Commercial |
$1,497.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,414.26
|
| Rate for Payer: PHP Commercial |
$1,414.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,081.50
|
| Rate for Payer: Priority Health SBD |
$1,048.22
|
|
|
HC PEDS ECHO W/DEFINITY
|
Facility
|
OP
|
$1,663.84
|
|
|
Service Code
|
HCPCS C8921
|
| Hospital Charge Code |
48000028
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$413.00 |
| Max. Negotiated Rate |
$2,168.96 |
| Rate for Payer: Aetna Commercial |
$1,414.26
|
| Rate for Payer: Aetna Medicare |
$801.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,081.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$963.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$963.16
|
| Rate for Payer: BCBS Complete |
$433.65
|
| Rate for Payer: BCBS MAPPO |
$770.53
|
| Rate for Payer: BCN Medicare Advantage |
$770.53
|
| Rate for Payer: Cash Price |
$1,331.07
|
| Rate for Payer: Cash Price |
$1,331.07
|
| Rate for Payer: Cofinity Commercial |
$1,164.69
|
| Rate for Payer: Cofinity Commercial |
$1,430.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,164.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,331.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$770.53
|
| Rate for Payer: Healthscope Commercial |
$1,497.46
|
| Rate for Payer: Mclaren Medicaid |
$413.00
|
| Rate for Payer: Mclaren Medicare |
$770.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$809.06
|
| Rate for Payer: Meridian Medicaid |
$433.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$886.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,414.26
|
| Rate for Payer: PACE Medicare |
$732.00
|
| Rate for Payer: PACE SWMI |
$770.53
|
| Rate for Payer: PHP Commercial |
$1,414.26
|
| Rate for Payer: PHP Medicare Advantage |
$770.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$413.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,081.50
|
| Rate for Payer: Priority Health Medicare |
$770.53
|
| Rate for Payer: Priority Health SBD |
$1,048.22
|
| Rate for Payer: Railroad Medicare Medicare |
$770.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,168.96
|
| Rate for Payer: UHC Core |
$1,231.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$770.53
|
| Rate for Payer: UHC Exchange |
$1,231.24
|
| Rate for Payer: UHC Medicare Advantage |
$770.53
|
| Rate for Payer: UHCCP Medicaid |
$433.81
|
| Rate for Payer: VA VA |
$770.53
|
|
|
HC PEDS OBS OVERFLOW PER HR
|
Facility
|
OP
|
$156.38
|
|
| Hospital Charge Code |
76900003
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$62.55 |
| Max. Negotiated Rate |
$140.74 |
| Rate for Payer: Aetna Commercial |
$132.92
|
| Rate for Payer: Aetna Medicare |
$78.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.65
|
| Rate for Payer: BCBS Complete |
$62.55
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cofinity Commercial |
$109.47
|
| Rate for Payer: Cofinity Commercial |
$134.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.10
|
| Rate for Payer: Healthscope Commercial |
$140.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.92
|
| Rate for Payer: PHP Commercial |
$132.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.65
|
| Rate for Payer: Priority Health SBD |
$98.52
|
|
|
HC PEDS OBS OVERFLOW PER HR
|
Facility
|
IP
|
$156.38
|
|
| Hospital Charge Code |
76900003
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$98.52 |
| Max. Negotiated Rate |
$140.74 |
| Rate for Payer: Aetna Commercial |
$132.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.65
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cofinity Commercial |
$109.47
|
| Rate for Payer: Cofinity Commercial |
$134.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.10
|
| Rate for Payer: Healthscope Commercial |
$140.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.92
|
| Rate for Payer: PHP Commercial |
$132.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.65
|
| Rate for Payer: Priority Health SBD |
$98.52
|
|
|
HC PEDS VENT INIT DAY
|
Facility
|
IP
|
$1,521.49
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000035
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$958.54 |
| Max. Negotiated Rate |
$1,369.34 |
| Rate for Payer: Aetna Commercial |
$1,293.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$988.97
|
| Rate for Payer: Cash Price |
$1,217.19
|
| Rate for Payer: Cofinity Commercial |
$1,065.04
|
| Rate for Payer: Cofinity Commercial |
$1,308.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,065.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,217.19
|
| Rate for Payer: Healthscope Commercial |
$1,369.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,293.27
|
| Rate for Payer: PHP Commercial |
$1,293.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$988.97
|
| Rate for Payer: Priority Health SBD |
$958.54
|
|
|
HC PEDS VENT INIT DAY
|
Facility
|
OP
|
$1,521.49
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000035
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$345.59 |
