|
HC CYTOPLASMIC NEUTROPHIL ANCA AB
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200173
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$45.99 |
| Max. Negotiated Rate |
$65.70 |
| Rate for Payer: Aetna Commercial |
$62.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.45
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cofinity Commercial |
$51.10
|
| Rate for Payer: Cofinity Commercial |
$62.78
|
| Rate for Payer: Healthscope Commercial |
$65.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.05
|
| Rate for Payer: PHP Commercial |
$62.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.10
|
| Rate for Payer: Priority Health SBD |
$45.99
|
|
|
HC DAVITA IP HEMODIALYSIS SGL
|
Facility
|
OP
|
$783.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
80100003
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$68.76 |
| Max. Negotiated Rate |
$2,039.31 |
| Rate for Payer: Aetna Commercial |
$665.55
|
| Rate for Payer: Aetna Medicare |
$646.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$508.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$777.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$777.24
|
| Rate for Payer: BCBS Complete |
$357.16
|
| Rate for Payer: BCBS MAPPO |
$621.79
|
| Rate for Payer: BCN Medicare Advantage |
$621.79
|
| Rate for Payer: Cash Price |
$626.40
|
| Rate for Payer: Cash Price |
$626.40
|
| Rate for Payer: Cofinity Commercial |
$548.10
|
| Rate for Payer: Cofinity Commercial |
$673.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$621.79
|
| Rate for Payer: Healthscope Commercial |
$704.70
|
| Rate for Payer: Mclaren Medicaid |
$340.12
|
| Rate for Payer: Mclaren Medicare |
$621.79
|
| Rate for Payer: Meridian Medicaid |
$357.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$652.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$715.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$665.55
|
| Rate for Payer: PACE Medicare |
$590.70
|
| Rate for Payer: PACE SWMI |
$621.79
|
| Rate for Payer: PHP Commercial |
$665.55
|
| Rate for Payer: PHP Medicare Advantage |
$621.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$340.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$548.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,039.31
|
| Rate for Payer: Priority Health Medicare |
$621.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,631.45
|
| Rate for Payer: Priority Health SBD |
$493.29
|
| Rate for Payer: Railroad Medicare Medicare |
$621.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$621.79
|
| Rate for Payer: UHC Exchange |
$68.76
|
| Rate for Payer: UHC Medicare Advantage |
$640.44
|
| Rate for Payer: VA VA |
$621.79
|
|
|
HC DAVITA IP HEMODIALYSIS SGL
|
Facility
|
IP
|
$783.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
80100003
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$493.29 |
| Max. Negotiated Rate |
$704.70 |
| Rate for Payer: Aetna Commercial |
$665.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$508.95
|
| Rate for Payer: Cash Price |
$626.40
|
| Rate for Payer: Cofinity Commercial |
$548.10
|
| Rate for Payer: Cofinity Commercial |
$673.38
|
| Rate for Payer: Healthscope Commercial |
$704.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$665.55
|
| Rate for Payer: PHP Commercial |
$665.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$548.10
|
| Rate for Payer: Priority Health SBD |
$493.29
|
|
|
HC DAVITA OP HEMODIALYSIS
|
Facility
|
OP
|
$855.04
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
88100002
|
|
Hospital Revenue Code
|
820
|
| Min. Negotiated Rate |
$340.12 |
| Max. Negotiated Rate |
$2,039.31 |
| Rate for Payer: Aetna Commercial |
$726.78
|
| Rate for Payer: Aetna Medicare |
$646.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$555.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$777.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$777.24
|
| Rate for Payer: BCBS Complete |
$357.16
|
| Rate for Payer: BCBS MAPPO |
$621.79
|
| Rate for Payer: BCN Medicare Advantage |
