|
HC ACCESS VENA CAVA
|
Facility
|
IP
|
$3,067.24
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
36100096
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,932.36 |
| Max. Negotiated Rate |
$2,760.52 |
| Rate for Payer: Aetna Commercial |
$2,607.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,993.71
|
| Rate for Payer: Cash Price |
$2,453.79
|
| Rate for Payer: Cofinity Commercial |
$2,637.83
|
| Rate for Payer: Cofinity Commercial |
$2,147.07
|
| Rate for Payer: Healthscope Commercial |
$2,760.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,607.15
|
| Rate for Payer: PHP Commercial |
$2,607.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,147.07
|
| Rate for Payer: Priority Health SBD |
$1,932.36
|
|
|
HC ACCESS VENA CAVA
|
Facility
|
OP
|
$3,067.24
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
36100096
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$103.80 |
| Max. Negotiated Rate |
$2,760.52 |
| Rate for Payer: Aetna Commercial |
$2,607.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,993.71
|
| Rate for Payer: BCBS Complete |
$1,226.90
|
| Rate for Payer: BCBS Trust/PPO |
$965.41
|
| Rate for Payer: Cash Price |
$2,453.79
|
| Rate for Payer: Cash Price |
$2,453.79
|
| Rate for Payer: Cofinity Commercial |
$2,637.83
|
| Rate for Payer: Cofinity Commercial |
$2,147.07
|
| Rate for Payer: Healthscope Commercial |
$2,760.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,607.15
|
| Rate for Payer: PHP Commercial |
$2,607.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,147.07
|
| Rate for Payer: Priority Health SBD |
$1,932.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.18
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$103.80
|
|
|
HC ACCESS WINDOW
|
Facility
|
OP
|
$38.17
|
|
| Hospital Charge Code |
27000624
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.27 |
| Max. Negotiated Rate |
$34.35 |
| Rate for Payer: Aetna Commercial |
$32.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.81
|
| Rate for Payer: BCBS Complete |
$15.27
|
| Rate for Payer: Cash Price |
$30.54
|
| Rate for Payer: Cofinity Commercial |
$26.72
|
| Rate for Payer: Cofinity Commercial |
$32.83
|
| Rate for Payer: Healthscope Commercial |
$34.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.44
|
| Rate for Payer: PHP Commercial |
$32.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.72
|
| Rate for Payer: Priority Health SBD |
$24.05
|
|
|
HC ACCESS WINDOW
|
Facility
|
IP
|
$38.17
|
|
| Hospital Charge Code |
27000624
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.05 |
| Max. Negotiated Rate |
$34.35 |
| Rate for Payer: Aetna Commercial |
$32.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.81
|
| Rate for Payer: Cash Price |
$30.54
|
| Rate for Payer: Cofinity Commercial |
$26.72
|
| Rate for Payer: Cofinity Commercial |
$32.83
|
| Rate for Payer: Healthscope Commercial |
$34.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.44
|
| Rate for Payer: PHP Commercial |
$32.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.72
|
| Rate for Payer: Priority Health SBD |
$24.05
|
|
|
HC ACCUNET EMBOLIC PROTECTION
|
Facility
|
OP
|
$3,932.93
|
|
| Hospital Charge Code |
27200110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,573.17 |
| Max. Negotiated Rate |
$3,539.64 |
| Rate for Payer: Aetna Commercial |
$3,342.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,556.40
|
| Rate for Payer: BCBS Complete |
$1,573.17
|
| Rate for Payer: Cash Price |
$3,146.34
|
| Rate for Payer: Cofinity Commercial |
$2,753.05
|
| Rate for Payer: Cofinity Commercial |
$3,382.32
|
| Rate for Payer: Healthscope Commercial |
$3,539.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,342.99
|
| Rate for Payer: PHP Commercial |
$3,342.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,753.05
|
| Rate for Payer: Priority Health SBD |
$2,477.75
|
|
|
HC ACCUNET EMBOLIC PROTECTION
|
Facility
|
IP
|
$3,932.93
|
|
| Hospital Charge Code |
27200110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$3,539.64 |
| Rate for Payer: Aetna Commercial |
$3,342.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,556.40
|
| Rate for Payer: Cash Price |
$3,146.34
|
| Rate for Payer: Cofinity Commercial |
$2,753.05
|
| Rate for Payer: Cofinity Commercial |
$3,382.32
|
| Rate for Payer: Healthscope Commercial |
$3,539.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,342.99
|
| Rate for Payer: PHP Commercial |
$3,342.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,753.05
|
| Rate for Payer: Priority Health SBD |
$2,477.75
|
|
|
HC ACETAMINOPHEN LVL.
