|
HC AEROSOLIZED MEDICATION
|
Facility
|
OP
|
$152.66
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
41000012
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$34.05 |
| Max. Negotiated Rate |
$705.61 |
| Rate for Payer: Aetna Commercial |
$129.76
|
| Rate for Payer: Aetna Medicare |
$226.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.74
|
| Rate for Payer: BCBS Complete |
$119.83
|
| Rate for Payer: BCBS MAPPO |
$218.19
|
| Rate for Payer: BCBS Trust/PPO |
$34.05
|
| Rate for Payer: BCN Commercial |
$34.05
|
| Rate for Payer: BCN Medicare Advantage |
$218.19
|
| Rate for Payer: Cash Price |
$122.13
|
| Rate for Payer: Cash Price |
$122.13
|
| Rate for Payer: Cofinity Advantage |
$106.86
|
| Rate for Payer: Cofinity Commercial |
$131.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.19
|
| Rate for Payer: Healthscope Commercial |
$137.39
|
| Rate for Payer: Mclaren Medicaid |
$114.11
|
| Rate for Payer: Mclaren Medicare |
$218.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$229.10
|
| Rate for Payer: Meridian Medicaid |
$229.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$240.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.76
|
| Rate for Payer: Nomi Health Commercial |
$654.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.50
|
| Rate for Payer: PACE Medicare |
$207.28
|
| Rate for Payer: PACE SWMI |
$218.19
|
| Rate for Payer: PHP Commercial |
$129.76
|
| Rate for Payer: PHP Medicare Advantage |
$218.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$705.61
|
| Rate for Payer: Priority Health Medicare |
$218.19
|
| Rate for Payer: Priority Health SBD |
$96.18
|
| Rate for Payer: Priority Health Tiered Network |
$564.49
|
| Rate for Payer: Railroad Medicare Medicare |
$218.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.23
|
| Rate for Payer: UHC Core |
$79.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$218.19
|
| Rate for Payer: UHC Exchange |
$60.00
|
| Rate for Payer: UHC Medicaid |
$114.11
|
| Rate for Payer: UHCCP Medicaid |
$114.11
|
| Rate for Payer: VA VA |
$218.19
|
|
|
HC AEROSOLIZED MEDICATION
|
Facility
|
IP
|
$152.66
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
41000012
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$96.18 |
| Max. Negotiated Rate |
$137.39 |
| Rate for Payer: Aetna Commercial |
$129.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.23
|
| Rate for Payer: Cash Price |
$122.13
|
| Rate for Payer: Cofinity Advantage |
$106.86
|
| Rate for Payer: Cofinity Commercial |
$131.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.13
|
| Rate for Payer: Healthscope Commercial |
$137.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.50
|
| Rate for Payer: PHP Commercial |
$129.76
|
| Rate for Payer: Priority Health SBD |
$96.18
|
|
|
HC AFB CULTURE
|
Facility
|
IP
|
$93.01
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
30600089
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.60 |
| Max. Negotiated Rate |
$83.71 |
| Rate for Payer: Aetna Commercial |
$79.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.46
|
| Rate for Payer: Cash Price |
$74.41
|
| Rate for Payer: Cofinity Advantage |
$65.11
|
| Rate for Payer: Cofinity Commercial |
$79.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.41
|
| Rate for Payer: Healthscope Commercial |
$83.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.76
|
| Rate for Payer: PHP Commercial |
$79.06
|
| Rate for Payer: Priority Health SBD |
$58.60
|
|
|
HC AFB CULTURE
|
Facility
|
OP
|
$93.01
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
30600089
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$83.71 |
| Rate for Payer: Aetna Commercial |
$79.06
|
| Rate for Payer: Aetna Medicare |
$11.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.50
|
| Rate for Payer: BCBS Complete |
$5.93
|
| Rate for Payer: BCBS MAPPO |
$10.80
|
| Rate for Payer: BCBS Trust/PPO |
$11.51
|
| Rate for Payer: BCN Commercial |
$11.51
|
| Rate for Payer: BCN Medicare Advantage |
$10.80
|
| Rate for Payer: Cash Price |
$74.41
|
| Rate for Payer: Cash Price |
$74.41
|
| Rate for Payer: Cofinity Advantage |
$65.11
|
| Rate for Payer: Cofinity Commercial |
$79.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.80
|
| Rate for Payer: Healthscope Commercial |
$83.71
|
| Rate for Payer: Mclaren Medicaid |
$5.65
|
| Rate for Payer: Mclaren Medicare |
$10.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.34
