|
HC TOTAL PROTEIN URINE
|
Facility
|
OP
|
$39.64
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
30100407
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$35.68 |
| Rate for Payer: Aetna Commercial |
$33.69
|
| Rate for Payer: Aetna Medicare |
$3.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.59
|
| Rate for Payer: BCBS Complete |
$2.02
|
| Rate for Payer: BCBS MAPPO |
$3.67
|
| Rate for Payer: BCBS Trust/PPO |
$3.91
|
| Rate for Payer: BCN Commercial |
$3.91
|
| Rate for Payer: BCN Medicare Advantage |
$3.67
|
| Rate for Payer: Cash Price |
$31.71
|
| Rate for Payer: Cash Price |
$31.71
|
| Rate for Payer: Cofinity Advantage |
$27.75
|
| Rate for Payer: Cofinity Commercial |
$34.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$35.68
|
| Rate for Payer: Mclaren Medicaid |
$1.92
|
| Rate for Payer: Mclaren Medicare |
$3.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.85
|
| Rate for Payer: Meridian Medicaid |
$3.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.69
|
| Rate for Payer: Nomi Health Commercial |
$5.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.73
|
| Rate for Payer: PACE Medicare |
$3.49
|
| Rate for Payer: PACE SWMI |
$3.67
|
| Rate for Payer: PHP Commercial |
$33.69
|
| Rate for Payer: PHP Medicare Advantage |
$3.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3.67
|
| Rate for Payer: Priority Health Medicare |
$3.67
|
| Rate for Payer: Priority Health SBD |
$24.97
|
| Rate for Payer: Priority Health Tiered Network |
$2.94
|
| Rate for Payer: Railroad Medicare Medicare |
$3.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.51
|
| Rate for Payer: UHC Core |
$5.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.67
|
| Rate for Payer: UHC Exchange |
$5.51
|
| Rate for Payer: UHC Medicaid |
$1.92
|
| Rate for Payer: UHCCP Medicaid |
$1.92
|
| Rate for Payer: VA VA |
$3.67
|
|
|
HC TOTAL T3
|
Facility
|
OP
|
$48.72
|
|
|
Service Code
|
CPT 84480
|
| Hospital Charge Code |
30100447
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.42 |
| Max. Negotiated Rate |
$43.85 |
| Rate for Payer: Aetna Commercial |
$41.41
|
| Rate for Payer: Aetna Medicare |
$14.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.73
|
| Rate for Payer: BCBS Complete |
$7.79
|
| Rate for Payer: BCBS MAPPO |
$14.18
|
| Rate for Payer: BCBS Trust/PPO |
$15.13
|
| Rate for Payer: BCN Commercial |
$15.13
|
| Rate for Payer: BCN Medicare Advantage |
$14.18
|
| Rate for Payer: Cash Price |
$38.98
|
| Rate for Payer: Cash Price |
$38.98
|
| Rate for Payer: Cofinity Advantage |
$34.10
|
| Rate for Payer: Cofinity Commercial |
$41.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.18
|
| Rate for Payer: Healthscope Commercial |
$43.85
|
| Rate for Payer: Mclaren Medicaid |
$7.42
|
| Rate for Payer: Mclaren Medicare |
$14.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.89
|
| Rate for Payer: Meridian Medicaid |
$14.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.41
|
| Rate for Payer: Nomi Health Commercial |
$21.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.54
|
| Rate for Payer: PACE Medicare |
$13.47
|
| Rate for Payer: PACE SWMI |
$14.18
|
| Rate for Payer: PHP Commercial |
$41.41
|
| Rate for Payer: PHP Medicare Advantage |
$14.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.18
|
| Rate for Payer: Priority Health Medicare |
$14.18
|
| Rate for Payer: Priority Health SBD |
$30.69
|
| Rate for Payer: Priority Health Tiered Network |
$11.34
|
| Rate for Payer: Railroad Medicare Medicare |
$14.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.27
|
| Rate for Payer: UHC Core |
$21.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.18
|
| Rate for Payer: UHC Exchange |
$21.27
|
| Rate for Payer: UHC Medicaid |
$7.42
|
| Rate for Payer: UHCCP Medicaid |
$7.42
|
| Rate for Payer: VA VA |
$14.18
|
|
|
HC TOTAL T3
|
Facility
|
IP
|
$48.72
|
|
|
Service Code
|
CPT 84480
|
| Hospital Charge Code |
30100447
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.69 |
| Max. Negotiated Rate |
$43.85 |