| Max. Negotiated Rate |
$1,814.93 |
| Rate for Payer: Aetna Commercial |
$1,293.27
|
| Rate for Payer: Aetna Medicare |
$670.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$988.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$805.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$805.95
|
| Rate for Payer: BCBS Complete |
$362.87
|
| Rate for Payer: BCBS MAPPO |
$644.76
|
| Rate for Payer: BCN Medicare Advantage |
$644.76
|
| Rate for Payer: Cash Price |
$1,217.19
|
| Rate for Payer: Cash Price |
$1,217.19
|
| Rate for Payer: Cofinity Commercial |
$1,308.48
|
| Rate for Payer: Cofinity Commercial |
$1,065.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,065.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,217.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$644.76
|
| Rate for Payer: Healthscope Commercial |
$1,369.34
|
| Rate for Payer: Mclaren Medicaid |
$345.59
|
| Rate for Payer: Mclaren Medicare |
$644.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$677.00
|
| Rate for Payer: Meridian Medicaid |
$362.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$741.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,293.27
|
| Rate for Payer: PACE Medicare |
$612.52
|
| Rate for Payer: PACE SWMI |
$644.76
|
| Rate for Payer: PHP Commercial |
$1,293.27
|
| Rate for Payer: PHP Medicare Advantage |
$644.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$345.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$988.97
|
| Rate for Payer: Priority Health Medicare |
$644.76
|
| Rate for Payer: Priority Health SBD |
$958.54
|
| Rate for Payer: Railroad Medicare Medicare |
$644.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,814.93
|
| Rate for Payer: UHC Core |
$1,125.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$644.76
|
| Rate for Payer: UHC Exchange |
$1,125.90
|
| Rate for Payer: UHC Medicare Advantage |
$644.76
|
| Rate for Payer: UHCCP Medicaid |
$363.00
|
| Rate for Payer: VA VA |
$644.76
|
|
|
HC PEDS VENT SUB DAY
|
Facility
|
OP
|
$1,315.21
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000036
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$345.59 |
| Max. Negotiated Rate |
$1,814.93 |
| Rate for Payer: Aetna Commercial |
$1,117.93
|
| Rate for Payer: Aetna Medicare |
$670.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$854.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$805.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$805.95
|
| Rate for Payer: BCBS Complete |
$362.87
|
| Rate for Payer: BCBS MAPPO |
$644.76
|
| Rate for Payer: BCN Medicare Advantage |
$644.76
|
| Rate for Payer: Cash Price |
$1,052.17
|
| Rate for Payer: Cash Price |
$1,052.17
|
| Rate for Payer: Cofinity Commercial |
$920.65
|
| Rate for Payer: Cofinity Commercial |
$1,131.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$920.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,052.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$644.76
|
| Rate for Payer: Healthscope Commercial |
$1,183.69
|
| Rate for Payer: Mclaren Medicaid |
$345.59
|
| Rate for Payer: Mclaren Medicare |
$644.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$677.00
|
| Rate for Payer: Meridian Medicaid |
$362.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$741.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,117.93
|
| Rate for Payer: PACE Medicare |
$612.52
|
| Rate for Payer: PACE SWMI |
$644.76
|
| Rate for Payer: PHP Commercial |
$1,117.93
|
| Rate for Payer: PHP Medicare Advantage |
$644.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$345.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$854.89
|
| Rate for Payer: Priority Health Medicare |
$644.76
|
| Rate for Payer: Priority Health SBD |
$828.58
|
| Rate for Payer: Railroad Medicare Medicare |
$644.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,814.93
|
| Rate for Payer: UHC Core |
$973.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$644.76
|
| Rate for Payer: UHC Exchange |
$973.26
|
| Rate for Payer: UHC Medicare Advantage |
$644.76
|
| Rate for Payer: UHCCP Medicaid |
$363.00
|
| Rate for Payer: VA VA |
$644.76
|
|
|
HC PEDS VENT SUB DAY
|
Facility
|
IP
|
$1,315.21
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000036
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$828.58 |
| Max. Negotiated Rate |
$1,183.69 |
| Rate for Payer: Aetna Commercial |
$1,117.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$854.89
|
| Rate for Payer: Cash Price |
$1,052.17
|
| Rate for Payer: Cofinity Commercial |
$1,131.08
|
| Rate for Payer: Cofinity Commercial |
$920.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$920.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,052.17
|
| Rate for Payer: Healthscope Commercial |
$1,183.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,117.93
|
| Rate for Payer: PHP Commercial |
$1,117.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$854.89
|
| Rate for Payer: Priority Health SBD |
$828.58
|
|
|
HC PEG TUBE INSERTION/TRAY
|
