|
HC CHLAMYDIA PNEUMONIAE CULTURE
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT 87110
|
| Hospital Charge Code |
30600088
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$68.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cofinity Commercial |
$68.80
|
| Rate for Payer: Cofinity Commercial |
$56.00
|
| Rate for Payer: Healthscope Commercial |
$72.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.00
|
| Rate for Payer: PHP Commercial |
$68.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.00
|
| Rate for Payer: Priority Health SBD |
$50.40
|
|
|
HC CHLAMYDIA PNEUMONIAE CULTURE
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT 87110
|
| Hospital Charge Code |
30600088
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.72 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$68.00
|
| Rate for Payer: Aetna Medicare |
$20.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.50
|
| Rate for Payer: BCBS Complete |
$11.26
|
| Rate for Payer: BCBS MAPPO |
$19.60
|
| Rate for Payer: BCBS Trust/PPO |
$15.35
|
| Rate for Payer: BCN Medicare Advantage |
$19.60
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cofinity Commercial |
$68.80
|
| Rate for Payer: Cofinity Commercial |
$56.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.60
|
| Rate for Payer: Healthscope Commercial |
$72.00
|
| Rate for Payer: Mclaren Medicaid |
$10.72
|
| Rate for Payer: Mclaren Medicare |
$19.60
|
| Rate for Payer: Meridian Medicaid |
$11.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.00
|
| Rate for Payer: PACE Medicare |
$18.62
|
| Rate for Payer: PACE SWMI |
$19.60
|
| Rate for Payer: PHP Commercial |
$68.00
|
| Rate for Payer: PHP Medicare Advantage |
$19.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.00
|
| Rate for Payer: Priority Health Medicare |
$19.60
|
| Rate for Payer: Priority Health SBD |
$50.40
|
| Rate for Payer: Railroad Medicare Medicare |
$19.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.52
|
| Rate for Payer: UHC Core |
$33.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.60
|
| Rate for Payer: UHC Exchange |
$19.60
|
| Rate for Payer: UHC Medicare Advantage |
$20.19
|
| Rate for Payer: VA VA |
$19.60
|
|
|
HC CHLAMYDIA PNEUMONIAE CULTURE REF LAB
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 87140
|
| Hospital Charge Code |
30600090
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.50
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: PHP Commercial |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health SBD |
$18.90
|
|
|
HC CHLAMYDIA PNEUMONIAE CULTURE REF LAB
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 87140
|
| Hospital Charge Code |
30600090
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: Aetna Medicare |
$5.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.96
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCBS MAPPO |
$5.57
|
| Rate for Payer: BCBS Trust/PPO |
$4.36
|
| Rate for Payer: BCN Medicare Advantage |
$5.57
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.57
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Mclaren Medicaid |
$3.05
|
| Rate for Payer: Mclaren Medicare |
$5.57
|
| Rate for Payer: Meridian Medicaid |
$3.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: PACE Medicare |
$5.29
|
| Rate for Payer: PACE SWMI |
$5.57
|
| Rate for Payer: PHP Commercial |
$25.50
|
| Rate for Payer: PHP Medicare Advantage |
$5.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health Medicare |
$5.57
|
| Rate for Payer: Priority Health SBD |
$18.90
|
| Rate for Payer: Railroad Medicare Medicare |
$5.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.68
|
| Rate for Payer: UHC Core |
$9.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.57
|
| Rate for Payer: UHC Exchange |
$5.57
|
| Rate for Payer: UHC Medicare Advantage |
$5.74
|
| Rate for Payer: VA VA |
$5.57
|
|
|
HC CHLORAMPHENICOL LEVEL
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 82415
|
| Hospital Charge Code |
30100151
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.25 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$63.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.75
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$52.50
