|
HC BCR/ABL P210 QUANT
|
Facility
|
IP
|
$397.95
|
|
|
Service Code
|
CPT 81206
|
| Hospital Charge Code |
31000096
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$250.71 |
| Max. Negotiated Rate |
$358.15 |
| Rate for Payer: Aetna Commercial |
$338.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.67
|
| Rate for Payer: Cash Price |
$318.36
|
| Rate for Payer: Cofinity Advantage |
$278.56
|
| Rate for Payer: Cofinity Commercial |
$342.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.36
|
| Rate for Payer: Healthscope Commercial |
$358.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$298.46
|
| Rate for Payer: PHP Commercial |
$338.26
|
| Rate for Payer: Priority Health SBD |
$250.71
|
|
|
HC BCRABL RNA, CMPT 1
|
Facility
|
OP
|
$259.28
|
|
|
Service Code
|
CPT 81207
|
| Hospital Charge Code |
31000144
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$75.75 |
| Max. Negotiated Rate |
$434.52 |
| Rate for Payer: Aetna Commercial |
$220.39
|
| Rate for Payer: Aetna Medicare |
$150.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$181.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$181.05
|
| Rate for Payer: BCBS Complete |
$79.55
|
| Rate for Payer: BCBS MAPPO |
$144.84
|
| Rate for Payer: BCBS Trust/PPO |
$154.43
|
| Rate for Payer: BCN Commercial |
$154.43
|
| Rate for Payer: BCN Medicare Advantage |
$144.84
|
| Rate for Payer: Cash Price |
$207.42
|
| Rate for Payer: Cash Price |
$207.42
|
| Rate for Payer: Cofinity Advantage |
$181.50
|
| Rate for Payer: Cofinity Commercial |
$222.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.84
|
| Rate for Payer: Healthscope Commercial |
$233.35
|
| Rate for Payer: Mclaren Medicaid |
$75.75
|
| Rate for Payer: Mclaren Medicare |
$144.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.08
|
| Rate for Payer: Meridian Medicaid |
$152.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$166.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$159.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.39
|
| Rate for Payer: Nomi Health Commercial |
$434.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.46
|
| Rate for Payer: PACE Medicare |
$137.60
|
| Rate for Payer: PACE SWMI |
$144.84
|
| Rate for Payer: PHP Commercial |
$220.39
|
| Rate for Payer: PHP Medicare Advantage |
$144.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$144.84
|
| Rate for Payer: Priority Health Medicare |
$144.84
|
| Rate for Payer: Priority Health SBD |
$163.35
|
| Rate for Payer: Priority Health Tiered Network |
$115.87
|
| Rate for Payer: Railroad Medicare Medicare |
$144.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.26
|
| Rate for Payer: UHC Core |
$217.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$144.84
|
| Rate for Payer: UHC Exchange |
$217.26
|
| Rate for Payer: UHC Medicaid |
$75.75
|
| Rate for Payer: UHCCP Medicaid |
$75.75
|
| Rate for Payer: VA VA |
$144.84
|
|
|
HC BCRABL RNA, CMPT 1
|
Facility
|
IP
|
$259.28
|
|
|
Service Code
|
CPT 81207
|
| Hospital Charge Code |
31000144
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$163.35 |
| Max. Negotiated Rate |
$233.35 |
| Rate for Payer: Aetna Commercial |
$220.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.53
|
| Rate for Payer: Cash Price |
$207.42
|
| Rate for Payer: Cofinity Advantage |
$181.50
|
| Rate for Payer: Cofinity Commercial |
$222.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.42
|
| Rate for Payer: Healthscope Commercial |
$233.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.46
|
| Rate for Payer: PHP Commercial |
$220.39
|
| Rate for Payer: Priority Health SBD |
$163.35
|
|
|
HC BCRABL RNA, CMPT 2
|
Facility
|
IP
|
$384.20
|
|
|
Service Code
|
CPT 81208
|
| Hospital Charge Code |
31000145
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$242.05 |
| Max. Negotiated Rate |
$345.78 |
| Rate for Payer: Aetna Commercial |
$326.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.73
|
| Rate for Payer: Cash Price |
$307.36
|
| Rate for Payer: Cofinity Advantage |
$268.94
|
| Rate for Payer: Cofinity Commercial |
$330.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.36
|