|
| Rate for Payer: Meridian Medicaid |
$11.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.06
|
| Rate for Payer: Nomi Health Commercial |
$16.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.76
|
| Rate for Payer: PACE Medicare |
$10.26
|
| Rate for Payer: PACE SWMI |
$10.80
|
| Rate for Payer: PHP Commercial |
$79.06
|
| Rate for Payer: PHP Medicare Advantage |
$10.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10.80
|
| Rate for Payer: Priority Health Medicare |
$10.80
|
| Rate for Payer: Priority Health SBD |
$58.60
|
| Rate for Payer: Priority Health Tiered Network |
$8.64
|
| Rate for Payer: Railroad Medicare Medicare |
$10.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.20
|
| Rate for Payer: UHC Core |
$16.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.80
|
| Rate for Payer: UHC Exchange |
$16.20
|
| Rate for Payer: UHC Medicaid |
$5.65
|
| Rate for Payer: UHCCP Medicaid |
$5.65
|
| Rate for Payer: VA VA |
$10.80
|
|
|
HC AFB SMEAR
|
Facility
|
IP
|
$59.82
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
30600105
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$37.69 |
| Max. Negotiated Rate |
$53.84 |
| Rate for Payer: Aetna Commercial |
$50.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.88
|
| Rate for Payer: Cash Price |
$47.86
|
| Rate for Payer: Cofinity Advantage |
$41.87
|
| Rate for Payer: Cofinity Commercial |
$51.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.86
|
| Rate for Payer: Healthscope Commercial |
$53.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.87
|
| Rate for Payer: PHP Commercial |
$50.85
|
| Rate for Payer: Priority Health SBD |
$37.69
|
|
|
HC AFB SMEAR
|
Facility
|
OP
|
$59.82
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
30600105
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$53.84 |
| Rate for Payer: Aetna Commercial |
$50.85
|
| Rate for Payer: Aetna Medicare |
$5.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.74
|
| Rate for Payer: BCBS Complete |
$2.96
|
| Rate for Payer: BCBS MAPPO |
$5.39
|
| Rate for Payer: BCBS Trust/PPO |
$5.74
|
| Rate for Payer: BCN Commercial |
$5.74
|
| Rate for Payer: BCN Medicare Advantage |
$5.39
|
| Rate for Payer: Cash Price |
$47.86
|
| Rate for Payer: Cash Price |
$47.86
|
| Rate for Payer: Cofinity Advantage |
$41.87
|
| Rate for Payer: Cofinity Commercial |
$51.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.39
|
| Rate for Payer: Healthscope Commercial |
$53.84
|
| Rate for Payer: Mclaren Medicaid |
$2.82
|
| Rate for Payer: Mclaren Medicare |
$5.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.66
|
| Rate for Payer: Meridian Medicaid |
$5.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.85
|
| Rate for Payer: Nomi Health Commercial |
$8.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.87
|
| Rate for Payer: PACE Medicare |
$5.12
|
| Rate for Payer: PACE SWMI |
$5.39
|
| Rate for Payer: PHP Commercial |
$50.85
|
| Rate for Payer: PHP Medicare Advantage |
$5.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.39
|
| Rate for Payer: Priority Health Medicare |
$5.39
|
| Rate for Payer: Priority Health SBD |
$37.69
|
| Rate for Payer: Priority Health Tiered Network |
$4.31
|
| Rate for Payer: Railroad Medicare Medicare |
$5.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.09
|
| Rate for Payer: UHC Core |
$8.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.39
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.82
|
| Rate for Payer: UHCCP Medicaid |
$2.82
|
| Rate for Payer: VA VA |
$5.39
|
|
|
HC AFFINITY 1.5 X 1.5 PER SQ CM
|
Facility
|
IP
|
$735.42
|
|
|
Service Code
|
HCPCS Q4159
|
| Hospital Charge Code |
63600124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$463.31 |
| Max. Negotiated Rate |
$661.88 |
| Rate for Payer: Aetna Commercial |
$625.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$478.02
|
| Rate for Payer: Cash Price |
$588.34
|
| Rate for Payer: Cofinity Advantage |
$514.79
|
| Rate for Payer: Cofinity Commercial |
$632.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.34
|
| Rate for Payer: Healthscope Commercial |
$661.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$625.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$551.57
|
| Rate for Payer: PHP Commercial |
$625.11
|
| Rate for Payer: Priority Health SBD |
$463.31
|
|
|
HC AFFINITY 1.5 X 1.5 PER SQ CM
|
Facility
|
OP
|
$735.42
|
|