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Healthscope Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
| Rate for Payer: PHP Commercial |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: Priority Health SBD |
$47.25
|
|
|
HC CHLORAMPHENICOL LEVEL
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 82415
|
| Hospital Charge Code |
30100151
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.93 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$63.75
|
| Rate for Payer: Aetna Medicare |
$13.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.84
|
| Rate for Payer: BCBS Complete |
$7.28
|
| Rate for Payer: BCBS MAPPO |
$12.67
|
| Rate for Payer: BCBS Trust/PPO |
$9.92
|
| Rate for Payer: BCN Medicare Advantage |
$12.67
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$52.50
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.67
|
| Rate for Payer: Healthscope Commercial |
$67.50
|
| Rate for Payer: Mclaren Medicaid |
$6.93
|
| Rate for Payer: Mclaren Medicare |
$12.67
|
| Rate for Payer: Meridian Medicaid |
$7.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
| Rate for Payer: PACE Medicare |
$12.04
|
| Rate for Payer: PACE SWMI |
$12.67
|
| Rate for Payer: PHP Commercial |
$63.75
|
| Rate for Payer: PHP Medicare Advantage |
$12.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: Priority Health Medicare |
$12.67
|
| Rate for Payer: Priority Health SBD |
$47.25
|
| Rate for Payer: Railroad Medicare Medicare |
$12.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.20
|
| Rate for Payer: UHC Core |
$21.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.67
|
| Rate for Payer: UHC Exchange |
$12.67
|
| Rate for Payer: UHC Medicare Advantage |
$13.05
|
| Rate for Payer: VA VA |
$12.67
|
|
|
HC CHLORIDE OTHER SOURCE
|
Facility
|
IP
|
$20.80
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
30100554
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$18.72 |
| Rate for Payer: Aetna Commercial |
$17.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.52
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Cofinity Commercial |
$17.89
|
| Rate for Payer: Cofinity Commercial |
$14.56
|
| Rate for Payer: Healthscope Commercial |
$18.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.68
|
| Rate for Payer: PHP Commercial |
$17.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.56
|
| Rate for Payer: Priority Health SBD |
$13.10
|
|
|
HC CHLORIDE OTHER SOURCE
|
Facility
|
IP
|
$20.80
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
30100513
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$18.72 |
| Rate for Payer: Aetna Commercial |
$17.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.52
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Cofinity Commercial |
$14.56
|
| Rate for Payer: Cofinity Commercial |
$17.89
|
| Rate for Payer: Healthscope Commercial |
$18.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.68
|
| Rate for Payer: PHP Commercial |
$17.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.56
|
| Rate for Payer: Priority Health SBD |
$13.10
|
|
|
HC CHLORIDE OTHER SOURCE
|
Facility
|
OP
|
$20.80
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
30100513
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$18.72 |
| Rate for Payer: Aetna Commercial |
$17.68
|
| Rate for Payer: Aetna Medicare |
$5.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.25
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.00
|
| Rate for Payer: BCBS Trust/PPO |
$3.92
|
| Rate for Payer: BCN Medicare Advantage |
$5.00
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Cofinity Commercial |
$14.56
|
| Rate for Payer: Cofinity Commercial |
$17.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.00
|
| Rate for Payer: Healthscope Commercial |
$18.72
|
| Rate for Payer: Mclaren Medicaid |
$2.74
|
| Rate for Payer: Mclaren Medicare |
$5.00
|
| Rate for Payer: Meridian Medicaid |
$2.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.68
|
| Rate for Payer: PACE Medicare |
$4.75
|
| Rate for Payer: PACE SWMI |
$5.00
|
| Rate for Payer: PHP Commercial |
$17.68
|
| Rate for Payer: PHP Medicare Advantage |
$5.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.56
|
| Rate for Payer: Priority Health Medicare |
$5.00
|