Facility
|
OP
|
$1,210.85
|
|
| Hospital Charge Code |
36000079
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$484.34 |
| Max. Negotiated Rate |
$1,089.77 |
| Rate for Payer: Aetna Commercial |
$1,029.22
|
| Rate for Payer: Aetna Medicare |
$605.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$787.05
|
| Rate for Payer: BCBS Complete |
$484.34
|
| Rate for Payer: Cash Price |
$968.68
|
| Rate for Payer: Cofinity Commercial |
$1,041.33
|
| Rate for Payer: Cofinity Commercial |
$847.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$847.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$968.68
|
| Rate for Payer: Healthscope Commercial |
$1,089.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,029.22
|
| Rate for Payer: PHP Commercial |
$1,029.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.05
|
| Rate for Payer: Priority Health SBD |
$762.84
|
|
|
HC PEG TUBE INSERTION/TRAY
|
Facility
|
IP
|
$1,210.85
|
|
| Hospital Charge Code |
36000079
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$762.84 |
| Max. Negotiated Rate |
$1,089.77 |
| Rate for Payer: Aetna Commercial |
$1,029.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$787.05
|
| Rate for Payer: Cash Price |
$968.68
|
| Rate for Payer: Cofinity Commercial |
$1,041.33
|
| Rate for Payer: Cofinity Commercial |
$847.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$847.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$968.68
|
| Rate for Payer: Healthscope Commercial |
$1,089.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,029.22
|
| Rate for Payer: PHP Commercial |
$1,029.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.05
|
| Rate for Payer: Priority Health SBD |
$762.84
|
|
|
HC PEJ FDG TUBE INSERTION/REPLACE
|
Facility
|
IP
|
$1,525.03
|
|
| Hospital Charge Code |
36000059
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$960.77 |
| Max. Negotiated Rate |
$1,372.53 |
| Rate for Payer: Aetna Commercial |
$1,296.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$991.27
|
| Rate for Payer: Cash Price |
$1,220.02
|
| Rate for Payer: Cofinity Commercial |
$1,067.52
|
| Rate for Payer: Cofinity Commercial |
$1,311.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,067.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,220.02
|
| Rate for Payer: Healthscope Commercial |
$1,372.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,296.28
|
| Rate for Payer: PHP Commercial |
$1,296.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$991.27
|
| Rate for Payer: Priority Health SBD |
$960.77
|
|
|
HC PEJ FDG TUBE INSERTION/REPLACE
|
Facility
|
OP
|
$1,525.03
|
|
| Hospital Charge Code |
36000059
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$610.01 |
| Max. Negotiated Rate |
$1,372.53 |
| Rate for Payer: Aetna Commercial |
$1,296.28
|
| Rate for Payer: Aetna Medicare |
$762.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$991.27
|
| Rate for Payer: BCBS Complete |
$610.01
|
| Rate for Payer: Cash Price |
$1,220.02
|
| Rate for Payer: Cofinity Commercial |
$1,067.52
|
| Rate for Payer: Cofinity Commercial |
$1,311.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,067.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,220.02
|
| Rate for Payer: Healthscope Commercial |
$1,372.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,296.28
|
| Rate for Payer: PHP Commercial |
$1,296.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$991.27
|
| Rate for Payer: Priority Health SBD |
$960.77
|
|
|
HC PELVIC EXAMINATION
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT 99459
|
| Hospital Charge Code |
51000129
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna Commercial |
$39.95
|
| Rate for Payer: Aetna Medicare |
$23.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.55
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$32.90
|
| Rate for Payer: Cofinity Commercial |
$40.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.60
|
| Rate for Payer: Healthscope Commercial |
$42.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.95
|
| Rate for Payer: PHP Commercial |
$39.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health SBD |
$29.61
|
|
|
HC PELVIC EXAMINATION
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT 99459
|
| Hospital Charge Code |
51000129
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.61 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna Commercial |
$39.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.55
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$32.90
|
| Rate for Payer: Cofinity Commercial |
$40.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.60
|
| Rate for Payer: Healthscope Commercial |
$42.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.95
|
| Rate for Payer: PHP Commercial |
$39.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health SBD |
$29.61
|
|
|
HC PENICILLIUM IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200055
|
|
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
|
|
