|
HC ALTERNARIA IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200027
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.09
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC ALTERNARIA IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200027
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
|
|
HC ALUMINUM
|
Facility
|
IP
|
$55.08
|
|
|
Service Code
|
CPT 82108
|
| Hospital Charge Code |
30100088
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.70 |
| Max. Negotiated Rate |
$49.57 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.80
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cofinity Commercial |
$38.56
|
| Rate for Payer: Cofinity Commercial |
$47.37
|
| Rate for Payer: Healthscope Commercial |
$49.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.82
|
| Rate for Payer: PHP Commercial |
$46.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.56
|
| Rate for Payer: Priority Health SBD |
$34.70
|
|
|
HC ALUMINUM
|
Facility
|
OP
|
$55.08
|
|
|
Service Code
|
CPT 82108
|
| Hospital Charge Code |
30100088
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$49.57 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna Medicare |
$26.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.85
|
| Rate for Payer: BCBS Complete |
$14.64
|
| Rate for Payer: BCBS MAPPO |
$25.48
|
| Rate for Payer: BCBS Trust/PPO |
$19.95
|
| Rate for Payer: BCN Medicare Advantage |
$25.48
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cofinity Commercial |
$47.37
|
| Rate for Payer: Cofinity Commercial |
$38.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.48
|
| Rate for Payer: Healthscope Commercial |
$49.57
|
| Rate for Payer: Mclaren Medicaid |
$13.94
|
| Rate for Payer: Mclaren Medicare |
$25.48
|
| Rate for Payer: Meridian Medicaid |
$14.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.82
|
| Rate for Payer: PACE Medicare |
$24.21
|
| Rate for Payer: PACE SWMI |
$25.48
|
| Rate for Payer: PHP Commercial |
$46.82
|
| Rate for Payer: PHP Medicare Advantage |
$25.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.56
|
| Rate for Payer: Priority Health Medicare |
$25.48
|
| Rate for Payer: Priority Health SBD |
$34.70
|
| Rate for Payer: Railroad Medicare Medicare |
$25.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.58
|
| Rate for Payer: UHC Core |
$43.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.48
|
| Rate for Payer: UHC Exchange |
$25.48
|
| Rate for Payer: UHC Medicare Advantage |
$26.24
|
| Rate for Payer: VA VA |
$25.48
|
|
|
HC AMIKACIN LEVEL
|
Facility
|
IP
|
$76.91
|
|
|
Service Code
|
CPT 80150
|
| Hospital Charge Code |
30100006
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.45 |
| Max. Negotiated Rate |
$69.22 |
| Rate for Payer: Aetna Commercial |
$65.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.99
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cofinity Commercial |
$53.84
|
| Rate for Payer: Cofinity Commercial |
$66.14
|
| Rate for Payer: Healthscope Commercial |
$69.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.37
|
| Rate for Payer: PHP Commercial |
$65.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.84
|
| Rate for Payer: Priority Health SBD |
$48.45
|
|
|
HC AMIKACIN LEVEL
|
Facility
|
OP
|
$76.91
|
|
|
Service Code
|
CPT 80150
|
| Hospital Charge Code |
30100006
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$69.22 |
| Rate for Payer: Aetna Commercial |
$65.37
|
| Rate for Payer: Aetna Medicare |
$15.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.85
|
| Rate for Payer: BCBS Complete |
$8.66
|
| Rate for Payer: BCBS MAPPO |
$15.08
|
| Rate for Payer: BCBS Trust/PPO |
$11.81
|
| Rate for Payer: BCN Medicare Advantage |
$15.08
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cofinity Commercial |
$66.14
|
| Rate for Payer: Cofinity Commercial |
$53.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.08
|
| Rate for Payer: Healthscope Commercial |
$69.22
|
| Rate for Payer: Mclaren Medicaid |
$8.25
|
| Rate for Payer: Mclaren Medicare |
$15.08
|
| Rate for Payer: Meridian Medicaid |
$8.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.37
|
| Rate for Payer: PACE Medicare |
$14.33
|
| Rate for Payer: PACE SWMI |
$15.08
|
| Rate for Payer: PHP Commercial |
$65.37