$621.79
|
| Rate for Payer: Cash Price |
$684.03
|
| Rate for Payer: Cash Price |
$684.03
|
| Rate for Payer: Cofinity Commercial |
$735.33
|
| Rate for Payer: Cofinity Commercial |
$598.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$621.79
|
| Rate for Payer: Healthscope Commercial |
$769.54
|
| Rate for Payer: Mclaren Medicaid |
$340.12
|
| Rate for Payer: Mclaren Medicare |
$621.79
|
| Rate for Payer: Meridian Medicaid |
$357.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$652.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$715.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$726.78
|
| Rate for Payer: PACE Medicare |
$590.70
|
| Rate for Payer: PACE SWMI |
$621.79
|
| Rate for Payer: PHP Commercial |
$726.78
|
| Rate for Payer: PHP Medicare Advantage |
$621.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$340.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,039.31
|
| Rate for Payer: Priority Health Medicare |
$621.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,631.45
|
| Rate for Payer: Priority Health SBD |
$538.68
|
| Rate for Payer: Railroad Medicare Medicare |
$621.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$621.79
|
| Rate for Payer: UHC Medicare Advantage |
$640.44
|
| Rate for Payer: VA VA |
$621.79
|
|
|
HC DAVITA OP HEMODIALYSIS
|
Facility
|
IP
|
$855.04
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
88100002
|
|
Hospital Revenue Code
|
820
|
| Min. Negotiated Rate |
$538.68 |
| Max. Negotiated Rate |
$769.54 |
| Rate for Payer: Aetna Commercial |
$726.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$555.78
|
| Rate for Payer: Cash Price |
$684.03
|
| Rate for Payer: Cofinity Commercial |
$598.53
|
| Rate for Payer: Cofinity Commercial |
$735.33
|
| Rate for Payer: Healthscope Commercial |
$769.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$726.78
|
| Rate for Payer: PHP Commercial |
$726.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.53
|
| Rate for Payer: Priority Health SBD |
$538.68
|
|
|
HC DBL PIGTAIL BILIARY STENT
|
Facility
|
OP
|
$768.06
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27800064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.22 |
| Max. Negotiated Rate |
$691.25 |
| Rate for Payer: Aetna Commercial |
$652.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$499.24
|
| Rate for Payer: BCBS Complete |
$307.22
|
| Rate for Payer: Cash Price |
$614.45
|
| Rate for Payer: Cofinity Commercial |
$537.64
|
| Rate for Payer: Cofinity Commercial |
$660.53
|
| Rate for Payer: Healthscope Commercial |
$691.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$652.85
|
| Rate for Payer: PHP Commercial |
$652.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$537.64
|
| Rate for Payer: Priority Health SBD |
$483.88
|
|
|
HC DBL PIGTAIL BILIARY STENT
|
Facility
|
IP
|
$768.06
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27800064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$483.88 |
| Max. Negotiated Rate |
$691.25 |
| Rate for Payer: Aetna Commercial |
$652.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$499.24
|
| Rate for Payer: Cash Price |
$614.45
|
| Rate for Payer: Cofinity Commercial |
$537.64
|
| Rate for Payer: Cofinity Commercial |
$660.53
|
| Rate for Payer: Healthscope Commercial |
$691.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$652.85
|
| Rate for Payer: PHP Commercial |
$652.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$537.64
|
| Rate for Payer: Priority Health SBD |
$483.88
|
|
|
HC D & C
|
Facility
|
OP
|
$2,001.38
|
|
| Hospital Charge Code |
45000037
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$800.55 |
| Max. Negotiated Rate |
$1,801.24 |
| Rate for Payer: Aetna Commercial |
$1,701.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,300.90
|
| Rate for Payer: BCBS Complete |
$800.55
|
| Rate for Payer: Cash Price |
$1,601.10
|
| Rate for Payer: Cofinity Commercial |
$1,400.97
|
| Rate for Payer: Cofinity Commercial |
$1,721.19
|
