|
HC DRAINAGE SOFT TISSUE W IMAGE GUIDANCE
|
Facility
|
OP
|
$3,112.41
|
|
|
Service Code
|
CPT 10030
|
| Hospital Charge Code |
36100422
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$129.99 |
| Max. Negotiated Rate |
$2,801.17 |
| Rate for Payer: Aetna Commercial |
$2,645.55
|
| Rate for Payer: Aetna Medicare |
$651.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,023.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$782.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$782.55
|
| Rate for Payer: BCBS Complete |
$359.60
|
| Rate for Payer: BCBS MAPPO |
$626.04
|
| Rate for Payer: BCBS Trust/PPO |
$506.28
|
| Rate for Payer: BCN Medicare Advantage |
$626.04
|
| Rate for Payer: Cash Price |
$2,489.93
|
| Rate for Payer: Cash Price |
$2,489.93
|
| Rate for Payer: Cofinity Commercial |
$2,676.67
|
| Rate for Payer: Cofinity Commercial |
$2,178.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$626.04
|
| Rate for Payer: Healthscope Commercial |
$2,801.17
|
| Rate for Payer: Mclaren Medicaid |
$342.44
|
| Rate for Payer: Mclaren Medicare |
$626.04
|
| Rate for Payer: Meridian Medicaid |
$359.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$657.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,645.55
|
| Rate for Payer: PACE Medicare |
$594.74
|
| Rate for Payer: PACE SWMI |
$626.04
|
| Rate for Payer: PHP Commercial |
$2,645.55
|
| Rate for Payer: PHP Medicare Advantage |
$626.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,178.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,945.97
|
| Rate for Payer: Priority Health Medicare |
$626.04
|
| Rate for Payer: Priority Health Narrow Network |
$1,556.78
|
| Rate for Payer: Priority Health SBD |
$1,960.82
|
| Rate for Payer: Railroad Medicare Medicare |
$626.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.99
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$626.04
|
| Rate for Payer: UHC Exchange |
$129.99
|
| Rate for Payer: UHC Medicare Advantage |
$644.82
|
| Rate for Payer: VA VA |
$626.04
|
|
|
HC DRAINAGE SOFT TISSUE W IMAGE GUIDANCE
|
Facility
|
IP
|
$3,112.41
|
|
|
Service Code
|
CPT 10030
|
| Hospital Charge Code |
36100422
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,960.82 |
| Max. Negotiated Rate |
$2,801.17 |
| Rate for Payer: Aetna Commercial |
$2,645.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,023.07
|
| Rate for Payer: Cash Price |
$2,489.93
|
| Rate for Payer: Cofinity Commercial |
$2,178.69
|
| Rate for Payer: Cofinity Commercial |
$2,676.67
|
| Rate for Payer: Healthscope Commercial |
$2,801.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,645.55
|
| Rate for Payer: PHP Commercial |
$2,645.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,178.69
|
| Rate for Payer: Priority Health SBD |
$1,960.82
|
|
|
HC DRAINAGE VISCERAL
|
Facility
|
IP
|
$3,984.73
|
|
|
Service Code
|
CPT 49405
|
| Hospital Charge Code |
36100432
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,510.38 |
| Max. Negotiated Rate |
$3,586.26 |
| Rate for Payer: Aetna Commercial |
$3,387.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,590.07
|
| Rate for Payer: Cash Price |
$3,187.78
|
| Rate for Payer: Cofinity Commercial |
$2,789.31
|
| Rate for Payer: Cofinity Commercial |
$3,426.87
|
| Rate for Payer: Healthscope Commercial |
$3,586.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,387.02
|
| Rate for Payer: PHP Commercial |
$3,387.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,789.31
|
| Rate for Payer: Priority Health SBD |
$2,510.38
|
|
|
HC DRAINAGE VISCERAL
|
Facility
|
OP
|
$3,984.73
|
|
|
Service Code
|
CPT 49405
|
| Hospital Charge Code |
36100432
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$185.66 |
| Max. Negotiated Rate |
$3,586.26 |
| Rate for Payer: Aetna Commercial |
$3,387.02
|
| Rate for Payer: Aetna Medicare |
$1,500.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,590.07
|
| 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 |
$531.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,442.61
|
| Rate for Payer: Cash Price |
$3,187.78
|
| Rate for Payer: Cash Price |
$3,187.78
|
| Rate for Payer: Cofinity Commercial |
$3,426.87
|
| Rate for Payer: Cofinity Commercial |
$2,789.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,442.61
|
| Rate for Payer: Healthscope Commercial |
$3,586.26
|
| 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 |
$3,387.02
|
| Rate for Payer: PACE Medicare |
$1,370.48
|
| Rate for Payer: PACE SWMI |
$1,442.61
|
| Rate for Payer: PHP Commercial |
$3,387.02
|
| 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 |