| Rate for Payer: Aetna Commercial |
$41.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.67
|
| Rate for Payer: Cash Price |
$38.98
|
| Rate for Payer: Cofinity Advantage |
$34.10
|
| Rate for Payer: Cofinity Commercial |
$41.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.98
|
| Rate for Payer: Healthscope Commercial |
$43.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.54
|
| Rate for Payer: PHP Commercial |
$41.41
|
| Rate for Payer: Priority Health SBD |
$30.69
|
|
|
HC TOXICOLOGY SCREEN SALIVA
|
Facility
|
IP
|
$169.79
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100665
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$106.97 |
| Max. Negotiated Rate |
$152.81 |
| Rate for Payer: Aetna Commercial |
$144.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.36
|
| Rate for Payer: Cash Price |
$135.83
|
| Rate for Payer: Cofinity Advantage |
$118.85
|
| Rate for Payer: Cofinity Commercial |
$146.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.83
|
| Rate for Payer: Healthscope Commercial |
$152.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.34
|
| Rate for Payer: PHP Commercial |
$144.32
|
| Rate for Payer: Priority Health SBD |
$106.97
|
|
|
HC TOXICOLOGY SCREEN SALIVA
|
Facility
|
OP
|
$169.79
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100665
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$152.81 |
| Rate for Payer: Aetna Commercial |
$144.32
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.36
|
| 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 |
$34.13
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$66.26
|
| Rate for Payer: BCN Commercial |
$66.26
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$135.83
|
| Rate for Payer: Cash Price |
$135.83
|
| Rate for Payer: Cofinity Advantage |
$118.85
|
| Rate for Payer: Cofinity Commercial |
$146.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$152.81
|
| Rate for Payer: Mclaren Medicaid |
$32.50
|
| 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 |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.32
|
| Rate for Payer: Nomi Health Commercial |
$93.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.34
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$144.32
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$62.14
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$106.97
|
| Rate for Payer: Priority Health Tiered Network |
$49.71
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.21
|
| Rate for Payer: UHC Core |
$93.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$62.14
|
| Rate for Payer: UHC Exchange |
$93.21
|
| Rate for Payer: UHC Medicaid |
$32.50
|
| Rate for Payer: UHCCP Medicaid |
$32.50
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC TOXOPLASMA AB IGG
|
Facility
|
OP
|
$117.57
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
30200321
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.53 |
| Max. Negotiated Rate |
$105.81 |
| Rate for Payer: Aetna Commercial |
$99.93
|
| Rate for Payer: Aetna Medicare |
$14.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.99
|
| Rate for Payer: BCBS Complete |
$7.90
|
| Rate for Payer: BCBS MAPPO |
$14.39
|
| Rate for Payer: BCBS Trust/PPO |
$15.34
|
| Rate for Payer: BCN Commercial |
$15.34
|
| Rate for Payer: BCN Medicare Advantage |
$14.39
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cofinity Advantage |
$82.30
|
| Rate for Payer: Cofinity Commercial |
$101.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.39
|
| Rate for Payer: Healthscope Commercial |
$105.81
|
| Rate for Payer: Mclaren Medicaid |
$7.53
|
| Rate for Payer: Mclaren Medicare |
$14.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.11
|
| Rate for Payer: Meridian Medicaid |
$15.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.93
|
| Rate for Payer: Nomi Health Commercial |
$21.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.18
|
| Rate for Payer: PACE Medicare |
$13.67
|
| Rate for Payer: PACE SWMI |
$14.39
|
| Rate for Payer: PHP Commercial |