|
Service Code
|
HCPCS Q4159
|
| Hospital Charge Code |
63600124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$2,440.29 |
| Rate for Payer: Aetna Commercial |
$625.11
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$478.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$817.10
|
| Rate for Payer: BCN Commercial |
$2,440.29
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$588.34
|
| Rate for Payer: Cash Price |
$588.34
|
| Rate for Payer: Cash Price |
$588.34
|
| Rate for Payer: Cofinity Advantage |
$514.79
|
| Rate for Payer: Cofinity Commercial |
$632.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$661.88
|
| Rate for Payer: Mclaren Medicaid |
$64.85
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$625.11
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$551.57
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$625.11
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$463.31
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC AFFINITY 2.5 X 2.5 PER SQ CM
|
Facility
|
IP
|
$443.49
|
|
|
Service Code
|
HCPCS Q4159
|
| Hospital Charge Code |
63600125
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$279.40 |
| Max. Negotiated Rate |
$399.14 |
| Rate for Payer: Aetna Commercial |
$376.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.27
|
| Rate for Payer: Cash Price |
$354.79
|
| Rate for Payer: Cofinity Advantage |
$310.44
|
| Rate for Payer: Cofinity Commercial |
$381.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.79
|
| Rate for Payer: Healthscope Commercial |
$399.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$332.62
|
| Rate for Payer: PHP Commercial |
$376.97
|
| Rate for Payer: Priority Health SBD |
$279.40
|
|
|
HC AFFINITY 2.5 X 2.5 PER SQ CM
|
Facility
|
OP
|
$443.49
|
|
|
Service Code
|
HCPCS Q4159
|
| Hospital Charge Code |
63600125
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$2,440.29 |
| Rate for Payer: Aetna Commercial |
$376.97
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$817.10
|
| Rate for Payer: BCN Commercial |
$2,440.29
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$354.79
|
| Rate for Payer: Cash Price |
$354.79
|
| Rate for Payer: Cash Price |
$354.79
|
| Rate for Payer: Cofinity Advantage |
$310.44
|
| Rate for Payer: Cofinity Commercial |
$381.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$399.14
|
| Rate for Payer: Mclaren Medicaid |
$64.85
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.97
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$332.62
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$376.97
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$279.40
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC AFP SINGLE MARKER SCRN,MS
|
Facility
|
IP
|
$49.88
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
30100622
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.42 |
| Max. Negotiated Rate |
$44.89 |
| Rate for Payer: Aetna Commercial |
$42.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.42
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cofinity Advantage |
$34.92
|
| Rate for Payer: Cofinity Commercial |
$42.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.90
|
| Rate for Payer: Healthscope Commercial |
$44.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.41
|
| Rate for Payer: PHP Commercial |
$42.40
|
| Rate for Payer: Priority Health SBD |
$31.42
|
|
|
HC AFP SINGLE MARKER SCRN,MS
|
Facility
|
OP
|
$49.88
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
30100622
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$44.89 |
| Rate for Payer: Aetna Commercial |
$42.40
|
| Rate for Payer: Aetna Medicare |
$17.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.96
|
| Rate for Payer: BCBS Complete |
$9.21
|
| Rate for Payer: BCBS MAPPO |
$16.77
|
| Rate for Payer: BCBS Trust/PPO |
$17.88
|
| Rate for Payer: BCN Commercial |
$17.88
|
| Rate for Payer: BCN Medicare Advantage |
$16.77
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cofinity Advantage |
$34.92
|
| Rate for Payer: Cofinity Commercial |
$42.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.77
|
| Rate for Payer: Healthscope Commercial |
$44.89
|
| Rate for Payer: Mclaren Medicaid |
$8.77
|
| Rate for Payer: Mclaren Medicare |
$16.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.61
|
| Rate for Payer: Meridian Medicaid |
$17.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.40