|
| Rate for Payer: PHP Medicare Advantage |
$15.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.84
|
| Rate for Payer: Priority Health Medicare |
$15.08
|
| Rate for Payer: Priority Health SBD |
$48.45
|
| Rate for Payer: Railroad Medicare Medicare |
$15.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.10
|
| Rate for Payer: UHC Core |
$25.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.08
|
| Rate for Payer: UHC Exchange |
$15.08
|
| Rate for Payer: UHC Medicare Advantage |
$15.53
|
| Rate for Payer: VA VA |
$15.08
|
|
|
HC AMINO ACID FRACTIONATION
|
Facility
|
IP
|
$155.04
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
30100091
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.68 |
| Max. Negotiated Rate |
$139.54 |
| Rate for Payer: Aetna Commercial |
$131.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.78
|
| Rate for Payer: Cash Price |
$124.03
|
| Rate for Payer: Cofinity Commercial |
$108.53
|
| Rate for Payer: Cofinity Commercial |
$133.33
|
| Rate for Payer: Healthscope Commercial |
$139.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.78
|
| Rate for Payer: PHP Commercial |
$131.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.53
|
| Rate for Payer: Priority Health SBD |
$97.68
|
|
|
HC AMINO ACID FRACTIONATION
|
Facility
|
OP
|
$155.04
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
30100091
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$139.54 |
| Rate for Payer: Aetna Commercial |
$131.78
|
| Rate for Payer: Aetna Medicare |
$17.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.09
|
| Rate for Payer: BCBS Complete |
$9.69
|
| Rate for Payer: BCBS MAPPO |
$16.87
|
| Rate for Payer: BCBS Trust/PPO |
$13.21
|
| Rate for Payer: BCN Medicare Advantage |
$16.87
|
| Rate for Payer: Cash Price |
$124.03
|
| Rate for Payer: Cash Price |
$124.03
|
| Rate for Payer: Cofinity Commercial |
$133.33
|
| Rate for Payer: Cofinity Commercial |
$108.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.87
|
| Rate for Payer: Healthscope Commercial |
$139.54
|
| Rate for Payer: Mclaren Medicaid |
$9.23
|
| Rate for Payer: Mclaren Medicare |
$16.87
|
| Rate for Payer: Meridian Medicaid |
$9.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.78
|
| Rate for Payer: PACE Medicare |
$16.03
|
| Rate for Payer: PACE SWMI |
$16.87
|
| Rate for Payer: PHP Commercial |
$131.78
|
| Rate for Payer: PHP Medicare Advantage |
$16.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.53
|
| Rate for Payer: Priority Health Medicare |
$16.87
|
| Rate for Payer: Priority Health SBD |
$97.68
|
| Rate for Payer: Railroad Medicare Medicare |
$16.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.24
|
| Rate for Payer: UHC Core |
$28.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.87
|
| Rate for Payer: UHC Exchange |
$16.87
|
| Rate for Payer: UHC Medicare Advantage |
$17.38
|
| Rate for Payer: VA VA |
$16.87
|
|
|
HC AMINO ACID QUANT CSF
|
Facility
|
IP
|
$229.50
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
30100093
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$144.58 |
| Max. Negotiated Rate |
$206.55 |
| Rate for Payer: Aetna Commercial |
$195.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.18
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cofinity Commercial |
$160.65
|
| Rate for Payer: Cofinity Commercial |
$197.37
|
| Rate for Payer: Healthscope Commercial |
$206.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$195.08
|
| Rate for Payer: PHP Commercial |
$195.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.65
|
| Rate for Payer: Priority Health SBD |
$144.58
|
|
|
HC AMINO ACID QUANT CSF
|
Facility
|
OP
|
$229.50
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
30100093
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$206.55 |
| Rate for Payer: Aetna Commercial |
$195.08
|
| Rate for Payer: Aetna Medicare |
$17.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.09
|
| Rate for Payer: BCBS Complete |
$9.69
|
| Rate for Payer: BCBS MAPPO |
$16.87
|
| Rate for Payer: BCBS Trust/PPO |
$13.21
|
| Rate for Payer: BCN Medicare Advantage |
$16.87
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cofinity Commercial |
$160.65
|
| Rate for Payer: Cofinity Commercial |