|
Facility
|
IP
|
$126.58
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100648
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$79.75 |
| Max. Negotiated Rate |
$113.92 |
| Rate for Payer: Aetna Commercial |
$107.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.28
|
| Rate for Payer: Cash Price |
$101.26
|
| Rate for Payer: Cofinity Commercial |
$108.86
|
| Rate for Payer: Cofinity Commercial |
$88.61
|
| Rate for Payer: Healthscope Commercial |
$113.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.59
|
| Rate for Payer: PHP Commercial |
$107.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.61
|
| Rate for Payer: Priority Health SBD |
$79.75
|
|
|
HC ACETAMINOPHEN LVL.
|
Facility
|
OP
|
$126.58
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100648
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$113.92 |
| Rate for Payer: Aetna Commercial |
$107.59
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: BCBS Complete |
$35.69
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$48.67
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$101.26
|
| Rate for Payer: Cash Price |
$101.26
|
| Rate for Payer: Cofinity Commercial |
$88.61
|
| Rate for Payer: Cofinity Commercial |
$108.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$113.92
|
| Rate for Payer: Mclaren Medicaid |
$33.99
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Medicaid |
$35.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.59
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$107.59
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.61
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$79.75
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.57
|
| Rate for Payer: UHC Core |
$95.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Exchange |
$62.14
|
| Rate for Payer: UHC Medicare Advantage |
$64.00
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC ACETOMINOPHEN THERAPEUTIC DRUG ASSAY
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 80143
|
| Hospital Charge Code |
30100729
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.70 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health SBD |
$25.70
|
|
|
HC ACETOMINOPHEN THERAPEUTIC DRUG ASSAY
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
CPT 80143
|
| Hospital Charge Code |
30100729
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: BCBS Complete |
$10.71
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$14.60
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Mclaren Medicaid |
$10.20
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Medicaid |
$10.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health SBD |
$25.70
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.37
|
| Rate for Payer: UHC Core |
$22.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Exchange |
$18.64
|
| Rate for Payer: UHC Medicare Advantage |
$19.20
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC ACETYLCHOLINE RECEPTOR AB
|
Facility
|
IP
|
$75.48
|
|
|
Service Code
|
CPT 86041
|
| Hospital Charge Code |
30100254
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.55 |
| Max. Negotiated Rate |
$67.93 |
| Rate for Payer: Aetna Commercial |
$64.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.06
|
| Rate for Payer: Cash Price |
$60.38
|
| Rate for Payer: Cofinity Commercial |
$52.84
|
| Rate for Payer: Cofinity Commercial |
$64.91
|
| Rate for Payer: Healthscope Commercial |
$67.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.16
|
| Rate for Payer: PHP Commercial |
$64.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.84
|
| Rate for Payer: Priority Health SBD |
$47.55
|
|
|
HC ACETYLCHOLINE RECEPTOR AB
|
Facility
|
OP
|
$75.48
|
|
|
Service Code
|
CPT 86041
|
| Hospital Charge Code |
30100254
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$67.93 |
| Rate for Payer: Aetna Commercial |
$64.16
|
| Rate for Payer: Aetna Medicare |
$19.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.00
|
| Rate for Payer: BCBS Complete |
$10.57
|
| Rate for Payer: BCBS MAPPO |
$18.40
|
| Rate for Payer: BCN Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$60.38