| Rate for Payer: Healthscope Commercial |
$345.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$326.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$288.15
|
| Rate for Payer: PHP Commercial |
$326.57
|
| Rate for Payer: Priority Health SBD |
$242.05
|
|
|
HC BCRABL RNA, CMPT 2
|
Facility
|
OP
|
$384.20
|
|
|
Service Code
|
CPT 81208
|
| Hospital Charge Code |
31000145
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$112.25 |
| Max. Negotiated Rate |
$643.86 |
| Rate for Payer: Aetna Commercial |
$326.57
|
| Rate for Payer: Aetna Medicare |
$223.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.27
|
| Rate for Payer: BCBS Complete |
$117.87
|
| Rate for Payer: BCBS MAPPO |
$214.62
|
| Rate for Payer: BCBS Trust/PPO |
$228.83
|
| Rate for Payer: BCN Commercial |
$228.83
|
| Rate for Payer: BCN Medicare Advantage |
$214.62
|
| Rate for Payer: Cash Price |
$307.36
|
| Rate for Payer: Cash Price |
$307.36
|
| Rate for Payer: Cofinity Advantage |
$268.94
|
| Rate for Payer: Cofinity Commercial |
$330.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$214.62
|
| Rate for Payer: Healthscope Commercial |
$345.78
|
| Rate for Payer: Mclaren Medicaid |
$112.25
|
| Rate for Payer: Mclaren Medicare |
$214.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.35
|
| Rate for Payer: Meridian Medicaid |
$225.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$246.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$326.57
|
| Rate for Payer: Nomi Health Commercial |
$643.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$288.15
|
| Rate for Payer: PACE Medicare |
$203.89
|
| Rate for Payer: PACE SWMI |
$214.62
|
| Rate for Payer: PHP Commercial |
$326.57
|
| Rate for Payer: PHP Medicare Advantage |
$214.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$214.62
|
| Rate for Payer: Priority Health Medicare |
$214.62
|
| Rate for Payer: Priority Health SBD |
$242.05
|
| Rate for Payer: Priority Health Tiered Network |
$171.70
|
| Rate for Payer: Railroad Medicare Medicare |
$214.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$321.93
|
| Rate for Payer: UHC Core |
$321.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$214.62
|
| Rate for Payer: UHC Exchange |
$321.93
|
| Rate for Payer: UHC Medicaid |
$112.25
|
| Rate for Payer: UHCCP Medicaid |
$112.25
|
| Rate for Payer: VA VA |
$214.62
|
|
|
HC BCRABL RNA, QUAL
|
Facility
|
IP
|
$293.50
|
|
|
Service Code
|
CPT 81206
|
| Hospital Charge Code |
31000143
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$184.91 |
| Max. Negotiated Rate |
$264.15 |
| Rate for Payer: Aetna Commercial |
$249.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.78
|
| Rate for Payer: Cash Price |
$234.80
|
| Rate for Payer: Cofinity Advantage |
$205.45
|
| Rate for Payer: Cofinity Commercial |
$252.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.80
|
| Rate for Payer: Healthscope Commercial |
$264.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$220.12
|
| Rate for Payer: PHP Commercial |
$249.47
|
| Rate for Payer: Priority Health SBD |
$184.91
|
|
|
HC BCRABL RNA, QUAL
|
Facility
|
OP
|
$293.50
|
|
|
Service Code
|
CPT 81206
|
| Hospital Charge Code |
31000143
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$85.75 |
| Max. Negotiated Rate |
$491.88 |
| Rate for Payer: Aetna Commercial |
$249.47
|
| Rate for Payer: Aetna Medicare |
$170.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.95
|
| Rate for Payer: BCBS Complete |
$90.05
|
| Rate for Payer: BCBS MAPPO |
$163.96
|
| Rate for Payer: BCBS Trust/PPO |
$174.81
|
| Rate for Payer: BCN Commercial |
$174.81
|
| Rate for Payer: BCN Medicare Advantage |
$163.96
|
| Rate for Payer: Cash Price |
$234.80
|
| Rate for Payer: Cash Price |
$234.80
|
| Rate for Payer: Cofinity Advantage |
$205.45
|
| Rate for Payer: Cofinity Commercial |
$252.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.96
|
| Rate for Payer: Healthscope Commercial |
$264.15
|
| Rate for Payer: Mclaren Medicaid |
$85.75
|
| Rate for Payer: Mclaren Medicare |
$163.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$172.16
|
| Rate for Payer: Meridian Medicaid |