$197.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.87
|
| Rate for Payer: Healthscope Commercial |
$206.55
|
| Rate for Payer: Mclaren Medicaid |
$9.23
|
| Rate for Payer: Mclaren Medicare |
$16.87
|
| Rate for Payer: Meridian Medicaid |
$9.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$195.08
|
| Rate for Payer: PACE Medicare |
$16.03
|
| Rate for Payer: PACE SWMI |
$16.87
|
| Rate for Payer: PHP Commercial |
$195.08
|
| Rate for Payer: PHP Medicare Advantage |
$16.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.65
|
| Rate for Payer: Priority Health Medicare |
$16.87
|
| Rate for Payer: Priority Health SBD |
$144.58
|
| Rate for Payer: Railroad Medicare Medicare |
$16.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.24
|
| Rate for Payer: UHC Core |
$28.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.87
|
| Rate for Payer: UHC Exchange |
$16.87
|
| Rate for Payer: UHC Medicare Advantage |
$17.38
|
| Rate for Payer: VA VA |
$16.87
|
|
|
HC AMINO ACID QUANT RANDOM URINE
|
Facility
|
IP
|
$209.10
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
30100092
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$131.73 |
| Max. Negotiated Rate |
$188.19 |
| Rate for Payer: Aetna Commercial |
$177.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.92
|
| Rate for Payer: Cash Price |
$167.28
|
| Rate for Payer: Cofinity Commercial |
$146.37
|
| Rate for Payer: Cofinity Commercial |
$179.83
|
| Rate for Payer: Healthscope Commercial |
$188.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.74
|
| Rate for Payer: PHP Commercial |
$177.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.37
|
| Rate for Payer: Priority Health SBD |
$131.73
|
|
|
HC AMINO ACID QUANT RANDOM URINE
|
Facility
|
OP
|
$209.10
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
30100092
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$188.19 |
| Rate for Payer: Aetna Commercial |
$177.74
|
| Rate for Payer: Aetna Medicare |
$17.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.09
|
| Rate for Payer: BCBS Complete |
$9.69
|
| Rate for Payer: BCBS MAPPO |
$16.87
|
| Rate for Payer: BCBS Trust/PPO |
$13.21
|
| Rate for Payer: BCN Medicare Advantage |
$16.87
|
| Rate for Payer: Cash Price |
$167.28
|
| Rate for Payer: Cash Price |
$167.28
|
| Rate for Payer: Cofinity Commercial |
$179.83
|
| Rate for Payer: Cofinity Commercial |
$146.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.87
|
| Rate for Payer: Healthscope Commercial |
$188.19
|
| Rate for Payer: Mclaren Medicaid |
$9.23
|
| Rate for Payer: Mclaren Medicare |
$16.87
|
| Rate for Payer: Meridian Medicaid |
$9.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.74
|
| Rate for Payer: PACE Medicare |
$16.03
|
| Rate for Payer: PACE SWMI |
$16.87
|
| Rate for Payer: PHP Commercial |
$177.74
|
| Rate for Payer: PHP Medicare Advantage |
$16.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.37
|
| Rate for Payer: Priority Health Medicare |
$16.87
|
| Rate for Payer: Priority Health SBD |
$131.73
|
| Rate for Payer: Railroad Medicare Medicare |
$16.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.24
|
| Rate for Payer: UHC Core |
$28.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.87
|
| Rate for Payer: UHC Exchange |
$16.87
|
| Rate for Payer: UHC Medicare Advantage |
$17.38
|
| Rate for Payer: VA VA |
$16.87
|
|
|
HC AMINOLEVULINIC ACID URINE
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 82135
|
| Hospital Charge Code |
30100089
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Aetna Commercial |
$73.10
|
| Rate for Payer: Aetna Medicare |
$17.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.56
|
| Rate for Payer: BCBS Complete |
$9.45
|
| Rate for Payer: BCBS MAPPO |
$16.45
|
| Rate for Payer: BCBS Trust/PPO |
$12.88
|
| Rate for Payer: BCN Medicare Advantage |
$16.45
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cofinity Commercial |
$73.96
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.45
|
| Rate for Payer: Healthscope Commercial |
$77.40
|
| Rate for Payer: Mclaren Medicaid |
$9.00
|
| Rate for Payer: Mclaren Medicare |
$16.45
|
| Rate for Payer: Meridian Medicaid |
$9.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.10
|
| Rate for Payer: PACE Medicare |
$15.63
|
| Rate for Payer: PACE SWMI |