| Rate for Payer: Healthscope Commercial |
$1,801.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,701.17
|
| Rate for Payer: PHP Commercial |
$1,701.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,400.97
|
| Rate for Payer: Priority Health SBD |
$1,260.87
|
|
|
HC D & C
|
Facility
|
IP
|
$2,001.38
|
|
| Hospital Charge Code |
45000037
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,260.87 |
| Max. Negotiated Rate |
$1,801.24 |
| Rate for Payer: Aetna Commercial |
$1,701.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,300.90
|
| Rate for Payer: Cash Price |
$1,601.10
|
| Rate for Payer: Cofinity Commercial |
$1,400.97
|
| Rate for Payer: Cofinity Commercial |
$1,721.19
|
| Rate for Payer: Healthscope Commercial |
$1,801.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,701.17
|
| Rate for Payer: PHP Commercial |
$1,701.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,400.97
|
| Rate for Payer: Priority Health SBD |
$1,260.87
|
|
|
HC D&C (OB SURGERY)
|
Facility
|
OP
|
$1,030.78
|
|
| Hospital Charge Code |
36000026
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$412.31 |
| Max. Negotiated Rate |
$927.70 |
| Rate for Payer: Aetna Commercial |
$876.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$670.01
|
| Rate for Payer: BCBS Complete |
$412.31
|
| Rate for Payer: Cash Price |
$824.62
|
| Rate for Payer: Cofinity Commercial |
$721.55
|
| Rate for Payer: Cofinity Commercial |
$886.47
|
| Rate for Payer: Healthscope Commercial |
$927.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$876.16
|
| Rate for Payer: PHP Commercial |
$876.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$721.55
|
| Rate for Payer: Priority Health SBD |
$649.39
|
|
|
HC D&C (OB SURGERY)
|
Facility
|
IP
|
$1,030.78
|
|
| Hospital Charge Code |
36000026
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$649.39 |
| Max. Negotiated Rate |
$927.70 |
| Rate for Payer: Aetna Commercial |
$876.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$670.01
|
| Rate for Payer: Cash Price |
$824.62
|
| Rate for Payer: Cofinity Commercial |
$721.55
|
| Rate for Payer: Cofinity Commercial |
$886.47
|
| Rate for Payer: Healthscope Commercial |
$927.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$876.16
|
| Rate for Payer: PHP Commercial |
$876.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$721.55
|
| Rate for Payer: Priority Health SBD |
$649.39
|
|
|
HC D & C POSTPARTUM
|
Facility
|
OP
|
$7,789.74
|
|
|
Service Code
|
CPT 59160
|
| Hospital Charge Code |
76100341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$187.30 |
| Max. Negotiated Rate |
$8,478.18 |
| Rate for Payer: Aetna Commercial |
$6,621.28
|
| Rate for Payer: Aetna Medicare |
$2,893.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,063.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,477.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,477.26
|
| Rate for Payer: BCBS Complete |
$1,597.87
|
| Rate for Payer: BCBS MAPPO |
$2,781.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,610.55
|
| Rate for Payer: BCN Medicare Advantage |
$2,781.81
|
| Rate for Payer: Cash Price |
$6,231.79
|
| Rate for Payer: Cash Price |
$6,231.79
|
| Rate for Payer: Cofinity Commercial |
$6,699.18
|
| Rate for Payer: Cofinity Commercial |
$5,452.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,781.81
|
| Rate for Payer: Healthscope Commercial |
$7,010.77
|
| Rate for Payer: Mclaren Medicaid |
$1,521.65
|
| Rate for Payer: Mclaren Medicare |
$2,781.81
|
| Rate for Payer: Meridian Medicaid |
$1,597.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,920.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,199.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,621.28
|
| Rate for Payer: PACE Medicare |
$2,642.72
|
| Rate for Payer: PACE SWMI |
$2,781.81
|
| Rate for Payer: PHP Commercial |
$6,621.28
|
| Rate for Payer: PHP Medicare Advantage |
$2,781.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,521.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,452.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,478.18