|
| Rate for Payer: Nomi Health Commercial |
$25.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.41
|
| Rate for Payer: PACE Medicare |
$15.93
|
| Rate for Payer: PACE SWMI |
$16.77
|
| Rate for Payer: PHP Commercial |
$42.40
|
| Rate for Payer: PHP Medicare Advantage |
$16.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16.77
|
| Rate for Payer: Priority Health Medicare |
$16.77
|
| Rate for Payer: Priority Health SBD |
$31.42
|
| Rate for Payer: Priority Health Tiered Network |
$13.42
|
| Rate for Payer: Railroad Medicare Medicare |
$16.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.16
|
| Rate for Payer: UHC Core |
$25.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.77
|
| Rate for Payer: UHC Exchange |
$25.16
|
| Rate for Payer: UHC Medicaid |
$8.77
|
| Rate for Payer: UHCCP Medicaid |
$8.77
|
| Rate for Payer: VA VA |
$16.77
|
|
|
HC AFTER HOURS ACCESS
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 99050
|
| Hospital Charge Code |
98300006
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$60.57 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$10.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: BCBS Complete |
$8.32
|
| Rate for Payer: BCBS Trust/PPO |
$60.57
|
| Rate for Payer: BCN Commercial |
$60.57
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Advantage |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.61
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health SBD |
$13.11
|
|
|
HC AFTER HOURS ACCESS
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 99050
|
| Hospital Charge Code |
98300006
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$13.11 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Advantage |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.61
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health SBD |
$13.11
|
|
|
HC ALBUMIN SERUM
|
Facility
|
IP
|
$39.43
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100072
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.84 |
| Max. Negotiated Rate |
$35.49 |
| Rate for Payer: Aetna Commercial |
$33.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.63
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Cofinity Advantage |
$27.60
|
| Rate for Payer: Cofinity Commercial |
$33.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.54
|
| Rate for Payer: Healthscope Commercial |
$35.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.57
|
| Rate for Payer: PHP Commercial |
$33.52
|
| Rate for Payer: Priority Health SBD |
$24.84
|
|
|
HC ALBUMIN SERUM
|
Facility
|
OP
|
$39.43
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100072
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$35.49 |
| Rate for Payer: Aetna Commercial |
$33.52
|
| Rate for Payer: Aetna Medicare |
$5.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.19
|
| Rate for Payer: BCBS Complete |
$2.72
|
| Rate for Payer: BCBS MAPPO |
$4.95
|
| Rate for Payer: BCN Medicare Advantage |
$4.95
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Cofinity Advantage |
$27.60
|
| Rate for Payer: Cofinity Commercial |
$33.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.95
|
| Rate for Payer: Healthscope Commercial |
$35.49
|
| Rate for Payer: Mclaren Medicaid |
$2.59
|
| Rate for Payer: Mclaren Medicare |
$4.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.20
|
| Rate for Payer: Meridian Medicaid |
$5.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.52
|
| Rate for Payer: Nomi Health Commercial |
$7.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.57
|
| Rate for Payer: PACE Medicare |
$4.70
|
| Rate for Payer: PACE SWMI |
$4.95
|
| Rate for Payer: PHP Commercial |
$33.52
|
| Rate for Payer: PHP Medicare Advantage |
$4.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.95
|
| Rate for Payer: Priority Health Medicare |
$4.95
|
| Rate for Payer: Priority Health SBD |
$24.84
|
| Rate for Payer: Priority Health Tiered Network |
$3.96
|
| Rate for Payer: Railroad Medicare Medicare |
$4.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.43
|
| Rate for Payer: UHC Core |
$7.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.95
|
| Rate for Payer: UHC Exchange |
$7.43
|
| Rate for Payer: UHC Medicaid |
$2.59
|
| Rate for Payer: UHCCP Medicaid |
$2.59
|
| Rate for Payer: VA VA |
$4.95
|
|
|
HC ALBUMIN URINE OR OTHER SOURCE
|
Facility
|
OP
|
$42.13
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