$16.45
|
| Rate for Payer: PHP Commercial |
$73.10
|
| Rate for Payer: PHP Medicare Advantage |
$16.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.20
|
| Rate for Payer: Priority Health Medicare |
$16.45
|
| Rate for Payer: Priority Health SBD |
$54.18
|
| Rate for Payer: Railroad Medicare Medicare |
$16.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.74
|
| Rate for Payer: UHC Core |
$27.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.45
|
| Rate for Payer: UHC Exchange |
$16.45
|
| Rate for Payer: UHC Medicare Advantage |
$16.94
|
| Rate for Payer: VA VA |
$16.45
|
|
|
HC AMINOLEVULINIC ACID URINE
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 82135
|
| Hospital Charge Code |
30100089
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.18 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Aetna Commercial |
$73.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.90
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Cofinity Commercial |
$73.96
|
| Rate for Payer: Healthscope Commercial |
$77.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.10
|
| Rate for Payer: PHP Commercial |
$73.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.20
|
| Rate for Payer: Priority Health SBD |
$54.18
|
|
|
HC AMIODARONE/CORDARONE LEVEL
|
Facility
|
OP
|
$39.07
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100287
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.18 |
| Max. Negotiated Rate |
$35.16 |
| Rate for Payer: Aetna Commercial |
$33.21
|
| Rate for Payer: Aetna Medicare |
$25.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.11
|
| Rate for Payer: BCBS Complete |
$13.84
|
| Rate for Payer: BCBS MAPPO |
$24.09
|
| Rate for Payer: BCBS Trust/PPO |
$18.87
|
| Rate for Payer: BCN Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$31.26
|
| Rate for Payer: Cash Price |
$31.26
|
| Rate for Payer: Cofinity Commercial |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$27.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.09
|
| Rate for Payer: Healthscope Commercial |
$35.16
|
| Rate for Payer: Mclaren Medicaid |
$13.18
|
| Rate for Payer: Mclaren Medicare |
$24.09
|
| Rate for Payer: Meridian Medicaid |
$13.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.21
|
| Rate for Payer: PACE Medicare |
$22.89
|
| Rate for Payer: PACE SWMI |
$24.09
|
| Rate for Payer: PHP Commercial |
$33.21
|
| Rate for Payer: PHP Medicare Advantage |
$24.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.35
|
| Rate for Payer: Priority Health Medicare |
$24.09
|
| Rate for Payer: Priority Health SBD |
$24.61
|
| Rate for Payer: Railroad Medicare Medicare |
$24.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.91
|
| Rate for Payer: UHC Core |
$30.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.09
|
| Rate for Payer: UHC Exchange |
$24.09
|
| Rate for Payer: UHC Medicare Advantage |
$24.81
|
| Rate for Payer: VA VA |
$24.09
|
|
|
HC AMIODARONE/CORDARONE LEVEL
|
Facility
|
IP
|
$39.07
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100287
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.61 |
| Max. Negotiated Rate |
$35.16 |
| Rate for Payer: Aetna Commercial |
$33.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.40
|
| Rate for Payer: Cash Price |
$31.26
|
| Rate for Payer: Cofinity Commercial |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$27.35
|
| Rate for Payer: Healthscope Commercial |
$35.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.21
|
| Rate for Payer: PHP Commercial |
$33.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.35
|
| Rate for Payer: Priority Health SBD |
$24.61
|
|
|
HC AMITRIPTYLINE
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
30100563
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna Commercial |
$36.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.95
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$36.98
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Healthscope Commercial |
$38.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.55
|
| Rate for Payer: PHP Commercial |
$36.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.10
|
| Rate for Payer: Priority Health SBD |
$27.09
|
| Rate for Payer: UHC Core |
$29.23
|
|
|
HC AMITRIPTYLINE