$2,789.31
|
| Rate for Payer: Priority Health Medicare |
$1,442.61
|
| Rate for Payer: Priority Health SBD |
$2,510.38
|
| Rate for Payer: Railroad Medicare Medicare |
$1,442.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.23
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,442.61
|
| Rate for Payer: UHC Exchange |
$185.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,485.89
|
| Rate for Payer: VA VA |
$1,442.61
|
|
|
HC DRAIN EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE
|
Facility
|
OP
|
$951.66
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
76100298
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$124.43 |
| Max. Negotiated Rate |
$856.49 |
| Rate for Payer: Aetna Commercial |
$808.91
|
| Rate for Payer: Aetna Medicare |
$651.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$618.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$782.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$782.55
|
| Rate for Payer: BCBS Complete |
$359.60
|
| Rate for Payer: BCBS MAPPO |
$626.04
|
| Rate for Payer: BCBS Trust/PPO |
$208.25
|
| Rate for Payer: BCN Medicare Advantage |
$626.04
|
| Rate for Payer: Cash Price |
$761.33
|
| Rate for Payer: Cash Price |
$761.33
|
| Rate for Payer: Cofinity Commercial |
$666.16
|
| Rate for Payer: Cofinity Commercial |
$818.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$626.04
|
| Rate for Payer: Healthscope Commercial |
$856.49
|
| Rate for Payer: Mclaren Medicaid |
$342.44
|
| Rate for Payer: Mclaren Medicare |
$626.04
|
| Rate for Payer: Meridian Medicaid |
$359.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$657.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$808.91
|
| Rate for Payer: PACE Medicare |
$594.74
|
| Rate for Payer: PACE SWMI |
$626.04
|
| Rate for Payer: PHP Commercial |
$808.91
|
| Rate for Payer: PHP Medicare Advantage |
$626.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$666.16
|
| Rate for Payer: Priority Health Medicare |
$626.04
|
| Rate for Payer: Priority Health SBD |
$599.55
|
| Rate for Payer: Railroad Medicare Medicare |
$626.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$626.04
|
| Rate for Payer: UHC Exchange |
$124.43
|
| Rate for Payer: UHC Medicare Advantage |
$644.82
|
| Rate for Payer: VA VA |
$626.04
|
|
|
HC DRAIN EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE
|
Facility
|
IP
|
$951.66
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
76100298
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$599.55 |
| Max. Negotiated Rate |
$856.49 |
| Rate for Payer: Aetna Commercial |
$808.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$618.58
|
| Rate for Payer: Cash Price |
$761.33
|
| Rate for Payer: Cofinity Commercial |
$666.16
|
| Rate for Payer: Cofinity Commercial |
$818.43
|
| Rate for Payer: Healthscope Commercial |
$856.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$808.91
|
| Rate for Payer: PHP Commercial |
$808.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$666.16
|
| Rate for Payer: Priority Health SBD |
$599.55
|
|
|
HC DRAW VENIPUNCTURE
|
Facility
|
IP
|
$15.30
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
30000001
|
|
Hospital Revenue Code
|
300
|
| 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 DRAW VENIPUNCTURE
|
Facility
|
OP
|
$15.30
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
30000001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: Aetna Medicare |
$9.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.04
|
| Rate for Payer: BCBS Complete |
$5.07
|
| Rate for Payer: BCBS MAPPO |
$8.83
|
| Rate for Payer: BCBS Trust/PPO |
$2.35
|
| Rate for Payer: BCN Medicare Advantage |
$8.83
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: City of Battle Creek Police Dept Commercial |
$50.00
|
| Rate for Payer: Cofinity Commercial |
$10.71
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.83
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Mclaren Medicaid |
$4.83
|
| Rate for Payer: Mclaren Medicare |
$8.83
|
| Rate for Payer: Meridian Medicaid |
$5.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.15
|
| Rate for Payer: Michigan State Police Michigan State Police |
$50.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PACE Medicare |
$8.39
|
| Rate for Payer: PACE SWMI |
$8.83
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: PHP Medicare Advantage |
$8.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health Medicare |
$8.83
|
| Rate for Payer: Priority Health SBD |
$9.64
|
| Rate for Payer: Railroad Medicare Medicare |
$8.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.60
|