| Rate for Payer: Priority Health SBD |
$13.10
|
| Rate for Payer: Railroad Medicare Medicare |
$5.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.00
|
| Rate for Payer: UHC Core |
$8.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.00
|
| Rate for Payer: UHC Exchange |
$5.00
|
| Rate for Payer: UHC Medicare Advantage |
$5.15
|
| Rate for Payer: VA VA |
$5.00
|
|
|
HC CHLORIDE OTHER SOURCE
|
Facility
|
OP
|
$20.80
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
30100554
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$18.72 |
| Rate for Payer: Aetna Commercial |
$17.68
|
| Rate for Payer: Aetna Medicare |
$5.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.25
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.00
|
| Rate for Payer: BCBS Trust/PPO |
$3.92
|
| Rate for Payer: BCN Medicare Advantage |
$5.00
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Cofinity Commercial |
$17.89
|
| Rate for Payer: Cofinity Commercial |
$14.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.00
|
| Rate for Payer: Healthscope Commercial |
$18.72
|
| Rate for Payer: Mclaren Medicaid |
$2.74
|
| Rate for Payer: Mclaren Medicare |
$5.00
|
| Rate for Payer: Meridian Medicaid |
$2.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.68
|
| Rate for Payer: PACE Medicare |
$4.75
|
| Rate for Payer: PACE SWMI |
$5.00
|
| Rate for Payer: PHP Commercial |
$17.68
|
| Rate for Payer: PHP Medicare Advantage |
$5.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.56
|
| Rate for Payer: Priority Health Medicare |
$5.00
|
| Rate for Payer: Priority Health SBD |
$13.10
|
| Rate for Payer: Railroad Medicare Medicare |
$5.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.00
|
| Rate for Payer: UHC Core |
$8.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.00
|
| Rate for Payer: UHC Exchange |
$5.00
|
| Rate for Payer: UHC Medicare Advantage |
$5.15
|
| Rate for Payer: VA VA |
$5.00
|
|
|
HC CHLORIDE SERUM
|
Facility
|
IP
|
$21.22
|
|
|
Service Code
|
CPT 82435
|
| Hospital Charge Code |
30100152
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.37 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Aetna Commercial |
$18.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.79
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$14.85
|
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Healthscope Commercial |
$19.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.04
|
| Rate for Payer: PHP Commercial |
$18.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.85
|
| Rate for Payer: Priority Health SBD |
$13.37
|
|
|
HC CHLORIDE SERUM
|
Facility
|
OP
|
$21.22
|
|
|
Service Code
|
CPT 82435
|
| Hospital Charge Code |
30100152
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Aetna Commercial |
$18.04
|
| Rate for Payer: Aetna Medicare |
$4.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.75
|
| Rate for Payer: BCBS Complete |
$2.64
|
| Rate for Payer: BCBS MAPPO |
$4.60
|
| Rate for Payer: BCN Medicare Advantage |
$4.60
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$14.85
|
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.60
|
| Rate for Payer: Healthscope Commercial |
$19.10
|
| Rate for Payer: Mclaren Medicaid |
$2.52
|
| Rate for Payer: Mclaren Medicare |
$4.60
|
| Rate for Payer: Meridian Medicaid |
$2.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.04
|
| Rate for Payer: PACE Medicare |
$4.37
|
| Rate for Payer: PACE SWMI |
$4.60
|
| Rate for Payer: PHP Commercial |
$18.04
|
| Rate for Payer: PHP Medicare Advantage |
$4.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.85
|
| Rate for Payer: Priority Health Medicare |
$4.60
|
| Rate for Payer: Priority Health SBD |
$13.37
|
| Rate for Payer: Railroad Medicare Medicare |
$4.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.52
|
| Rate for Payer: UHC Core |
$7.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.60
|
| Rate for Payer: UHC Exchange |
$4.60
|
| Rate for Payer: UHC Medicare Advantage |
$4.74
|
| Rate for Payer: VA VA |
$4.60
|
|
|
HC CHLORIDE URINE
|
Facility
|
IP
|
$37.90
|
|
|
Service Code
|
CPT 82436
|
| Hospital Charge Code |
30100153
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.88 |
| Max. Negotiated Rate |
$34.11 |
| Rate for Payer: Aetna Commercial |