|
| Rate for Payer: Cash Price |
$60.38
|
| Rate for Payer: Cofinity Commercial |
$64.91
|
| Rate for Payer: Cofinity Commercial |
$52.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$67.93
|
| Rate for Payer: Mclaren Medicaid |
$10.06
|
| Rate for Payer: Mclaren Medicare |
$18.40
|
| Rate for Payer: Meridian Medicaid |
$10.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.16
|
| Rate for Payer: PACE Medicare |
$17.48
|
| Rate for Payer: PACE SWMI |
$18.40
|
| Rate for Payer: PHP Commercial |
$64.16
|
| Rate for Payer: PHP Medicare Advantage |
$18.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.84
|
| Rate for Payer: Priority Health Medicare |
$18.40
|
| Rate for Payer: Priority Health SBD |
$47.55
|
| Rate for Payer: Railroad Medicare Medicare |
$18.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.08
|
| Rate for Payer: UHC Core |
$22.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.40
|
| Rate for Payer: UHC Exchange |
$18.40
|
| Rate for Payer: UHC Medicare Advantage |
$18.95
|
| Rate for Payer: VA VA |
$18.40
|
|
|
HC ACETYLCHOLINESTERASE AMNIOTIC
|
Facility
|
OP
|
$106.48
|
|
|
Service Code
|
CPT 82013
|
| Hospital Charge Code |
30100069
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$95.83 |
| Rate for Payer: Aetna Commercial |
$90.51
|
| Rate for Payer: Aetna Medicare |
$12.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.36
|
| Rate for Payer: BCBS Complete |
$7.06
|
| Rate for Payer: BCBS MAPPO |
$12.29
|
| Rate for Payer: BCBS Trust/PPO |
$9.63
|
| Rate for Payer: BCN Medicare Advantage |
$12.29
|
| Rate for Payer: Cash Price |
$85.18
|
| Rate for Payer: Cash Price |
$85.18
|
| Rate for Payer: Cofinity Commercial |
$91.57
|
| Rate for Payer: Cofinity Commercial |
$74.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.29
|
| Rate for Payer: Healthscope Commercial |
$95.83
|
| Rate for Payer: Mclaren Medicaid |
$6.72
|
| Rate for Payer: Mclaren Medicare |
$12.29
|
| Rate for Payer: Meridian Medicaid |
$7.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.51
|
| Rate for Payer: PACE Medicare |
$11.68
|
| Rate for Payer: PACE SWMI |
$12.29
|
| Rate for Payer: PHP Commercial |
$90.51
|
| Rate for Payer: PHP Medicare Advantage |
$12.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.54
|
| Rate for Payer: Priority Health Medicare |
$12.29
|
| Rate for Payer: Priority Health SBD |
$67.08
|
| Rate for Payer: Railroad Medicare Medicare |
$12.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.75
|
| Rate for Payer: UHC Core |
$18.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.29
|
| Rate for Payer: UHC Exchange |
$12.29
|
| Rate for Payer: UHC Medicare Advantage |
$12.66
|
| Rate for Payer: VA VA |
$12.29
|
|
|
HC ACETYLCHOLINESTERASE AMNIOTIC
|
Facility
|
IP
|
$106.48
|
|
|
Service Code
|
CPT 82013
|
| Hospital Charge Code |
30100069
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.08 |
| Max. Negotiated Rate |
$95.83 |
| Rate for Payer: Aetna Commercial |
$90.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.21
|
| Rate for Payer: Cash Price |
$85.18
|
| Rate for Payer: Cofinity Commercial |
$74.54
|
| Rate for Payer: Cofinity Commercial |
$91.57
|
| Rate for Payer: Healthscope Commercial |
$95.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.51
|
| Rate for Payer: PHP Commercial |
$90.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.54
|
| Rate for Payer: Priority Health SBD |
$67.08
|
|
|
HC ACH RECEPTOR MUSCLE MOD AB
|
Facility
|
IP
|
$96.90
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30000061
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.05 |
| Max. Negotiated Rate |
$87.21 |
| Rate for Payer: Aetna Commercial |
$82.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.98
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cofinity Commercial |
$67.83
|
| Rate for Payer: Cofinity Commercial |
$83.33
|
| Rate for Payer: Healthscope Commercial |
$87.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.36
|
| Rate for Payer: PHP Commercial |
$82.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.83
|
| Rate for Payer: Priority Health SBD |