$172.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$180.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.47
|
| Rate for Payer: Nomi Health Commercial |
$491.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$220.12
|
| Rate for Payer: PACE Medicare |
$155.76
|
| Rate for Payer: PACE SWMI |
$163.96
|
| Rate for Payer: PHP Commercial |
$249.47
|
| Rate for Payer: PHP Medicare Advantage |
$163.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$163.96
|
| Rate for Payer: Priority Health Medicare |
$163.96
|
| Rate for Payer: Priority Health SBD |
$184.91
|
| Rate for Payer: Priority Health Tiered Network |
$131.17
|
| Rate for Payer: Railroad Medicare Medicare |
$163.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.94
|
| Rate for Payer: UHC Core |
$245.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$163.96
|
| Rate for Payer: UHC Exchange |
$245.94
|
| Rate for Payer: UHC Medicaid |
$85.75
|
| Rate for Payer: UHCCP Medicaid |
$85.75
|
| Rate for Payer: VA VA |
$163.96
|
|
|
HC BDIAL APTT
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
30500096
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna Medicare |
$6.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.51
|
| Rate for Payer: BCBS Complete |
$3.30
|
| Rate for Payer: BCBS MAPPO |
$6.01
|
| Rate for Payer: BCBS Trust/PPO |
$6.41
|
| Rate for Payer: BCN Commercial |
$6.41
|
| Rate for Payer: BCN Medicare Advantage |
$6.01
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.01
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Mclaren Medicaid |
$3.14
|
| Rate for Payer: Mclaren Medicare |
$6.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.31
|
| Rate for Payer: Meridian Medicaid |
$6.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$9.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PACE Medicare |
$5.71
|
| Rate for Payer: PACE SWMI |
$6.01
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: PHP Medicare Advantage |
$6.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6.01
|
| Rate for Payer: Priority Health Medicare |
$6.01
|
| Rate for Payer: Priority Health SBD |
$16.71
|
| Rate for Payer: Priority Health Tiered Network |
$4.81
|
| Rate for Payer: Railroad Medicare Medicare |
$6.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.02
|
| Rate for Payer: UHC Core |
$9.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.01
|
| Rate for Payer: UHC Exchange |
$9.02
|
| Rate for Payer: UHC Medicaid |
$3.14
|
| Rate for Payer: UHCCP Medicaid |
$3.14
|
| Rate for Payer: VA VA |
$6.01
|
|
|
HC BDIAL APTT
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
30500096
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: Priority Health SBD |
$16.71
|
|
|
HC BDIAL DIRM
|
Facility
|
OP
|
$41.13
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
30500088
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$37.02 |
| Rate for Payer: Aetna Commercial |
$34.96
|
| Rate for Payer: Aetna Medicare |
$10.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.73
|
| 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 |
$5.59
|
| Rate for Payer: BCBS MAPPO |
$10.18
|
| Rate for Payer: BCBS Trust/PPO |
$10.86
|
| Rate for Payer: BCN Commercial |
$10.86
|
| Rate for Payer: BCN Medicare Advantage |
$10.18
|
| Rate for Payer: Cash Price |
$32.90
|
| Rate for Payer: Cash Price |
$32.90
|
| Rate for Payer: Cofinity Advantage |
$28.79
|
| Rate for Payer: Cofinity Commercial |
$35.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.18
|
| Rate for Payer: Healthscope Commercial |
$37.02
|
| Rate for Payer: Mclaren Medicaid |
$5.32
|
| Rate for Payer: Mclaren Medicare |
$10.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.69
|
| Rate for Payer: Meridian Medicaid |
$10.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.96
|
| Rate for Payer: Nomi Health Commercial |
$15.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.85
|
| Rate for Payer: PACE Medicare |
$9.67
|
| Rate for Payer: PACE SWMI |
$10.18
|
| Rate for Payer: PHP Commercial |
$34.96
|
| Rate for Payer: PHP Medicare Advantage |
$10.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10.18