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
30100563
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.09 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna Commercial |
$36.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.95
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$36.98
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Healthscope Commercial |
$38.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.55
|
| Rate for Payer: PHP Commercial |
$36.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.10
|
| Rate for Payer: Priority Health SBD |
$27.09
|
|
|
HC AMMONIA LEVEL
|
Facility
|
IP
|
$48.96
|
|
|
Service Code
|
CPT 82140
|
| Hospital Charge Code |
30100094
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.84 |
| Max. Negotiated Rate |
$44.06 |
| Rate for Payer: Aetna Commercial |
$41.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.82
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$42.11
|
| Rate for Payer: Healthscope Commercial |
$44.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.62
|
| Rate for Payer: PHP Commercial |
$41.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.27
|
| Rate for Payer: Priority Health SBD |
$30.84
|
|
|
HC AMMONIA LEVEL
|
Facility
|
OP
|
$48.96
|
|
|
Service Code
|
CPT 82140
|
| Hospital Charge Code |
30100094
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$44.06 |
| Rate for Payer: Aetna Commercial |
$41.62
|
| Rate for Payer: Aetna Medicare |
$15.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.21
|
| Rate for Payer: BCBS Complete |
$8.37
|
| Rate for Payer: BCBS MAPPO |
$14.57
|
| Rate for Payer: BCBS Trust/PPO |
$11.41
|
| Rate for Payer: BCN Medicare Advantage |
$14.57
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$42.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$44.06
|
| Rate for Payer: Mclaren Medicaid |
$7.97
|
| Rate for Payer: Mclaren Medicare |
$14.57
|
| Rate for Payer: Meridian Medicaid |
$8.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.62
|
| Rate for Payer: PACE Medicare |
$13.84
|
| Rate for Payer: PACE SWMI |
$14.57
|
| Rate for Payer: PHP Commercial |
$41.62
|
| Rate for Payer: PHP Medicare Advantage |
$14.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.27
|
| Rate for Payer: Priority Health Medicare |
$14.57
|
| Rate for Payer: Priority Health SBD |
$30.84
|
| Rate for Payer: Railroad Medicare Medicare |
$14.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.48
|
| Rate for Payer: UHC Core |
$24.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.57
|
| Rate for Payer: UHC Exchange |
$14.57
|
| Rate for Payer: UHC Medicare Advantage |
$15.01
|
| Rate for Payer: VA VA |
$14.57
|
|
|
HC AMNIOCENTESIS
|
Facility
|
IP
|
$800.53
|
|
|
Service Code
|
CPT 59001
|
| Hospital Charge Code |
76100006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$504.33 |
| Max. Negotiated Rate |
$720.48 |
| Rate for Payer: Aetna Commercial |
$680.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$520.34
|
| Rate for Payer: Cash Price |
$640.42
|
| Rate for Payer: Cofinity Commercial |
$560.37
|
| Rate for Payer: Cofinity Commercial |
$688.46
|
| Rate for Payer: Healthscope Commercial |
$720.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$680.45
|
| Rate for Payer: PHP Commercial |
$680.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.37
|
| Rate for Payer: Priority Health SBD |
$504.33
|
|
|
HC AMNIOCENTESIS
|
Facility
|
OP
|
$800.53
|
|
|
Service Code
|
CPT 59001
|
| Hospital Charge Code |
76100006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.95 |
| Max. Negotiated Rate |
$720.48 |
| Rate for Payer: Aetna Commercial |
$680.45
|
| Rate for Payer: Aetna Medicare |
$296.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$520.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$356.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$356.81
|
| Rate for Payer: BCBS Complete |
$163.96
|
| Rate for Payer: BCBS MAPPO |
$285.45
|
| Rate for Payer: BCBS Trust/PPO |
$109.95
|
| Rate for Payer: BCN Medicare Advantage |
$285.45
|
| Rate for Payer: Cash Price |
$640.42
|
| Rate for Payer: Cash Price |
$640.42
|
| Rate for Payer: Cofinity Commercial |
$688.46
|
| Rate for Payer: Cofinity Commercial |
$560.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.45