$61.05
|
|
|
HC ACH RECEPTOR MUSCLE MOD AB
|
Facility
|
OP
|
$96.90
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30000061
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$87.21 |
| Rate for Payer: Aetna Commercial |
$82.36
|
| Rate for Payer: Aetna Medicare |
$19.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.00
|
| Rate for Payer: BCBS Complete |
$10.57
|
| Rate for Payer: BCBS MAPPO |
$18.40
|
| Rate for Payer: BCBS Trust/PPO |
$14.41
|
| Rate for Payer: BCN Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cofinity Commercial |
$83.33
|
| Rate for Payer: Cofinity Commercial |
$67.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$87.21
|
| Rate for Payer: Mclaren Medicaid |
$10.06
|
| Rate for Payer: Mclaren Medicare |
$18.40
|
| Rate for Payer: Meridian Medicaid |
$10.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.36
|
| Rate for Payer: PACE Medicare |
$17.48
|
| Rate for Payer: PACE SWMI |
$18.40
|
| Rate for Payer: PHP Commercial |
$82.36
|
| Rate for Payer: PHP Medicare Advantage |
$18.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.83
|
| Rate for Payer: Priority Health Medicare |
$18.40
|
| Rate for Payer: Priority Health SBD |
$61.05
|
| Rate for Payer: Railroad Medicare Medicare |
$18.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.08
|
| Rate for Payer: UHC Core |
$22.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.40
|
| Rate for Payer: UHC Exchange |
$18.40
|
| Rate for Payer: UHC Medicare Advantage |
$18.95
|
| Rate for Payer: VA VA |
$18.40
|
|
|
HC ACHR GANGLIONIC NEURONAL AB
|
Facility
|
IP
|
$87.72
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30100606
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.26 |
| Max. Negotiated Rate |
$78.95 |
| Rate for Payer: Aetna Commercial |
$74.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.02
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Cofinity Commercial |
$75.44
|
| Rate for Payer: Healthscope Commercial |
$78.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.56
|
| Rate for Payer: PHP Commercial |
$74.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.40
|
| Rate for Payer: Priority Health SBD |
$55.26
|
|
|
HC ACHR GANGLIONIC NEURONAL AB
|
Facility
|
OP
|
$87.72
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30100606
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$78.95 |
| Rate for Payer: Aetna Commercial |
$74.56
|
| Rate for Payer: Aetna Medicare |
$19.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.00
|
| Rate for Payer: BCBS Complete |
$10.57
|
| Rate for Payer: BCBS MAPPO |
$18.40
|
| Rate for Payer: BCBS Trust/PPO |
$14.41
|
| Rate for Payer: BCN Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$75.44
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$78.95
|
| Rate for Payer: Mclaren Medicaid |
$10.06
|
| Rate for Payer: Mclaren Medicare |
$18.40
|
| Rate for Payer: Meridian Medicaid |
$10.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.56
|
| Rate for Payer: PACE Medicare |
$17.48
|
| Rate for Payer: PACE SWMI |
$18.40
|
| Rate for Payer: PHP Commercial |
$74.56
|
| Rate for Payer: PHP Medicare Advantage |
$18.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.40
|
| Rate for Payer: Priority Health Medicare |
$18.40
|
| Rate for Payer: Priority Health SBD |
$55.26
|
| Rate for Payer: Railroad Medicare Medicare |
$18.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.08
|
| Rate for Payer: UHC Core |
$22.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.40
|
| Rate for Payer: UHC Exchange |
$18.40
|
| Rate for Payer: UHC Medicare Advantage |
$18.95
|
| Rate for Payer: VA VA |
$18.40
|
|
|
HC ACNE SURGERY
|
Facility
|
OP
|
$267.34
|
|
|
Service Code
|
CPT 10040
|
| Hospital Charge Code |
76100282
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.31 |
| Max. Negotiated Rate |
$541.49 |
| Rate for Payer: Aetna Commercial |
$227.24
|
| Rate for Payer: Aetna Medicare |
$185.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.68
|
| Rate for Payer: BCBS Complete |
$102.32
|
| Rate for Payer: BCBS MAPPO |
$178.14
|
| Rate for Payer: BCBS Trust/PPO |
$47.31
|