$99.93
|
| Rate for Payer: PHP Medicare Advantage |
$14.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.39
|
| Rate for Payer: Priority Health Medicare |
$14.39
|
| Rate for Payer: Priority Health SBD |
$74.07
|
| Rate for Payer: Priority Health Tiered Network |
$11.51
|
| Rate for Payer: Railroad Medicare Medicare |
$14.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.59
|
| Rate for Payer: UHC Core |
$21.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.39
|
| Rate for Payer: UHC Exchange |
$21.59
|
| Rate for Payer: UHC Medicaid |
$7.53
|
| Rate for Payer: UHCCP Medicaid |
$7.53
|
| Rate for Payer: VA VA |
$14.39
|
|
|
HC TOXOPLASMA AB IGG
|
Facility
|
IP
|
$117.57
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
30200321
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$74.07 |
| Max. Negotiated Rate |
$105.81 |
| Rate for Payer: Aetna Commercial |
$99.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.42
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cofinity Advantage |
$82.30
|
| Rate for Payer: Cofinity Commercial |
$101.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.06
|
| Rate for Payer: Healthscope Commercial |
$105.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.18
|
| Rate for Payer: PHP Commercial |
$99.93
|
| Rate for Payer: Priority Health SBD |
$74.07
|
|
|
HC TOXOPLASMA AB IGM
|
Facility
|
OP
|
$42.45
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
30200323
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Aetna Commercial |
$36.08
|
| Rate for Payer: Aetna Medicare |
$14.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.01
|
| Rate for Payer: BCBS Complete |
$7.91
|
| Rate for Payer: BCBS MAPPO |
$14.41
|
| Rate for Payer: BCBS Trust/PPO |
$15.37
|
| Rate for Payer: BCN Commercial |
$15.37
|
| Rate for Payer: BCN Medicare Advantage |
$14.41
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Advantage |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$36.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.41
|
| Rate for Payer: Healthscope Commercial |
$38.20
|
| Rate for Payer: Mclaren Medicaid |
$7.54
|
| Rate for Payer: Mclaren Medicare |
$14.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.13
|
| Rate for Payer: Meridian Medicaid |
$15.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$21.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: PACE Medicare |
$13.69
|
| Rate for Payer: PACE SWMI |
$14.41
|
| Rate for Payer: PHP Commercial |
$36.08
|
| Rate for Payer: PHP Medicare Advantage |
$14.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.41
|
| Rate for Payer: Priority Health Medicare |
$14.41
|
| Rate for Payer: Priority Health SBD |
$26.74
|
| Rate for Payer: Priority Health Tiered Network |
$11.53
|
| Rate for Payer: Railroad Medicare Medicare |
$14.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.62
|
| Rate for Payer: UHC Core |
$21.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.41
|
| Rate for Payer: UHC Exchange |
$21.62
|
| Rate for Payer: UHC Medicaid |
$7.54
|
| Rate for Payer: UHCCP Medicaid |
$7.54
|
| Rate for Payer: VA VA |
$14.41
|
|
|
HC TOXOPLASMA AB IGM
|
Facility
|
IP
|
$42.45
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
30200323
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.74 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Aetna Commercial |
$36.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.59
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Advantage |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$36.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$38.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: PHP Commercial |
$36.08
|
| Rate for Payer: Priority Health SBD |
$26.74
|
|
|
HC TPMT AND NUDT15 GENOTYPE
|
Facility
|
IP
|
$540.06
|
|
|
Service Code
|
CPT 0034U
|
| Hospital Charge Code |
31000138
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$340.24 |
| Max. Negotiated Rate |
$486.05 |
| Rate for Payer: Aetna Commercial |