|
| Rate for Payer: Priority Health Medicare |
$10.18
|
| Rate for Payer: Priority Health SBD |
$25.91
|
| Rate for Payer: Priority Health Tiered Network |
$8.14
|
| Rate for Payer: Railroad Medicare Medicare |
$10.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.27
|
| Rate for Payer: UHC Core |
$15.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.18
|
| Rate for Payer: UHC Exchange |
$15.27
|
| Rate for Payer: UHC Medicaid |
$5.32
|
| Rate for Payer: UHCCP Medicaid |
$5.32
|
| Rate for Payer: VA VA |
$10.18
|
|
|
HC BDIAL DIRM
|
Facility
|
IP
|
$41.13
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
30500088
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$25.91 |
| Max. Negotiated Rate |
$37.02 |
| Rate for Payer: Aetna Commercial |
$34.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.73
|
| Rate for Payer: Cash Price |
$32.90
|
| Rate for Payer: Cofinity Advantage |
$28.79
|
| Rate for Payer: Cofinity Commercial |
$35.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.90
|
| Rate for Payer: Healthscope Commercial |
$37.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.85
|
| Rate for Payer: PHP Commercial |
$34.96
|
| Rate for Payer: Priority Health SBD |
$25.91
|
|
|
HC BDIAL F8A
|
Facility
|
OP
|
$68.29
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500091
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$61.46 |
| Rate for Payer: Aetna Commercial |
$58.05
|
| Rate for Payer: Aetna Medicare |
$18.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.39
|
| 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 |
$9.83
|
| Rate for Payer: BCBS MAPPO |
$17.90
|
| Rate for Payer: BCBS Trust/PPO |
$19.09
|
| Rate for Payer: BCN Commercial |
$19.09
|
| Rate for Payer: BCN Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$54.63
|
| Rate for Payer: Cash Price |
$54.63
|
| Rate for Payer: Cofinity Advantage |
$47.80
|
| Rate for Payer: Cofinity Commercial |
$58.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$61.46
|
| Rate for Payer: Mclaren Medicaid |
$9.36
|
| Rate for Payer: Mclaren Medicare |
$17.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.80
|
| Rate for Payer: Meridian Medicaid |
$18.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.05
|
| Rate for Payer: Nomi Health Commercial |
$26.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.22
|
| Rate for Payer: PACE Medicare |
$17.00
|
| Rate for Payer: PACE SWMI |
$17.90
|
| Rate for Payer: PHP Commercial |
$58.05
|
| Rate for Payer: PHP Medicare Advantage |
$17.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.90
|
| Rate for Payer: Priority Health Medicare |
$17.90
|
| Rate for Payer: Priority Health SBD |
$43.02
|
| Rate for Payer: Priority Health Tiered Network |
$14.32
|
| Rate for Payer: Railroad Medicare Medicare |
$17.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.85
|
| Rate for Payer: UHC Core |
$26.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.90
|
| Rate for Payer: UHC Exchange |
$26.85
|
| Rate for Payer: UHC Medicaid |
$9.36
|
| Rate for Payer: UHCCP Medicaid |
$9.36
|
| Rate for Payer: VA VA |
$17.90
|
|
|
HC BDIAL F8A
|
Facility
|
IP
|
$68.29
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500091
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$43.02 |
| Max. Negotiated Rate |
$61.46 |
| Rate for Payer: Aetna Commercial |
$58.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.39
|
| Rate for Payer: Cash Price |
$54.63
|
| Rate for Payer: Cofinity Advantage |
$47.80
|
| Rate for Payer: Cofinity Commercial |
$58.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.63
|
| Rate for Payer: Healthscope Commercial |
$61.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.22
|
| Rate for Payer: PHP Commercial |
$58.05
|
| Rate for Payer: Priority Health SBD |
$43.02
|
|
|
HC BDIAL FACTOR IX ASSAY
|
Facility
|
IP
|
$100.82
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
30500030
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$63.52 |
| Max. Negotiated Rate |
$90.74 |
| Rate for Payer: Aetna Commercial |
$85.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.53
|
| Rate for Payer: Cash Price |