| Rate for Payer: BCN Medicare Advantage |
$178.14
|
| Rate for Payer: Cash Price |
$213.87
|
| Rate for Payer: Cash Price |
$213.87
|
| Rate for Payer: Cofinity Commercial |
$229.91
|
| Rate for Payer: Cofinity Commercial |
$187.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.14
|
| Rate for Payer: Healthscope Commercial |
$240.61
|
| Rate for Payer: Mclaren Medicaid |
$97.44
|
| Rate for Payer: Mclaren Medicare |
$178.14
|
| Rate for Payer: Meridian Medicaid |
$102.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$187.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.24
|
| Rate for Payer: PACE Medicare |
$169.23
|
| Rate for Payer: PACE SWMI |
$178.14
|
| Rate for Payer: PHP Commercial |
$227.24
|
| Rate for Payer: PHP Medicare Advantage |
$178.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.49
|
| Rate for Payer: Priority Health Medicare |
$178.14
|
| Rate for Payer: Priority Health Narrow Network |
$433.19
|
| Rate for Payer: Priority Health SBD |
$168.42
|
| Rate for Payer: Railroad Medicare Medicare |
$178.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.14
|
| Rate for Payer: UHC Exchange |
$50.75
|
| Rate for Payer: UHC Medicare Advantage |
$183.48
|
| Rate for Payer: VA VA |
$178.14
|
|
|
HC ACNE SURGERY
|
Facility
|
IP
|
$267.34
|
|
|
Service Code
|
CPT 10040
|
| Hospital Charge Code |
76100282
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$168.42 |
| Max. Negotiated Rate |
$240.61 |
| Rate for Payer: Aetna Commercial |
$227.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.77
|
| Rate for Payer: Cash Price |
$213.87
|
| Rate for Payer: Cofinity Commercial |
$229.91
|
| Rate for Payer: Cofinity Commercial |
$187.14
|
| Rate for Payer: Healthscope Commercial |
$240.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.24
|
| Rate for Payer: PHP Commercial |
$227.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.14
|
| Rate for Payer: Priority Health SBD |
$168.42
|
|
|
HC ACOUSTIC IMMITANCE TESTING
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 92570
|
| Hospital Charge Code |
76100509
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$28.16 |
| Max. Negotiated Rate |
$436.07 |
| Rate for Payer: Aetna Commercial |
$124.10
|
| Rate for Payer: Aetna Medicare |
$144.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.74
|
| Rate for Payer: BCBS Complete |
$79.84
|
| Rate for Payer: BCBS MAPPO |
$138.99
|
| Rate for Payer: BCBS Trust/PPO |
$59.86
|
| Rate for Payer: BCN Medicare Advantage |
$138.99
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$102.20
|
| Rate for Payer: Cofinity Commercial |
$125.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.99
|
| Rate for Payer: Healthscope Commercial |
$131.40
|
| Rate for Payer: Mclaren Medicaid |
$76.03
|
| Rate for Payer: Mclaren Medicare |
$138.99
|
| Rate for Payer: Meridian Medicaid |
$79.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.10
|
| Rate for Payer: PACE Medicare |
$132.04
|
| Rate for Payer: PACE SWMI |
$138.99
|
| Rate for Payer: PHP Commercial |
$124.10
|
| Rate for Payer: PHP Medicare Advantage |
$138.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$436.07
|
| Rate for Payer: Priority Health Medicare |
$138.99
|
| Rate for Payer: Priority Health Narrow Network |
$348.85
|
| Rate for Payer: Priority Health SBD |
$91.98
|
| Rate for Payer: Railroad Medicare Medicare |
$138.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.99
|
| Rate for Payer: UHC Exchange |
$28.16
|
| Rate for Payer: UHC Medicare Advantage |
$143.16
|
| Rate for Payer: VA VA |
$138.99
|
|
|
HC ACOUSTIC IMMITANCE TESTING
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 92570
|
| Hospital Charge Code |
76100509
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$91.98 |
| Max. Negotiated Rate |
$131.40 |
| Rate for Payer: Aetna Commercial |
$124.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.90
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$125.56
|
| Rate for Payer: Cofinity Commercial |
$102.20
|
| Rate for Payer: Healthscope Commercial |
$131.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.10
|
| Rate for Payer: PHP Commercial |