$459.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$351.04
|
| Rate for Payer: Cash Price |
$432.05
|
| Rate for Payer: Cofinity Advantage |
$378.04
|
| Rate for Payer: Cofinity Commercial |
$464.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$432.05
|
| Rate for Payer: Healthscope Commercial |
$486.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$459.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$405.05
|
| Rate for Payer: PHP Commercial |
$459.05
|
| Rate for Payer: Priority Health SBD |
$340.24
|
|
|
HC TPMT AND NUDT15 GENOTYPE
|
Facility
|
OP
|
$540.06
|
|
|
Service Code
|
CPT 0034U
|
| Hospital Charge Code |
31000138
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$243.81 |
| Max. Negotiated Rate |
$1,398.51 |
| Rate for Payer: Aetna Commercial |
$459.05
|
| Rate for Payer: Aetna Medicare |
$484.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$351.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$582.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$582.71
|
| Rate for Payer: BCBS Complete |
$256.02
|
| Rate for Payer: BCBS MAPPO |
$466.17
|
| Rate for Payer: BCBS Trust/PPO |
$497.03
|
| Rate for Payer: BCN Commercial |
$497.03
|
| Rate for Payer: BCN Medicare Advantage |
$466.17
|
| Rate for Payer: Cash Price |
$432.05
|
| Rate for Payer: Cash Price |
$432.05
|
| Rate for Payer: Cofinity Advantage |
$378.04
|
| Rate for Payer: Cofinity Commercial |
$464.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$432.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$466.17
|
| Rate for Payer: Healthscope Commercial |
$486.05
|
| Rate for Payer: Mclaren Medicaid |
$243.81
|
| Rate for Payer: Mclaren Medicare |
$466.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$489.48
|
| Rate for Payer: Meridian Medicaid |
$489.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$536.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$512.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$459.05
|
| Rate for Payer: Nomi Health Commercial |
$1,398.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$405.05
|
| Rate for Payer: PACE Medicare |
$442.86
|
| Rate for Payer: PACE SWMI |
$466.17
|
| Rate for Payer: PHP Commercial |
$459.05
|
| Rate for Payer: PHP Medicare Advantage |
$466.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$243.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$466.17
|
| Rate for Payer: Priority Health Medicare |
$466.17
|
| Rate for Payer: Priority Health SBD |
$340.24
|
| Rate for Payer: Priority Health Tiered Network |
$372.94
|
| Rate for Payer: Railroad Medicare Medicare |
$466.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$699.26
|
| Rate for Payer: UHC Core |
$699.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$466.17
|
| Rate for Payer: UHC Exchange |
$699.26
|
| Rate for Payer: UHC Medicaid |
$243.81
|
| Rate for Payer: UHCCP Medicaid |
$243.81
|
| Rate for Payer: VA VA |
$466.17
|
|
|
HC TRACH BUTTON SUPPLY
|
Facility
|
OP
|
$305.31
|
|
| Hospital Charge Code |
27000159
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$119.99 |
| Max. Negotiated Rate |
$274.78 |
| Rate for Payer: Aetna Commercial |
$259.51
|
| Rate for Payer: Aetna Medicare |
$152.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.45
|
| Rate for Payer: BCBS Complete |
$122.12
|
| Rate for Payer: Cash Price |
$244.25
|
| Rate for Payer: Cofinity Advantage |
$213.72
|
| Rate for Payer: Cofinity Commercial |
$262.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.25
|
| Rate for Payer: Healthscope Commercial |
$274.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$244.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.98
|
| Rate for Payer: PHP Commercial |
$259.51
|
| Rate for Payer: Priority Health SBD |
$192.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.45
|
| Rate for Payer: UHC Core |
$159.07
|
| Rate for Payer: UHC Exchange |
$119.99
|
|
|
HC TRACH BUTTON SUPPLY
|
Facility
|
IP
|
$305.31
|
|
| Hospital Charge Code |
27000159
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$192.35 |