| Rate for Payer: UHC Core |
$3.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.83
|
| Rate for Payer: UHC Exchange |
$8.83
|
| Rate for Payer: UHC Medicare Advantage |
$9.09
|
| Rate for Payer: VA VA |
$8.83
|
|
|
HC DRSG MEPILEX AG FOAM 8X20
|
Facility
|
IP
|
$363.14
|
|
|
Service Code
|
HCPCS A6214
|
| Hospital Charge Code |
27000065
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$228.78 |
| Max. Negotiated Rate |
$326.83 |
| Rate for Payer: Aetna Commercial |
$308.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.04
|
| Rate for Payer: Cash Price |
$290.51
|
| Rate for Payer: Cofinity Commercial |
$312.30
|
| Rate for Payer: Cofinity Commercial |
$254.20
|
| Rate for Payer: Healthscope Commercial |
$326.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$308.67
|
| Rate for Payer: PHP Commercial |
$308.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.20
|
| Rate for Payer: Priority Health SBD |
$228.78
|
|
|
HC DRSG MEPILEX AG FOAM 8X20
|
Facility
|
OP
|
$363.14
|
|
|
Service Code
|
HCPCS A6214
|
| Hospital Charge Code |
27000065
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$326.83 |
| Rate for Payer: Aetna Commercial |
$308.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.04
|
| Rate for Payer: BCBS Complete |
$145.26
|
| Rate for Payer: BCBS Trust/PPO |
$39.78
|
| Rate for Payer: Cash Price |
$290.51
|
| Rate for Payer: Cash Price |
$290.51
|
| Rate for Payer: Cofinity Commercial |
$254.20
|
| Rate for Payer: Cofinity Commercial |
$312.30
|
| Rate for Payer: Healthscope Commercial |
$326.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$308.67
|
| Rate for Payer: PHP Commercial |
$308.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.20
|
| Rate for Payer: Priority Health SBD |
$228.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.86
|
| Rate for Payer: UHC Exchange |
$14.05
|
|
|
HC DRSG MEPILEX BORDER LITE 4X5 EA
|
Facility
|
OP
|
$5.53
|
|
|
Service Code
|
HCPCS A6213
|
| Hospital Charge Code |
62300221
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$52.30 |
| Rate for Payer: Aetna Commercial |
$4.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.59
|
| Rate for Payer: BCBS Complete |
$2.21
|
| Rate for Payer: BCBS Trust/PPO |
$52.30
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Cofinity Commercial |
$4.76
|
| Rate for Payer: Cofinity Commercial |
$3.87
|
| Rate for Payer: Healthscope Commercial |
$4.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.70
|
| Rate for Payer: PHP Commercial |
$4.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.87
|
| Rate for Payer: Priority Health SBD |
$3.48
|
|
|
HC DRSG MEPILEX BORDER LITE 4X5 EA
|
Facility
|
IP
|
$5.53
|
|
|
Service Code
|
HCPCS A6213
|
| Hospital Charge Code |
62300221
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$4.98 |
| Rate for Payer: Aetna Commercial |
$4.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.59
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Cofinity Commercial |
$3.87
|
| Rate for Payer: Cofinity Commercial |
$4.76
|
| Rate for Payer: Healthscope Commercial |
$4.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.70
|
| Rate for Payer: PHP Commercial |
$4.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.87
|
| Rate for Payer: Priority Health SBD |
$3.48
|
|
|
HC DRSG MEPILEX BORDER SACRUM 9X9 EA
|
Facility
|
OP
|
$26.81
|
|
|
Service Code
|
HCPCS A6214
|
| Hospital Charge Code |
62300222
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$10.72 |
| Max. Negotiated Rate |
$39.78 |
| Rate for Payer: Aetna Commercial |
$22.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.43
|
| Rate for Payer: BCBS Complete |
$10.72
|
| Rate for Payer: BCBS Trust/PPO |
$39.78
|
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: Cofinity Commercial |
$18.77
|
| Rate for Payer: Cofinity Commercial |
$23.06
|
| Rate for Payer: Healthscope Commercial |
$24.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.79
|
| Rate for Payer: PHP Commercial |
$22.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.77
|
| Rate for Payer: Priority Health SBD |
$16.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.86
|
| Rate for Payer: UHC Exchange |
$14.05
|
|
|
HC DRSG MEPILEX BORDER SACRUM 9X9 EA
|
Facility
|
IP
|
$26.81
|
|
|
Service Code
|
HCPCS A6214
|
| Hospital Charge Code |
62300222
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$16.89 |
| Max. Negotiated Rate |
$24.13 |
| Rate for Payer: Aetna Commercial |
$22.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.43
|
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: Cofinity Commercial |