|
| Rate for Payer: Healthscope Commercial |
$720.48
|
| Rate for Payer: Mclaren Medicaid |
$156.14
|
| Rate for Payer: Mclaren Medicare |
$285.45
|
| Rate for Payer: Meridian Medicaid |
$163.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$299.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$328.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$680.45
|
| Rate for Payer: PACE Medicare |
$271.18
|
| Rate for Payer: PACE SWMI |
$285.45
|
| Rate for Payer: PHP Commercial |
$680.45
|
| Rate for Payer: PHP Medicare Advantage |
$285.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.37
|
| Rate for Payer: Priority Health Medicare |
$285.45
|
| Rate for Payer: Priority Health SBD |
$504.33
|
| Rate for Payer: Railroad Medicare Medicare |
$285.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$285.45
|
| Rate for Payer: UHC Exchange |
$175.18
|
| Rate for Payer: UHC Medicare Advantage |
$294.01
|
| Rate for Payer: VA VA |
$285.45
|
|
|
HC AMNIOCENTESIS DIAGNOSTIC
|
Facility
|
IP
|
$429.05
|
|
|
Service Code
|
CPT 59000
|
| Hospital Charge Code |
36100261
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$270.30 |
| Max. Negotiated Rate |
$386.14 |
| Rate for Payer: Aetna Commercial |
$364.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.88
|
| Rate for Payer: Cash Price |
$343.24
|
| Rate for Payer: Cofinity Commercial |
$300.34
|
| Rate for Payer: Cofinity Commercial |
$368.98
|
| Rate for Payer: Healthscope Commercial |
$386.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.69
|
| Rate for Payer: PHP Commercial |
$364.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.34
|
| Rate for Payer: Priority Health SBD |
$270.30
|
|
|
HC AMNIOCENTESIS DIAGNOSTIC
|
Facility
|
OP
|
$429.05
|
|
|
Service Code
|
CPT 59000
|
| Hospital Charge Code |
36100261
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.57 |
| Max. Negotiated Rate |
$894.14 |
| Rate for Payer: Aetna Commercial |
$364.69
|
| Rate for Payer: Aetna Medicare |
$743.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$894.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$894.14
|
| Rate for Payer: BCBS Complete |
$410.87
|
| Rate for Payer: BCBS MAPPO |
$715.31
|
| Rate for Payer: BCBS Trust/PPO |
$439.74
|
| Rate for Payer: BCN Medicare Advantage |
$715.31
|
| Rate for Payer: Cash Price |
$343.24
|
| Rate for Payer: Cash Price |
$343.24
|
| Rate for Payer: Cofinity Commercial |
$368.98
|
| Rate for Payer: Cofinity Commercial |
$300.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$715.31
|
| Rate for Payer: Healthscope Commercial |
$386.14
|
| Rate for Payer: Mclaren Medicaid |
$391.27
|
| Rate for Payer: Mclaren Medicare |
$715.31
|
| Rate for Payer: Meridian Medicaid |
$410.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$751.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$822.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.69
|
| Rate for Payer: PACE Medicare |
$679.54
|
| Rate for Payer: PACE SWMI |
$715.31
|
| Rate for Payer: PHP Commercial |
$364.69
|
| Rate for Payer: PHP Medicare Advantage |
$715.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$391.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.34
|
| Rate for Payer: Priority Health Medicare |
$715.31
|
| Rate for Payer: Priority Health SBD |
$270.30
|
| Rate for Payer: Railroad Medicare Medicare |
$715.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$715.31
|
| Rate for Payer: UHC Exchange |
$79.57
|
| Rate for Payer: UHC Medicare Advantage |
$736.77
|
| Rate for Payer: VA VA |
$715.31
|
|
|
HC AMNIOINFUSION
|
Facility
|
IP
|
$563.36
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
76100007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$354.92 |
| Max. Negotiated Rate |
$507.02 |
| Rate for Payer: Aetna Commercial |
$478.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$366.18
|
| Rate for Payer: Cash Price |
$450.69
|
| Rate for Payer: Cofinity Commercial |
$394.35
|
| Rate for Payer: Cofinity Commercial |
$484.49
|
| Rate for Payer: Healthscope Commercial |
$507.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$478.86
|
| Rate for Payer: PHP Commercial |
$478.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$394.35
|
| Rate for Payer: Priority Health SBD |
$354.92
|
|