| Max. Negotiated Rate |
$274.78 |
| Rate for Payer: Aetna Commercial |
$259.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.45
|
| Rate for Payer: Cash Price |
$244.25
|
| Rate for Payer: Cofinity Advantage |
$213.72
|
| Rate for Payer: Cofinity Commercial |
$262.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.25
|
| Rate for Payer: Healthscope Commercial |
$274.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.98
|
| Rate for Payer: PHP Commercial |
$259.51
|
| Rate for Payer: Priority Health SBD |
$192.35
|
|
|
HC TRACHEOBRNCHSC THRU EST TRACHS INC
|
Facility
|
IP
|
$1,352.52
|
|
|
Service Code
|
CPT 31615
|
| Hospital Charge Code |
76100389
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$852.09 |
| Max. Negotiated Rate |
$1,217.27 |
| Rate for Payer: Aetna Commercial |
$1,149.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$879.14
|
| Rate for Payer: Cash Price |
$1,082.02
|
| Rate for Payer: Cofinity Advantage |
$946.76
|
| Rate for Payer: Cofinity Commercial |
$1,163.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,082.02
|
| Rate for Payer: Healthscope Commercial |
$1,217.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,149.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,014.39
|
| Rate for Payer: PHP Commercial |
$1,149.64
|
| Rate for Payer: Priority Health SBD |
$852.09
|
|
|
HC TRACHEOBRNCHSC THRU EST TRACHS INC
|
Facility
|
OP
|
$1,352.52
|
|
|
Service Code
|
CPT 31615
|
| Hospital Charge Code |
76100389
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.05 |
| Max. Negotiated Rate |
$1,737.88 |
| Rate for Payer: Aetna Commercial |
$1,149.64
|
| Rate for Payer: Aetna Medicare |
$558.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$879.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.74
|
| Rate for Payer: BCBS Complete |
$295.13
|
| Rate for Payer: BCBS MAPPO |
$537.39
|
| Rate for Payer: BCBS Trust/PPO |
$519.62
|
| Rate for Payer: BCN Commercial |
$519.62
|
| Rate for Payer: BCN Medicare Advantage |
$537.39
|
| Rate for Payer: Cash Price |
$1,082.02
|
| Rate for Payer: Cash Price |
$1,082.02
|
| Rate for Payer: Cash Price |
$1,082.02
|
| Rate for Payer: Cofinity Advantage |
$946.76
|
| Rate for Payer: Cofinity Commercial |
$1,163.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,082.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.39
|
| Rate for Payer: Healthscope Commercial |
$1,217.27
|
| Rate for Payer: Mclaren Medicaid |
$281.05
|
| Rate for Payer: Mclaren Medicare |
$537.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.26
|
| Rate for Payer: Meridian Medicaid |
$564.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$618.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$591.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,149.64
|
| Rate for Payer: Nomi Health Commercial |
$1,612.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,014.39
|
| Rate for Payer: PACE Medicare |
$510.52
|
| Rate for Payer: PACE SWMI |
$537.39
|
| Rate for Payer: PHP Commercial |
$1,149.64
|
| Rate for Payer: PHP Medicare Advantage |
$537.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,737.88
|
| Rate for Payer: Priority Health Medicare |
$537.39
|
| Rate for Payer: Priority Health SBD |
$852.09
|
| Rate for Payer: Priority Health Tiered Network |
$1,390.30
|
| Rate for Payer: Railroad Medicare Medicare |
$537.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$879.14
|
| Rate for Payer: UHC Core |
$704.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$537.39
|
| Rate for Payer: UHC Exchange |
$531.54
|
| Rate for Payer: UHC Medicaid |
$281.05
|
| Rate for Payer: UHCCP Medicaid |
$281.05
|
| Rate for Payer: VA VA |
$537.39
|
|
|
HC TRACHEOSTOMA REVJ SMPL W/O FLAP ROTATION
|
Facility
|
IP
|
$8,229.56
|
|
|
Service Code
|
CPT 31613
|
| Hospital Charge Code |
76100404
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,184.62 |
| Max. Negotiated Rate |
$7,406.60 |
| Rate for Payer: Aetna Commercial |
$6,995.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,349.21