$32.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.64
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Cofinity Commercial |
$26.53
|
| Rate for Payer: Cofinity Commercial |
$32.59
|
| Rate for Payer: Healthscope Commercial |
$34.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.22
|
| Rate for Payer: PHP Commercial |
$32.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.53
|
| Rate for Payer: Priority Health SBD |
$23.88
|
|
|
HC CHLORIDE URINE
|
Facility
|
OP
|
$37.90
|
|
|
Service Code
|
CPT 82436
|
| Hospital Charge Code |
30100153
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$34.11 |
| Rate for Payer: Aetna Commercial |
$32.22
|
| Rate for Payer: Aetna Medicare |
$5.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.19
|
| Rate for Payer: BCBS Complete |
$3.30
|
| Rate for Payer: BCBS MAPPO |
$5.75
|
| Rate for Payer: BCBS Trust/PPO |
$4.50
|
| Rate for Payer: BCN Medicare Advantage |
$5.75
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Cofinity Commercial |
$32.59
|
| Rate for Payer: Cofinity Commercial |
$26.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.75
|
| Rate for Payer: Healthscope Commercial |
$34.11
|
| Rate for Payer: Mclaren Medicaid |
$3.15
|
| Rate for Payer: Mclaren Medicare |
$5.75
|
| Rate for Payer: Meridian Medicaid |
$3.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.22
|
| Rate for Payer: PACE Medicare |
$5.46
|
| Rate for Payer: PACE SWMI |
$5.75
|
| Rate for Payer: PHP Commercial |
$32.22
|
| Rate for Payer: PHP Medicare Advantage |
$5.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.53
|
| Rate for Payer: Priority Health Medicare |
$5.75
|
| Rate for Payer: Priority Health SBD |
$23.88
|
| Rate for Payer: Railroad Medicare Medicare |
$5.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.90
|
| Rate for Payer: UHC Core |
$8.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.75
|
| Rate for Payer: UHC Exchange |
$5.75
|
| Rate for Payer: UHC Medicare Advantage |
$5.92
|
| Rate for Payer: VA VA |
$5.75
|
|
|
HC CHLOROZINE BATH
|
Facility
|
IP
|
$4.39
|
|
| Hospital Charge Code |
27000094
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$3.95 |
| Rate for Payer: Aetna Commercial |
$3.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.85
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Cofinity Commercial |
$3.07
|
| Rate for Payer: Cofinity Commercial |
$3.78
|
| Rate for Payer: Healthscope Commercial |
$3.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.73
|
| Rate for Payer: PHP Commercial |
$3.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.07
|
| Rate for Payer: Priority Health SBD |
$2.77
|
|
|
HC CHLOROZINE BATH
|
Facility
|
OP
|
$4.39
|
|
| Hospital Charge Code |
27000094
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$3.95 |
| Rate for Payer: Aetna Commercial |
$3.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.85
|
| Rate for Payer: BCBS Complete |
$1.76
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Cofinity Commercial |
$3.07
|
| Rate for Payer: Cofinity Commercial |
$3.78
|
| Rate for Payer: Healthscope Commercial |
$3.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.73
|
| Rate for Payer: PHP Commercial |
$3.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.07
|
| Rate for Payer: Priority Health SBD |
$2.77
|
|
|
HC CHOLANGIOGRAPHY INJ INCLD GUIDE EXISTING ACCESS
|
Facility
|
OP
|
$561.12
|
|
|
Service Code
|
CPT 47531
|
| Hospital Charge Code |
36100488
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$67.45 |
| Max. Negotiated Rate |
$5,427.00 |
| Rate for Payer: Aetna Commercial |
$476.95
|
| Rate for Payer: Aetna Medicare |
$3,201.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,847.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,847.99
|
| Rate for Payer: BCBS Complete |
$1,768.23
|
| Rate for Payer: BCBS MAPPO |
$3,078.39
|
| Rate for Payer: BCBS Trust/PPO |
$796.64
|
| Rate for Payer: BCN Medicare Advantage |
$3,078.39
|
| Rate for Payer: Cash Price |
$448.90
|
| Rate for Payer: Cash Price |
$448.90
|
| Rate for Payer: Cofinity Commercial |
$482.56
|
| Rate for Payer: Cofinity Commercial |
$392.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,078.39
|
| Rate for Payer: Healthscope Commercial |