|
| Rate for Payer: Priority Health Medicare |
$2,781.81
|
| Rate for Payer: Priority Health Narrow Network |
$6,782.54
|
| Rate for Payer: Priority Health SBD |
$4,907.54
|
| Rate for Payer: Railroad Medicare Medicare |
$2,781.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,781.81
|
| Rate for Payer: UHC Exchange |
$187.30
|
| Rate for Payer: UHC Medicare Advantage |
$2,865.26
|
| Rate for Payer: VA VA |
$2,781.81
|
|
|
HC D & C POSTPARTUM
|
Facility
|
IP
|
$7,789.74
|
|
|
Service Code
|
CPT 59160
|
| Hospital Charge Code |
76100341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,907.54 |
| Max. Negotiated Rate |
$7,010.77 |
| Rate for Payer: Aetna Commercial |
$6,621.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,063.33
|
| Rate for Payer: Cash Price |
$6,231.79
|
| Rate for Payer: Cofinity Commercial |
$5,452.82
|
| Rate for Payer: Cofinity Commercial |
$6,699.18
|
| Rate for Payer: Healthscope Commercial |
$7,010.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,621.28
|
| Rate for Payer: PHP Commercial |
$6,621.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,452.82
|
| Rate for Payer: Priority Health SBD |
$4,907.54
|
|
|
HC DDAVP CMPT1
|
Facility
|
OP
|
$37.74
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
30500024
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.55 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Aetna Commercial |
$32.08
|
| Rate for Payer: Aetna Medicare |
$23.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.68
|
| Rate for Payer: BCBS Complete |
$13.18
|
| Rate for Payer: BCBS MAPPO |
$22.94
|
| Rate for Payer: BCBS Trust/PPO |
$17.97
|
| Rate for Payer: BCN Medicare Advantage |
$22.94
|
| Rate for Payer: Cash Price |
$30.19
|
| Rate for Payer: Cash Price |
$30.19
|
| Rate for Payer: Cofinity Commercial |
$32.46
|
| Rate for Payer: Cofinity Commercial |
$26.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.94
|
| Rate for Payer: Healthscope Commercial |
$33.97
|
| Rate for Payer: Mclaren Medicaid |
$12.55
|
| Rate for Payer: Mclaren Medicare |
$22.94
|
| Rate for Payer: Meridian Medicaid |
$13.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.08
|
| Rate for Payer: PACE Medicare |
$21.79
|
| Rate for Payer: PACE SWMI |
$22.94
|
| Rate for Payer: PHP Commercial |
$32.08
|
| Rate for Payer: PHP Medicare Advantage |
$22.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.42
|
| Rate for Payer: Priority Health Medicare |
$22.94
|
| Rate for Payer: Priority Health SBD |
$23.78
|
| Rate for Payer: Railroad Medicare Medicare |
$22.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.53
|
| Rate for Payer: UHC Core |
$39.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.94
|
| Rate for Payer: UHC Exchange |
$22.94
|
| Rate for Payer: UHC Medicare Advantage |
$23.63
|
| Rate for Payer: VA VA |
$22.94
|
|
|
HC DDAVP CMPT1
|
Facility
|
IP
|
$37.74
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
30500024
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$23.78 |
| Max. Negotiated Rate |
$33.97 |
| Rate for Payer: Aetna Commercial |
$32.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.53
|
| Rate for Payer: Cash Price |
$30.19
|
| Rate for Payer: Cofinity Commercial |
$26.42
|
| Rate for Payer: Cofinity Commercial |
$32.46
|
| Rate for Payer: Healthscope Commercial |
$33.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.08
|
| Rate for Payer: PHP Commercial |
$32.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.42
|
| Rate for Payer: Priority Health SBD |
$23.78
|
|
|
HC DDAVP CMPT2
|
Facility
|
IP
|
$37.74
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
30500027
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$23.78 |
| Max. Negotiated Rate |
$33.97 |
| Rate for Payer: Aetna Commercial |
$32.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.53
|
| Rate for Payer: Cash Price |
$30.19
|
| Rate for Payer: Cofinity Commercial |
$32.46
|