|
| Rate for Payer: Cash Price |
$6,583.65
|
| Rate for Payer: Cofinity Advantage |
$5,760.69
|
| Rate for Payer: Cofinity Commercial |
$7,077.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,583.65
|
| Rate for Payer: Healthscope Commercial |
$7,406.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,995.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,172.17
|
| Rate for Payer: PHP Commercial |
$6,995.13
|
| Rate for Payer: Priority Health SBD |
$5,184.62
|
|
|
HC TRACHEOSTOMA REVJ SMPL W/O FLAP ROTATION
|
Facility
|
OP
|
$8,229.56
|
|
|
Service Code
|
CPT 31613
|
| Hospital Charge Code |
76100404
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,256.18 |
| Max. Negotiated Rate |
$10,683.35 |
| Rate for Payer: Aetna Commercial |
$6,995.13
|
| Rate for Payer: Aetna Medicare |
$3,435.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,349.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,129.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,129.43
|
| Rate for Payer: BCBS Complete |
$1,814.30
|
| Rate for Payer: BCBS MAPPO |
$3,303.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,256.18
|
| Rate for Payer: BCN Commercial |
$1,256.18
|
| Rate for Payer: BCN Medicare Advantage |
$3,303.54
|
| Rate for Payer: Cash Price |
$6,583.65
|
| Rate for Payer: Cash Price |
$6,583.65
|
| Rate for Payer: Cash Price |
$6,583.65
|
| Rate for Payer: Cofinity Advantage |
$5,760.69
|
| Rate for Payer: Cofinity Commercial |
$7,077.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,583.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,303.54
|
| Rate for Payer: Healthscope Commercial |
$7,406.60
|
| Rate for Payer: Mclaren Medicaid |
$1,727.75
|
| Rate for Payer: Mclaren Medicare |
$3,303.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,468.72
|
| Rate for Payer: Meridian Medicaid |
$3,468.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,799.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,633.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,995.13
|
| Rate for Payer: Nomi Health Commercial |
$9,910.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,172.17
|
| Rate for Payer: PACE Medicare |
$3,138.36
|
| Rate for Payer: PACE SWMI |
$3,303.54
|
| Rate for Payer: PHP Commercial |
$6,995.13
|
| Rate for Payer: PHP Medicare Advantage |
$3,303.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,727.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,683.35
|
| Rate for Payer: Priority Health Medicare |
$3,303.54
|
| Rate for Payer: Priority Health SBD |
$5,184.62
|
| Rate for Payer: Priority Health Tiered Network |
$8,546.68
|
| Rate for Payer: Railroad Medicare Medicare |
$3,303.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,349.21
|
| Rate for Payer: UHC Core |
$4,287.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,303.54
|
| Rate for Payer: UHC Exchange |
$3,234.22
|
| Rate for Payer: UHC Medicaid |
$1,727.75
|
| Rate for Payer: UHCCP Medicaid |
$1,727.75
|
| Rate for Payer: VA VA |
$3,303.54
|
|
|
HC TRACH TUBE INSERTION
|
Facility
|
IP
|
$517.69
|
|
| Hospital Charge Code |
27000160
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$326.14 |
| Max. Negotiated Rate |
$465.92 |
| Rate for Payer: Aetna Commercial |
$440.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.50
|
| Rate for Payer: Cash Price |
$414.15
|
| Rate for Payer: Cofinity Advantage |
$362.38
|
| Rate for Payer: Cofinity Commercial |
$445.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$414.15
|
| Rate for Payer: Healthscope Commercial |
$465.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$440.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$388.27
|
| Rate for Payer: PHP Commercial |
$440.04
|
| Rate for Payer: Priority Health SBD |
$326.14
|
|
|
HC TRACH TUBE INSERTION
|
Facility
|
OP
|
$517.69
|
|
| Hospital Charge Code |
27000160
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$203.45 |
| Max. Negotiated Rate |
$465.92 |
| Rate for Payer: Aetna Commercial |
$440.04
|
| Rate for Payer: Aetna Medicare |