$505.01
|
| Rate for Payer: Mclaren Medicaid |
$1,683.88
|
| Rate for Payer: Mclaren Medicare |
$3,078.39
|
| Rate for Payer: Meridian Medicaid |
$1,768.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,232.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,540.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$476.95
|
| Rate for Payer: PACE Medicare |
$2,924.47
|
| Rate for Payer: PACE SWMI |
$3,078.39
|
| Rate for Payer: PHP Commercial |
$476.95
|
| Rate for Payer: PHP Medicare Advantage |
$3,078.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,683.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$392.78
|
| Rate for Payer: Priority Health Medicare |
$3,078.39
|
| Rate for Payer: Priority Health SBD |
$353.51
|
| Rate for Payer: Railroad Medicare Medicare |
$3,078.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.20
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,078.39
|
| Rate for Payer: UHC Exchange |
$67.45
|
| Rate for Payer: UHC Medicare Advantage |
$3,170.74
|
| Rate for Payer: VA VA |
$3,078.39
|
|
|
HC CHOLANGIOGRAPHY INJ INCLD GUIDE EXISTING ACCESS
|
Facility
|
IP
|
$561.12
|
|
|
Service Code
|
CPT 47531
|
| Hospital Charge Code |
36100488
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$353.51 |
| Max. Negotiated Rate |
$505.01 |
| Rate for Payer: Aetna Commercial |
$476.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.73
|
| Rate for Payer: Cash Price |
$448.90
|
| Rate for Payer: Cofinity Commercial |
$392.78
|
| Rate for Payer: Cofinity Commercial |
$482.56
|
| Rate for Payer: Healthscope Commercial |
$505.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$476.95
|
| Rate for Payer: PHP Commercial |
$476.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$392.78
|
| Rate for Payer: Priority Health SBD |
$353.51
|
|
|
HC CHOLANGIOGRAPHY INJ INCLD GUIDE NEW ACCESS
|
Facility
|
IP
|
$3,610.82
|
|
|
Service Code
|
CPT 47532
|
| Hospital Charge Code |
36100489
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,274.82 |
| Max. Negotiated Rate |
$3,249.74 |
| Rate for Payer: Aetna Commercial |
$3,069.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,347.03
|
| Rate for Payer: Cash Price |
$2,888.66
|
| Rate for Payer: Cofinity Commercial |
$2,527.57
|
| Rate for Payer: Cofinity Commercial |
$3,105.31
|
| Rate for Payer: Healthscope Commercial |
$3,249.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,069.20
|
| Rate for Payer: PHP Commercial |
$3,069.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,527.57
|
| Rate for Payer: Priority Health SBD |
$2,274.82
|
|
|
HC CHOLANGIOGRAPHY INJ INCLD GUIDE NEW ACCESS
|
Facility
|
OP
|
$3,610.82
|
|
|
Service Code
|
CPT 47532
|
| Hospital Charge Code |
36100489
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$201.05 |
| Max. Negotiated Rate |
$5,427.00 |
| Rate for Payer: Aetna Commercial |
$3,069.20
|
| Rate for Payer: Aetna Medicare |
$3,201.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,347.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,847.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,847.99
|
| Rate for Payer: BCBS Complete |
$1,768.23
|
| Rate for Payer: BCBS MAPPO |
$3,078.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,488.99
|
| Rate for Payer: BCN Medicare Advantage |
$3,078.39
|
| Rate for Payer: Cash Price |
$2,888.66
|
| Rate for Payer: Cash Price |
$2,888.66
|
| Rate for Payer: Cofinity Commercial |
$3,105.31
|
| Rate for Payer: Cofinity Commercial |
$2,527.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,078.39
|
| Rate for Payer: Healthscope Commercial |
$3,249.74
|
| Rate for Payer: Mclaren Medicaid |
$1,683.88
|
| Rate for Payer: Mclaren Medicare |
$3,078.39
|
| Rate for Payer: Meridian Medicaid |
$1,768.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,232.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,540.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,069.20
|
| Rate for Payer: PACE Medicare |
$2,924.47
|
| Rate for Payer: PACE SWMI |
$3,078.39
|
| Rate for Payer: PHP Commercial |
$3,069.20
|
| Rate for Payer: PHP Medicare Advantage |
$3,078.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,683.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,527.57
|