| Rate for Payer: Cofinity Commercial |
$26.42
|
| Rate for Payer: Healthscope Commercial |
$33.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.08
|
| Rate for Payer: PHP Commercial |
$32.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.42
|
| Rate for Payer: Priority Health SBD |
$23.78
|
|
|
HC DDAVP CMPT2
|
Facility
|
OP
|
$37.74
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
30500027
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.55 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Aetna Commercial |
$32.08
|
| Rate for Payer: Aetna Medicare |
$23.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.68
|
| Rate for Payer: BCBS Complete |
$13.18
|
| Rate for Payer: BCBS MAPPO |
$22.94
|
| Rate for Payer: BCBS Trust/PPO |
$17.97
|
| Rate for Payer: BCN Medicare Advantage |
$22.94
|
| Rate for Payer: Cash Price |
$30.19
|
| Rate for Payer: Cash Price |
$30.19
|
| Rate for Payer: Cofinity Commercial |
$32.46
|
| Rate for Payer: Cofinity Commercial |
$26.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.94
|
| Rate for Payer: Healthscope Commercial |
$33.97
|
| Rate for Payer: Mclaren Medicaid |
$12.55
|
| Rate for Payer: Mclaren Medicare |
$22.94
|
| Rate for Payer: Meridian Medicaid |
$13.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.08
|
| Rate for Payer: PACE Medicare |
$21.79
|
| Rate for Payer: PACE SWMI |
$22.94
|
| Rate for Payer: PHP Commercial |
$32.08
|
| Rate for Payer: PHP Medicare Advantage |
$22.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.42
|
| Rate for Payer: Priority Health Medicare |
$22.94
|
| Rate for Payer: Priority Health SBD |
$23.78
|
| Rate for Payer: Railroad Medicare Medicare |
$22.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.53
|
| Rate for Payer: UHC Core |
$39.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.94
|
| Rate for Payer: UHC Exchange |
$22.94
|
| Rate for Payer: UHC Medicare Advantage |
$23.63
|
| Rate for Payer: VA VA |
$22.94
|
|
|
HC DDAVP FACTOR VIII RISTOCETIN V
|
Facility
|
IP
|
$37.74
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500021
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$23.78 |
| Max. Negotiated Rate |
$33.97 |
| Rate for Payer: Aetna Commercial |
$32.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.53
|
| Rate for Payer: Cash Price |
$30.19
|
| Rate for Payer: Cofinity Commercial |
$26.42
|
| Rate for Payer: Cofinity Commercial |
$32.46
|
| Rate for Payer: Healthscope Commercial |
$33.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.08
|
| Rate for Payer: PHP Commercial |
$32.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.42
|
| Rate for Payer: Priority Health SBD |
$23.78
|
|
|
HC DDAVP FACTOR VIII RISTOCETIN V
|
Facility
|
OP
|
$37.74
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500021
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$33.97 |
| Rate for Payer: Aetna Commercial |
$32.08
|
| Rate for Payer: Aetna Medicare |
$18.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.38
|
| Rate for Payer: BCBS Complete |
$10.28
|
| Rate for Payer: BCBS MAPPO |
$17.90
|
| Rate for Payer: BCBS Trust/PPO |
$14.02
|
| Rate for Payer: BCN Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$30.19
|
| Rate for Payer: Cash Price |
$30.19
|
| Rate for Payer: Cofinity Commercial |
$26.42
|
| Rate for Payer: Cofinity Commercial |
$32.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$33.97
|
| Rate for Payer: Mclaren Medicaid |
$9.79
|
| Rate for Payer: Mclaren Medicare |
$17.90
|
| Rate for Payer: Meridian Medicaid |
$10.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.08
|
| Rate for Payer: PACE Medicare |
$17.00
|
| Rate for Payer: PACE SWMI |
$17.90
|
| Rate for Payer: PHP Commercial |
$32.08
|
| Rate for Payer: PHP Medicare Advantage |
$17.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.42
|
| Rate for Payer: Priority Health Medicare |
$17.90
|
| Rate for Payer: Priority Health SBD |
$23.78
|
| Rate for Payer: Railroad Medicare Medicare |