$258.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.50
|
| Rate for Payer: BCBS Complete |
$207.08
|
| Rate for Payer: Cash Price |
$414.15
|
| Rate for Payer: Cofinity Advantage |
$362.38
|
| Rate for Payer: Cofinity Commercial |
$445.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$414.15
|
| Rate for Payer: Healthscope Commercial |
$465.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$414.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$440.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$388.27
|
| Rate for Payer: PHP Commercial |
$440.04
|
| Rate for Payer: Priority Health SBD |
$326.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.50
|
| Rate for Payer: UHC Core |
$269.72
|
| Rate for Payer: UHC Exchange |
$203.45
|
|
|
HC TRACH TUBE REPLACEMENT
|
Facility
|
IP
|
$181.11
|
|
|
Service Code
|
CPT 31502
|
| Hospital Charge Code |
45000072
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$114.10 |
| Max. Negotiated Rate |
$163.00 |
| Rate for Payer: Aetna Commercial |
$153.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.72
|
| Rate for Payer: Cash Price |
$144.89
|
| Rate for Payer: Cofinity Advantage |
$126.78
|
| Rate for Payer: Cofinity Commercial |
$155.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.89
|
| Rate for Payer: Healthscope Commercial |
$163.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.83
|
| Rate for Payer: PHP Commercial |
$153.94
|
| Rate for Payer: Priority Health SBD |
$114.10
|
|
|
HC TRACH TUBE REPLACEMENT
|
Facility
|
OP
|
$181.11
|
|
|
Service Code
|
CPT 31502
|
| Hospital Charge Code |
45000072
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$109.57 |
| Max. Negotiated Rate |
$763.21 |
| Rate for Payer: Aetna Commercial |
$153.94
|
| Rate for Payer: Aetna Medicare |
$245.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$295.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$295.00
|
| Rate for Payer: BCBS Complete |
$129.61
|
| Rate for Payer: BCBS MAPPO |
$236.00
|
| Rate for Payer: BCBS Trust/PPO |
$109.57
|
| Rate for Payer: BCN Commercial |
$109.57
|
| Rate for Payer: BCN Medicare Advantage |
$236.00
|
| Rate for Payer: Cash Price |
$144.89
|
| Rate for Payer: Cash Price |
$144.89
|
| Rate for Payer: Cash Price |
$144.89
|
| Rate for Payer: Cofinity Advantage |
$126.78
|
| Rate for Payer: Cofinity Commercial |
$155.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.00
|
| Rate for Payer: Healthscope Commercial |
$163.00
|
| Rate for Payer: Mclaren Medicaid |
$123.43
|
| Rate for Payer: Mclaren Medicare |
$236.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.80
|
| Rate for Payer: Meridian Medicaid |
$247.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$259.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.94
|
| Rate for Payer: Nomi Health Commercial |
$708.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.83
|
| Rate for Payer: PACE Medicare |
$224.20
|
| Rate for Payer: PACE SWMI |
$236.00
|
| Rate for Payer: PHP Commercial |
$153.94
|
| Rate for Payer: PHP Medicare Advantage |
$236.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$763.21
|
| Rate for Payer: Priority Health Medicare |
$236.00
|
| Rate for Payer: Priority Health SBD |
$114.10
|
| Rate for Payer: Priority Health Tiered Network |
$610.57
|
| Rate for Payer: Railroad Medicare Medicare |
$236.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$236.00
|
| Rate for Payer: UHC Medicaid |
$123.43
|
| Rate for Payer: UHCCP Medicaid |
$144.00
|
| Rate for Payer: VA VA |
$236.00
|
|
|
HC TRACTION MECHANICAL
|
Facility
|
IP
|
$122.04
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
42000009
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$76.89 |
| Max. Negotiated Rate |
$109.84 |
| Rate for Payer: Aetna Commercial |
$103.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.33
|
| Rate for Payer: Cash Price |
$97.63
|
| Rate for Payer: Cofinity Advantage |
$85.43
|
| Rate for Payer: Cofinity Commercial |
$104.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.63