| Rate for Payer: Priority Health Medicare |
$3,078.39
|
| Rate for Payer: Priority Health SBD |
$2,274.82
|
| Rate for Payer: Railroad Medicare Medicare |
$3,078.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.16
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,078.39
|
| Rate for Payer: UHC Exchange |
$201.05
|
| Rate for Payer: UHC Medicare Advantage |
$3,170.74
|
| Rate for Payer: VA VA |
$3,078.39
|
|
|
HC CHOLESTEROL
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
30100155
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health SBD |
$12.85
|
|
|
HC CHOLESTEROL
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
30100155
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$4.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.44
|
| Rate for Payer: BCBS Complete |
$2.50
|
| Rate for Payer: BCBS MAPPO |
$4.35
|
| Rate for Payer: BCN Medicare Advantage |
$4.35
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.35
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Mclaren Medicaid |
$2.38
|
| Rate for Payer: Mclaren Medicare |
$4.35
|
| Rate for Payer: Meridian Medicaid |
$2.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PACE Medicare |
$4.13
|
| Rate for Payer: PACE SWMI |
$4.35
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: PHP Medicare Advantage |
$4.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health Medicare |
$4.35
|
| Rate for Payer: Priority Health SBD |
$12.85
|
| Rate for Payer: Railroad Medicare Medicare |
$4.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.22
|
| Rate for Payer: UHC Core |
$7.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.35
|
| Rate for Payer: UHC Exchange |
$4.35
|
| Rate for Payer: UHC Medicare Advantage |
$4.48
|
| Rate for Payer: VA VA |
$4.35
|
|
|
HC CHOLESTEROL, TOTAL LMPP
|
Facility
|
IP
|
$15.30
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
30100688
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.94
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$10.71
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health SBD |
$9.64
|
|
|
HC CHOLESTEROL, TOTAL LMPP
|
Facility
|
OP
|
$15.30
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
30100688
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: Aetna Medicare |
$4.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.44
|
| Rate for Payer: BCBS Complete |
$2.50
|
| Rate for Payer: BCBS MAPPO |
$4.35
|
| Rate for Payer: BCN Medicare Advantage |
$4.35
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Cofinity Commercial |
$10.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.35
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Mclaren Medicaid |
$2.38
|
| Rate for Payer: Mclaren Medicare |
$4.35
|
| Rate for Payer: Meridian Medicaid |
$2.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PACE Medicare |
$4.13
|
| Rate for Payer: PACE SWMI |
$4.35
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: PHP Medicare Advantage |
$4.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health Medicare |
$4.35
|
| Rate for Payer: Priority Health SBD |
$9.64
|
| Rate for Payer: Railroad Medicare Medicare |
$4.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.22
|
| Rate for Payer: UHC Core |
$7.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.35
|
| Rate for Payer: UHC Exchange |
$4.35
|
| Rate for Payer: UHC Medicare Advantage |
$4.48
|
| Rate for Payer: VA VA |
$4.35
|
|
|
HC CHOLETEC PER STUDY
|
Facility
|
OP
|
$454.84
|
|
|
Service Code
|
HCPCS A9537
|
| Hospital Charge Code |
34300003
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$72.87 |
| Max. Negotiated Rate |
$409.36 |
| Rate for Payer: Aetna Commercial |
$386.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.65
|
| Rate for Payer: BCBS Complete |
$181.94
|
| Rate for Payer: BCBS Trust/PPO |
$72.87
|
| Rate for Payer: Cash Price |
$363.87
|
| Rate for Payer: Cash Price |
$363.87
|
| Rate for Payer: Cofinity Commercial |
$318.39
|
| Rate for Payer: Cofinity Commercial |
$391.16
|
| Rate for Payer: Healthscope Commercial |
$409.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$386.61
|
| Rate for Payer: PHP Commercial |
$386.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.39
|
| Rate for Payer: Priority Health SBD |
$286.55
|
|