$17.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.48
|
| Rate for Payer: UHC Core |
$30.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.90
|
| Rate for Payer: UHC Exchange |
$17.90
|
| Rate for Payer: UHC Medicare Advantage |
$18.44
|
| Rate for Payer: VA VA |
$17.90
|
|
|
HC D-DIMER QUANTITATIVE
|
Facility
|
OP
|
$122.20
|
|
|
Service Code
|
CPT 85380
|
| Hospital Charge Code |
30500081
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna Commercial |
$103.87
|
| Rate for Payer: Aetna Medicare |
$10.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.72
|
| Rate for Payer: BCBS Complete |
$5.85
|
| Rate for Payer: BCBS MAPPO |
$10.18
|
| Rate for Payer: BCBS Trust/PPO |
$7.98
|
| Rate for Payer: BCN Medicare Advantage |
$10.18
|
| Rate for Payer: Cash Price |
$97.76
|
| Rate for Payer: Cash Price |
$97.76
|
| Rate for Payer: Cofinity Commercial |
$85.54
|
| Rate for Payer: Cofinity Commercial |
$105.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.18
|
| Rate for Payer: Healthscope Commercial |
$109.98
|
| Rate for Payer: Mclaren Medicaid |
$5.57
|
| Rate for Payer: Mclaren Medicare |
$10.18
|
| Rate for Payer: Meridian Medicaid |
$5.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$103.87
|
| Rate for Payer: PACE Medicare |
$9.67
|
| Rate for Payer: PACE SWMI |
$10.18
|
| Rate for Payer: PHP Commercial |
$103.87
|
| Rate for Payer: PHP Medicare Advantage |
$10.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.54
|
| Rate for Payer: Priority Health Medicare |
$10.18
|
| Rate for Payer: Priority Health SBD |
$76.99
|
| Rate for Payer: Railroad Medicare Medicare |
$10.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.22
|
| Rate for Payer: UHC Core |
$17.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.18
|
| Rate for Payer: UHC Exchange |
$10.18
|
| Rate for Payer: UHC Medicare Advantage |
$10.49
|
| Rate for Payer: VA VA |
$10.18
|
|
|
HC D-DIMER QUANTITATIVE
|
Facility
|
IP
|
$122.20
|
|
|
Service Code
|
CPT 85380
|
| Hospital Charge Code |
30500081
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$76.99 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna Commercial |
$103.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.43
|
| Rate for Payer: Cash Price |
$97.76
|
| Rate for Payer: Cofinity Commercial |
$105.09
|
| Rate for Payer: Cofinity Commercial |
$85.54
|
| Rate for Payer: Healthscope Commercial |
$109.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$103.87
|
| Rate for Payer: PHP Commercial |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.54
|
| Rate for Payer: Priority Health SBD |
$76.99
|
|
|
HC DEBRIDE BONE FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$2,165.56
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
45000070
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$220.04 |
| Max. Negotiated Rate |
$4,536.73 |
| Rate for Payer: Aetna Commercial |
$1,840.73
|
| Rate for Payer: Aetna Medicare |
$1,500.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,407.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,803.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,803.26
|
| Rate for Payer: BCBS Complete |
$828.64
|
| Rate for Payer: BCBS MAPPO |
$1,442.61
|
| Rate for Payer: BCBS Trust/PPO |
$807.54
|
| Rate for Payer: BCN Medicare Advantage |
$1,442.61
|
| Rate for Payer: Cash Price |
$1,732.45
|
| Rate for Payer: Cash Price |
$1,732.45
|
| Rate for Payer: Cofinity Commercial |
$1,515.89
|
| Rate for Payer: Cofinity Commercial |
$1,862.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,442.61
|
| Rate for Payer: Healthscope Commercial |
$1,949.00
|
| Rate for Payer: Mclaren Medicaid |
$789.11
|
| Rate for Payer: Mclaren Medicare |
$1,442.61
|
| Rate for Payer: Meridian Medicaid |
$828.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,514.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,659.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,840.73
|
| Rate for Payer: PACE Medicare |
$1,370.48
|
| Rate for Payer: PACE SWMI |
$1,442.61
|