$18.77
|
| Rate for Payer: Cofinity Commercial |
$23.06
|
| Rate for Payer: Healthscope Commercial |
$24.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.79
|
| Rate for Payer: PHP Commercial |
$22.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.77
|
| Rate for Payer: Priority Health SBD |
$16.89
|
|
|
HC DRUG SCREEN 10 URINE
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000134
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$95.77 |
| Rate for Payer: Aetna Commercial |
$86.70
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: BCBS Complete |
$35.69
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$48.67
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$87.72
|
| Rate for Payer: Cofinity Commercial |
$71.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Mclaren Medicaid |
$33.99
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Medicaid |
$35.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.70
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$86.70
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.40
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$64.26
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.57
|
| Rate for Payer: UHC Core |
$95.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Exchange |
$62.14
|
| Rate for Payer: UHC Medicare Advantage |
$64.00
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC DRUG SCREEN 10 URINE
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000134
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.26 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$86.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.30
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$71.40
|
| Rate for Payer: Cofinity Commercial |
$87.72
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.70
|
| Rate for Payer: PHP Commercial |
$86.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.40
|
| Rate for Payer: Priority Health SBD |
$64.26
|
|
|
HC DRUG SCREEN COLLECT-OUTSIDE SVC
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 99000
|
| Hospital Charge Code |
98300005
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna Commercial |
$20.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.60
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS Trust/PPO |
$10.60
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$20.64
|
| Rate for Payer: Cofinity Commercial |
$16.80
|
| Rate for Payer: Healthscope Commercial |
$21.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.40
|
| Rate for Payer: PHP Commercial |
$20.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.80
|
| Rate for Payer: Priority Health SBD |
$15.12
|
| Rate for Payer: UHC Core |
$8.17
|
|
|
HC DRUG SCREEN COLLECT-OUTSIDE SVC
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 99000
|
| Hospital Charge Code |
98300005
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna Commercial |
$20.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.60
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$20.64
|
| Rate for Payer: Healthscope Commercial |
$21.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.40
|
| Rate for Payer: PHP Commercial |
$20.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.80
|
| Rate for Payer: Priority Health SBD |
$15.12
|
|
|
HC DRUG SCREEN QUAL EA PROC
|
Facility
|
OP
|
$47.28
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30100652
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$42.55 |
| Rate for Payer: Aetna Commercial |
$40.19
|
| Rate for Payer: Aetna Medicare |
$13.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.75
|
| Rate for Payer: BCBS Complete |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$12.60
|
| Rate for Payer: BCBS Trust/PPO |
$9.87
|
| Rate for Payer: BCN Medicare Advantage |
$12.60
|
| Rate for Payer: Cash Price |
$37.82
|
| Rate for Payer: Cash Price |
$37.82
|
| Rate for Payer: Cofinity Commercial |
$33.10
|
| Rate for Payer: Cofinity Commercial |
$40.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$42.55
|
| Rate for Payer: Mclaren Medicaid |
$6.89
|
| Rate for Payer: Mclaren Medicare |
$12.60
|
| Rate for Payer: Meridian Medicaid |
$7.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.19
|
| Rate for Payer: PACE Medicare |
$11.97
|
| Rate for Payer: PACE SWMI |
$12.60
|
| Rate for Payer: PHP Commercial |
$40.19
|
| Rate for Payer: PHP Medicare Advantage |
$12.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.10
|
| Rate for Payer: Priority Health Medicare |
$12.60
|
| Rate for Payer: Priority Health SBD |
$29.79
|