30100663
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.07 |
| Max. Negotiated Rate |
$37.92 |
| Rate for Payer: Aetna Commercial |
$35.81
|
| Rate for Payer: Aetna Medicare |
$8.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.72
|
| Rate for Payer: BCBS Complete |
$4.27
|
| Rate for Payer: BCBS MAPPO |
$7.78
|
| Rate for Payer: BCBS Trust/PPO |
$8.30
|
| Rate for Payer: BCN Commercial |
$8.30
|
| Rate for Payer: BCN Medicare Advantage |
$7.78
|
| Rate for Payer: Cash Price |
$33.70
|
| Rate for Payer: Cash Price |
$33.70
|
| Rate for Payer: Cofinity Advantage |
$29.49
|
| Rate for Payer: Cofinity Commercial |
$36.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.78
|
| Rate for Payer: Healthscope Commercial |
$37.92
|
| Rate for Payer: Mclaren Medicaid |
$4.07
|
| Rate for Payer: Mclaren Medicare |
$7.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.17
|
| Rate for Payer: Meridian Medicaid |
$8.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.81
|
| Rate for Payer: Nomi Health Commercial |
$11.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.60
|
| Rate for Payer: PACE Medicare |
$7.39
|
| Rate for Payer: PACE SWMI |
$7.78
|
| Rate for Payer: PHP Commercial |
$35.81
|
| Rate for Payer: PHP Medicare Advantage |
$7.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$7.78
|
| Rate for Payer: Priority Health Medicare |
$7.78
|
| Rate for Payer: Priority Health SBD |
$26.54
|
| Rate for Payer: Priority Health Tiered Network |
$6.22
|
| Rate for Payer: Railroad Medicare Medicare |
$7.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.67
|
| Rate for Payer: UHC Core |
$11.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.78
|
| Rate for Payer: UHC Exchange |
$11.67
|
| Rate for Payer: UHC Medicaid |
$4.07
|
| Rate for Payer: UHCCP Medicaid |
$4.07
|
| Rate for Payer: VA VA |
$7.78
|
|
|
HC ALBUMIN URINE OR OTHER SOURCE
|
Facility
|
IP
|
$42.13
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
30100663
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.54 |
| Max. Negotiated Rate |
$37.92 |
| Rate for Payer: Aetna Commercial |
$35.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.38
|
| Rate for Payer: Cash Price |
$33.70
|
| Rate for Payer: Cofinity Advantage |
$29.49
|
| Rate for Payer: Cofinity Commercial |
$36.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.70
|
| Rate for Payer: Healthscope Commercial |
$37.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.60
|
| Rate for Payer: PHP Commercial |
$35.81
|
| Rate for Payer: Priority Health SBD |
$26.54
|
|
|
HC ALBUTEROL, INHALATION SOLUTION, UNIT DOSE 1MG
|
Facility
|
IP
|
$6.36
|
|
|
Service Code
|
CPT J7613
|
| Hospital Charge Code |
63600110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$5.72 |
| Rate for Payer: Aetna Commercial |
$5.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.13
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cofinity Advantage |
$4.45
|
| Rate for Payer: Cofinity Commercial |
$5.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.09
|
| Rate for Payer: Healthscope Commercial |
$5.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.77
|
| Rate for Payer: PHP Commercial |
$5.41
|
| Rate for Payer: Priority Health SBD |
$4.01
|
|
|
HC ALBUTEROL, INHALATION SOLUTION, UNIT DOSE 1MG
|
Facility
|
OP
|
$6.36
|
|
|
Service Code
|
CPT J7613
|
| Hospital Charge Code |
63600110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$5.72 |
| Rate for Payer: Aetna Commercial |
$5.41
|
| Rate for Payer: Aetna Medicare |
$3.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.13
|
| Rate for Payer: BCBS Complete |
$2.54
|
| Rate for Payer: BCBS Trust/PPO |
$0.17
|
| Rate for Payer: BCN Commercial |
$0.17
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cofinity Advantage |
$4.45
|
| Rate for Payer: Cofinity Commercial |
$5.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.09
|
| Rate for Payer: Healthscope Commercial |
$5.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.77
|
| Rate for Payer: PHP Commercial |
$5.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.07
|
| Rate for Payer: Priority Health SBD |
$4.01
|
| Rate for Payer: Priority Health Tiered Network |
$0.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.13
|
| Rate for Payer: UHC Core |
$3.31
|
| Rate for Payer: UHC Exchange |
$2.50
|
|
|
HC ALBUTEROL, UP TO 2.5 MG AND IPRATROPIUM BROMIDE, UP TO 0.5 MG
|
Facility