| Rate for Payer: PHP Commercial |
$1,840.73
|
| Rate for Payer: PHP Medicare Advantage |
$1,442.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$789.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,515.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,536.73
|
| Rate for Payer: Priority Health Medicare |
$1,442.61
|
| Rate for Payer: Priority Health Narrow Network |
$3,629.38
|
| Rate for Payer: Priority Health SBD |
$1,364.30
|
| Rate for Payer: Railroad Medicare Medicare |
$1,442.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,442.61
|
| Rate for Payer: UHC Exchange |
$220.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,485.89
|
| Rate for Payer: VA VA |
$1,442.61
|
|
|
HC DEBRIDE BONE FIRST 20 SQ CM OR LESS
|
Facility
|
IP
|
$2,165.56
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
45000070
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,364.30 |
| Max. Negotiated Rate |
$1,949.00 |
| Rate for Payer: Aetna Commercial |
$1,840.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,407.61
|
| Rate for Payer: Cash Price |
$1,732.45
|
| Rate for Payer: Cofinity Commercial |
$1,515.89
|
| Rate for Payer: Cofinity Commercial |
$1,862.38
|
| Rate for Payer: Healthscope Commercial |
$1,949.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,840.73
|
| Rate for Payer: PHP Commercial |
$1,840.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,515.89
|
| Rate for Payer: Priority Health SBD |
$1,364.30
|
|
|
HC DEBRIDE ECZEMTOUS/INFECT SKIN UP TO 10%
|
Facility
|
OP
|
$524.69
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
76100078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.55 |
| Max. Negotiated Rate |
$1,757.43 |
| Rate for Payer: Aetna Commercial |
$445.99
|
| Rate for Payer: Aetna Medicare |
$581.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$341.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$698.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$698.54
|
| Rate for Payer: BCBS Complete |
$320.99
|
| Rate for Payer: BCBS MAPPO |
$558.83
|
| Rate for Payer: BCBS Trust/PPO |
$23.55
|
| Rate for Payer: BCN Medicare Advantage |
$558.83
|
| Rate for Payer: Cash Price |
$419.75
|
| Rate for Payer: Cash Price |
$419.75
|
| Rate for Payer: Cofinity Commercial |
$451.23
|
| Rate for Payer: Cofinity Commercial |
$367.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.83
|
| Rate for Payer: Healthscope Commercial |
$472.22
|
| Rate for Payer: Mclaren Medicaid |
$305.68
|
| Rate for Payer: Mclaren Medicare |
$558.83
|
| Rate for Payer: Meridian Medicaid |
$320.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.99
|
| Rate for Payer: PACE Medicare |
$530.89
|
| Rate for Payer: PACE SWMI |
$558.83
|
| Rate for Payer: PHP Commercial |
$445.99
|
| Rate for Payer: PHP Medicare Advantage |
$558.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,757.43
|
| Rate for Payer: Priority Health Medicare |
$558.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,405.94
|
| Rate for Payer: Priority Health SBD |
$330.55
|
| Rate for Payer: Railroad Medicare Medicare |
$558.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.83
|
| Rate for Payer: UHC Exchange |
$26.85
|
| Rate for Payer: UHC Medicare Advantage |
$575.59
|
| Rate for Payer: VA VA |
$558.83
|
|
|
HC DEBRIDE ECZEMTOUS/INFECT SKIN UP TO 10%
|
Facility
|
IP
|
$524.69
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
76100078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.55 |
| Max. Negotiated Rate |
$472.22 |
| Rate for Payer: Aetna Commercial |
$445.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$341.05
|
| Rate for Payer: Cash Price |
$419.75
|
| Rate for Payer: Cofinity Commercial |
$367.28
|
| Rate for Payer: Cofinity Commercial |
$451.23
|
| Rate for Payer: Healthscope Commercial |
$472.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.99
|
| Rate for Payer: PHP Commercial |
$445.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.28
|
| Rate for Payer: Priority Health SBD |
$330.55
|
|