| Rate for Payer: Railroad Medicare Medicare |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.12
|
| Rate for Payer: UHC Core |
$17.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.60
|
| Rate for Payer: UHC Exchange |
$12.60
|
| Rate for Payer: UHC Medicare Advantage |
$12.98
|
| Rate for Payer: VA VA |
$12.60
|
|
|
HC DRUG SCREEN QUAL EA PROC
|
Facility
|
IP
|
$47.28
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30100652
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.79 |
| Max. Negotiated Rate |
$42.55 |
| Rate for Payer: Aetna Commercial |
$40.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.73
|
| Rate for Payer: Cash Price |
$37.82
|
| Rate for Payer: Cofinity Commercial |
$33.10
|
| Rate for Payer: Cofinity Commercial |
$40.66
|
| Rate for Payer: Healthscope Commercial |
$42.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.19
|
| Rate for Payer: PHP Commercial |
$40.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.10
|
| Rate for Payer: Priority Health SBD |
$29.79
|
|
|
HC DRUG SCREEN QUANTALCOHOLS
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100732
|
|
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 DRUG SCREEN QUANTALCOHOLS
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100732
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.22 |
| 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: BCBS Complete |
$30.00
|
| 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: 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
|
| Rate for Payer: UHC Core |
$28.22
|
|
|
HC DSDNA AB WITH REFLEX, IGG, S
|
Facility
|
OP
|
$38.74
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
30200505
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$34.87 |
| Rate for Payer: Aetna Commercial |
$32.93
|
| Rate for Payer: Aetna Medicare |
$14.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.18
|
| Rate for Payer: BCBS Complete |
$7.89
|
| Rate for Payer: BCBS MAPPO |
$13.74
|
| Rate for Payer: BCBS Trust/PPO |
$10.76
|
| Rate for Payer: BCN Medicare Advantage |
$13.74
|
| Rate for Payer: Cash Price |
$30.99
|
| Rate for Payer: Cash Price |
$30.99
|
| Rate for Payer: Cofinity Commercial |
$33.32
|
| Rate for Payer: Cofinity Commercial |
$27.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.74
|
| Rate for Payer: Healthscope Commercial |
$34.87
|
| Rate for Payer: Mclaren Medicaid |
$7.52
|
| Rate for Payer: Mclaren Medicare |
$13.74
|
| Rate for Payer: Meridian Medicaid |
$7.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.93
|
| Rate for Payer: PACE Medicare |
$13.05
|
| Rate for Payer: PACE SWMI |
$13.74
|
| Rate for Payer: PHP Commercial |
$32.93
|
| Rate for Payer: PHP Medicare Advantage |
$13.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.12
|
| Rate for Payer: Priority Health Medicare |
$13.74
|
| Rate for Payer: Priority Health SBD |
$24.41
|
| Rate for Payer: Railroad Medicare Medicare |
$13.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.49
|
| Rate for Payer: UHC Core |
$23.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.74
|
| Rate for Payer: UHC Exchange |
$13.74
|
| Rate for Payer: UHC Medicare Advantage |
$14.15
|
| Rate for Payer: VA VA |
$13.74
|
|
|
HC DSDNA AB WITH REFLEX, IGG, S
|
Facility
|
IP
|
$38.74
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
30200505
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.41 |
| Max. Negotiated Rate |
$34.87 |
| Rate for Payer: Aetna Commercial |
$32.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.18
|
| Rate for Payer: Cash Price |
$30.99
|
| Rate for Payer: Cofinity Commercial |
$27.12
|
| Rate for Payer: Cofinity Commercial |
$33.32
|
| Rate for Payer: Healthscope Commercial |
$34.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.93
|
| Rate for Payer: PHP Commercial |
$32.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.12
|
| Rate for Payer: Priority Health SBD |
$24.41
|
|
|
HC DSMA TC 99M PER STUDY
|
Facility
|
IP
|
$381.09
|
|
|
Service Code
|
HCPCS A9551
|
| Hospital Charge Code |
34300004
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$240.09 |
| Max. Negotiated Rate |
$342.98 |
| Rate for Payer: Aetna Commercial |
$323.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.71
|
| Rate for Payer: Cash Price |
$304.87
|
| Rate for Payer: Cofinity Commercial |
$266.76
|
| Rate for Payer: Cofinity Commercial |
$327.74
|
| Rate for Payer: Healthscope Commercial |
$342.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.93
|
| Rate for Payer: PHP Commercial |
$323.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.76
|
| Rate for Payer: Priority Health SBD |
$240.09
|
|