|
| Rate for Payer: Healthscope Commercial |
$109.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.53
|
| Rate for Payer: PHP Commercial |
$103.73
|
| Rate for Payer: Priority Health SBD |
$76.89
|
|
|
HC TRACTION MECHANICAL
|
Facility
|
OP
|
$122.04
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
42000009
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$103.73
|
| Rate for Payer: Aetna Medicare |
$61.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.33
|
| Rate for Payer: BCBS Complete |
$48.82
|
| Rate for Payer: BCBS Trust/PPO |
$13.40
|
| Rate for Payer: BCN Commercial |
$13.40
|
| Rate for Payer: Cash Price |
$97.63
|
| Rate for Payer: Cash Price |
$97.63
|
| Rate for Payer: Cash Price |
$97.63
|
| Rate for Payer: Cofinity Advantage |
$85.43
|
| Rate for Payer: Cofinity Commercial |
$104.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.63
|
| Rate for Payer: Healthscope Commercial |
$109.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.73
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.53
|
| Rate for Payer: PHP Commercial |
$103.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15.00
|
| Rate for Payer: Priority Health SBD |
$76.89
|
| Rate for Payer: Priority Health Tiered Network |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.33
|
| Rate for Payer: UHC Core |
$63.58
|
| Rate for Payer: UHC Exchange |
$47.96
|
|
|
HC TRANS CARE MGMT 14 DAYS
|
Facility
|
OP
|
$122.04
|
|
|
Service Code
|
CPT 99495
|
| Hospital Charge Code |
51000086
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.96 |
| Max. Negotiated Rate |
$428.99 |
| Rate for Payer: Aetna Commercial |
$103.73
|
| Rate for Payer: Aetna Medicare |
$137.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.82
|
| Rate for Payer: BCBS Complete |
$72.86
|
| Rate for Payer: BCBS MAPPO |
$132.66
|
| Rate for Payer: BCN Medicare Advantage |
$132.66
|
| Rate for Payer: Cash Price |
$97.63
|
| Rate for Payer: Cash Price |
$97.63
|
| Rate for Payer: Cofinity Advantage |
$85.43
|
| Rate for Payer: Cofinity Commercial |
$104.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.66
|
| Rate for Payer: Healthscope Commercial |
$109.84
|
| Rate for Payer: Mclaren Medicaid |
$69.38
|
| Rate for Payer: Mclaren Medicare |
$132.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.29
|
| Rate for Payer: Meridian Medicaid |
$139.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.73
|
| Rate for Payer: Nomi Health Commercial |
$397.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.53
|
| Rate for Payer: PACE Medicare |
$126.03
|
| Rate for Payer: PACE SWMI |
$132.66
|
| Rate for Payer: PHP Commercial |
$103.73
|
| Rate for Payer: PHP Medicare Advantage |
$132.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.99
|
| Rate for Payer: Priority Health Medicare |
$132.66
|
| Rate for Payer: Priority Health SBD |
$76.89
|
| Rate for Payer: Priority Health Tiered Network |
$343.19
|
| Rate for Payer: Railroad Medicare Medicare |
$132.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.33
|
| Rate for Payer: UHC Core |
$63.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.66
|
| Rate for Payer: UHC Exchange |
$47.96
|
| Rate for Payer: UHC Medicaid |
$69.38
|
| Rate for Payer: UHCCP Medicaid |
$69.38
|
| Rate for Payer: VA VA |
$132.66
|
|
|
HC TRANS CARE MGMT 14 DAYS
|
Facility
|
IP
|
$122.04
|
|
|
Service Code
|
CPT 99495
|
| Hospital Charge Code |
51000086
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$76.89 |
| Max. Negotiated Rate |
$109.84 |
| Rate for Payer: Aetna Commercial |
$103.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.33
|
| Rate for Payer: Cash Price |
$97.63
|
| Rate for Payer: Cofinity Advantage |
$85.43
|
| Rate for Payer: Cofinity Commercial |
$104.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.63
|
| Rate for Payer: Healthscope Commercial |
$109.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.53
|
| Rate for Payer: PHP Commercial |
$103.73
|
| Rate for Payer: Priority Health SBD |
$76.89
|
|