|
OP
|
$4.24
|
|
|
Service Code
|
CPT J7620
|
| Hospital Charge Code |
63600111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Medicare |
$2.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.76
|
| Rate for Payer: BCBS Complete |
$1.70
|
| Rate for Payer: Cash Price |
$3.39
|
| Rate for Payer: Cash Price |
$3.39
|
| Rate for Payer: Cofinity Advantage |
$2.97
|
| Rate for Payer: Cofinity Commercial |
$3.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.39
|
| Rate for Payer: Healthscope Commercial |
$3.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.18
|
| Rate for Payer: PHP Commercial |
$3.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.20
|
| Rate for Payer: Priority Health SBD |
$2.67
|
| Rate for Payer: Priority Health Tiered Network |
$0.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.76
|
| Rate for Payer: UHC Core |
$2.21
|
| Rate for Payer: UHC Exchange |
$1.67
|
|
|
HC ALBUTEROL, UP TO 2.5 MG AND IPRATROPIUM BROMIDE, UP TO 0.5 MG
|
Facility
|
IP
|
$4.24
|
|
|
Service Code
|
CPT J7620
|
| Hospital Charge Code |
63600111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.76
|
| Rate for Payer: Cash Price |
$3.39
|
| Rate for Payer: Cofinity Advantage |
$2.97
|
| Rate for Payer: Cofinity Commercial |
$3.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.39
|
| Rate for Payer: Healthscope Commercial |
$3.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.18
|
| Rate for Payer: PHP Commercial |
$3.60
|
| Rate for Payer: Priority Health SBD |
$2.67
|
|
|
HC ALCOHOL ETHANOL LVL.
|
Facility
|
IP
|
$128.40
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100651
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$80.89 |
| Max. Negotiated Rate |
$115.56 |
| Rate for Payer: Aetna Commercial |
$109.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.46
|
| Rate for Payer: Cash Price |
$102.72
|
| Rate for Payer: Cofinity Advantage |
$89.88
|
| Rate for Payer: Cofinity Commercial |
$110.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.72
|
| Rate for Payer: Healthscope Commercial |
$115.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.30
|
| Rate for Payer: PHP Commercial |
$109.14
|
| Rate for Payer: Priority Health SBD |
$80.89
|
|
|
HC ALCOHOL ETHANOL LVL.
|
Facility
|
OP
|
$128.40
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100651
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$115.56 |
| Rate for Payer: Aetna Commercial |
$109.14
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: BCBS Complete |
$34.13
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$66.26
|
| Rate for Payer: BCN Commercial |
$66.26
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$102.72
|
| Rate for Payer: Cash Price |
$102.72
|
| Rate for Payer: Cofinity Advantage |
$89.88
|
| Rate for Payer: Cofinity Commercial |
$110.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$115.56
|
| Rate for Payer: Mclaren Medicaid |
$32.50
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.14
|
| Rate for Payer: Nomi Health Commercial |
$93.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.30
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$109.14
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$62.14
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$80.89
|
| Rate for Payer: Priority Health Tiered Network |
$49.71
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.21
|
| Rate for Payer: UHC Core |
$93.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$62.14
|
| Rate for Payer: UHC Exchange |
$93.21
|
| Rate for Payer: UHC Medicaid |
$32.50
|
| Rate for Payer: UHCCP Medicaid |
$32.50
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC ALCOHOL ETHANOL LVL REFLEX
|
Facility
|
OP
|
$67.63
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100617
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.05 |
| Max. Negotiated Rate |
$60.87 |
| Rate for Payer: Aetna Commercial |
$57.49
|
| Rate for Payer: Aetna Medicare |
$33.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.96
|
| Rate for Payer: BCBS Complete |
$27.05
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Advantage |
$47.34
|
| Rate for Payer: Cofinity Commercial |
$58.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Healthscope Commercial |
$60.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.72
|
| Rate for Payer: PHP Commercial |
$57.49
|
| Rate for Payer: Priority Health SBD |
$42.61
|
|