$124.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.20
|
| Rate for Payer: Priority Health SBD |
$91.98
|
|
|
HC ACTIGRAPHY
|
Facility
|
OP
|
$270.16
|
|
|
Service Code
|
CPT 95803
|
| Hospital Charge Code |
92000016
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$29.77 |
| Max. Negotiated Rate |
$243.14 |
| Rate for Payer: Aetna Commercial |
$229.64
|
| Rate for Payer: Aetna Medicare |
$56.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.04
|
| Rate for Payer: BCBS Complete |
$31.26
|
| Rate for Payer: BCBS MAPPO |
$54.43
|
| Rate for Payer: BCN Medicare Advantage |
$54.43
|
| Rate for Payer: Cash Price |
$216.13
|
| Rate for Payer: Cash Price |
$216.13
|
| Rate for Payer: Cofinity Commercial |
$232.34
|
| Rate for Payer: Cofinity Commercial |
$189.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.43
|
| Rate for Payer: Healthscope Commercial |
$243.14
|
| Rate for Payer: Mclaren Medicaid |
$29.77
|
| Rate for Payer: Mclaren Medicare |
$54.43
|
| Rate for Payer: Meridian Medicaid |
$31.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.64
|
| Rate for Payer: PACE Medicare |
$51.71
|
| Rate for Payer: PACE SWMI |
$54.43
|
| Rate for Payer: PHP Commercial |
$229.64
|
| Rate for Payer: PHP Medicare Advantage |
$54.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.33
|
| Rate for Payer: Priority Health Medicare |
$54.43
|
| Rate for Payer: Priority Health Narrow Network |
$138.66
|
| Rate for Payer: Priority Health SBD |
$170.20
|
| Rate for Payer: Railroad Medicare Medicare |
$54.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.43
|
| Rate for Payer: UHC Exchange |
$132.94
|
| Rate for Payer: UHC Medicare Advantage |
$56.06
|
| Rate for Payer: VA VA |
$54.43
|
|
|
HC ACTIGRAPHY
|
Facility
|
IP
|
$270.16
|
|
|
Service Code
|
CPT 95803
|
| Hospital Charge Code |
92000016
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$170.20 |
| Max. Negotiated Rate |
$243.14 |
| Rate for Payer: Aetna Commercial |
$229.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.60
|
| Rate for Payer: Cash Price |
$216.13
|
| Rate for Payer: Cofinity Commercial |
$189.11
|
| Rate for Payer: Cofinity Commercial |
$232.34
|
| Rate for Payer: Healthscope Commercial |
$243.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.64
|
| Rate for Payer: PHP Commercial |
$229.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.11
|
| Rate for Payer: Priority Health SBD |
$170.20
|
|
|
HC ACTIVATED PROTEIN C RESISTANCE
|
Facility
|
OP
|
$90.78
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
30500040
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.38 |
| Max. Negotiated Rate |
$81.70 |
| Rate for Payer: Aetna Commercial |
$77.16
|
| Rate for Payer: Aetna Medicare |
$15.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.15
|
| Rate for Payer: BCBS Complete |
$8.80
|
| Rate for Payer: BCBS MAPPO |
$15.32
|
| Rate for Payer: BCBS Trust/PPO |
$12.00
|
| Rate for Payer: BCN Medicare Advantage |
$15.32
|
| Rate for Payer: Cash Price |
$72.62
|
| Rate for Payer: Cash Price |
$72.62
|
| Rate for Payer: Cofinity Commercial |
$78.07
|
| Rate for Payer: Cofinity Commercial |
$63.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.32
|
| Rate for Payer: Healthscope Commercial |
$81.70
|
| Rate for Payer: Mclaren Medicaid |
$8.38
|
| Rate for Payer: Mclaren Medicare |
$15.32
|
| Rate for Payer: Meridian Medicaid |
$8.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$77.16
|
| Rate for Payer: PACE Medicare |
$14.55
|
| Rate for Payer: PACE SWMI |
$15.32
|
| Rate for Payer: PHP Commercial |
$77.16
|
| Rate for Payer: PHP Medicare Advantage |
$15.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.55
|
| Rate for Payer: Priority Health Medicare |
$15.32
|
| Rate for Payer: Priority Health SBD |
$57.19
|
| Rate for Payer: Railroad Medicare Medicare |
$15.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.38
|
| Rate for Payer: UHC Core |
$26.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.32
|
| Rate for Payer: UHC Exchange |
$15.32
|
| Rate for Payer: UHC Medicare Advantage |
$15.78
|
| Rate for Payer: VA VA |
$15.32
|
|