$80.66
|
| Rate for Payer: Cofinity Advantage |
$70.57
|
| Rate for Payer: Cofinity Commercial |
$86.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.66
|
| Rate for Payer: Healthscope Commercial |
$90.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.61
|
| Rate for Payer: PHP Commercial |
$85.70
|
| Rate for Payer: Priority Health SBD |
$63.52
|
|
|
HC BDIAL FACTOR IX ASSAY
|
Facility
|
OP
|
$100.82
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
30500030
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$90.74 |
| Rate for Payer: Aetna Commercial |
$85.70
|
| Rate for Payer: Aetna Medicare |
$19.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.80
|
| Rate for Payer: BCBS Complete |
$10.46
|
| Rate for Payer: BCBS MAPPO |
$19.04
|
| Rate for Payer: BCBS Trust/PPO |
$20.30
|
| Rate for Payer: BCN Commercial |
$20.30
|
| Rate for Payer: BCN Medicare Advantage |
$19.04
|
| Rate for Payer: Cash Price |
$80.66
|
| Rate for Payer: Cash Price |
$80.66
|
| Rate for Payer: Cofinity Advantage |
$70.57
|
| Rate for Payer: Cofinity Commercial |
$86.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.04
|
| Rate for Payer: Healthscope Commercial |
$90.74
|
| Rate for Payer: Mclaren Medicaid |
$9.96
|
| Rate for Payer: Mclaren Medicare |
$19.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.99
|
| Rate for Payer: Meridian Medicaid |
$19.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.70
|
| Rate for Payer: Nomi Health Commercial |
$28.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.61
|
| Rate for Payer: PACE Medicare |
$18.09
|
| Rate for Payer: PACE SWMI |
$19.04
|
| Rate for Payer: PHP Commercial |
$85.70
|
| Rate for Payer: PHP Medicare Advantage |
$19.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19.04
|
| Rate for Payer: Priority Health Medicare |
$19.04
|
| Rate for Payer: Priority Health SBD |
$63.52
|
| Rate for Payer: Priority Health Tiered Network |
$15.23
|
| Rate for Payer: Railroad Medicare Medicare |
$19.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.56
|
| Rate for Payer: UHC Core |
$28.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19.04
|
| Rate for Payer: UHC Exchange |
$28.56
|
| Rate for Payer: UHC Medicaid |
$9.96
|
| Rate for Payer: UHCCP Medicaid |
$9.96
|
| Rate for Payer: VA VA |
$19.04
|
|
|
HC BDIAL FIBC
|
Facility
|
OP
|
$36.08
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
30500090
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$32.47 |
| Rate for Payer: Aetna Commercial |
$30.67
|
| Rate for Payer: Aetna Medicare |
$10.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.15
|
| Rate for Payer: BCBS Complete |
$5.34
|
| Rate for Payer: BCBS MAPPO |
$9.72
|
| Rate for Payer: BCBS Trust/PPO |
$10.36
|
| Rate for Payer: BCN Commercial |
$10.36
|
| Rate for Payer: BCN Medicare Advantage |
$9.72
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cofinity Advantage |
$25.26
|
| Rate for Payer: Cofinity Commercial |
$31.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.72
|
| Rate for Payer: Healthscope Commercial |
$32.47
|
| Rate for Payer: Mclaren Medicaid |
$5.08
|
| Rate for Payer: Mclaren Medicare |
$9.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.21
|
| Rate for Payer: Meridian Medicaid |
$10.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.67
|
| Rate for Payer: Nomi Health Commercial |
$14.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.06
|
| Rate for Payer: PACE Medicare |
$9.23
|
| Rate for Payer: PACE SWMI |
$9.72
|
| Rate for Payer: PHP Commercial |
$30.67
|
| Rate for Payer: PHP Medicare Advantage |
$9.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.72
|
| Rate for Payer: Priority Health Medicare |
$9.72
|
| Rate for Payer: Priority Health SBD |
$22.73
|
| Rate for Payer: Priority Health Tiered Network |
$7.78
|
| Rate for Payer: Railroad Medicare Medicare |
$9.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.58
|
| Rate for Payer: UHC Core |
$14.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9.72
|
| Rate for Payer: UHC Exchange |
$14.58
|
| Rate for Payer: UHC Medicaid |
$5.08
|
| Rate for Payer: UHCCP Medicaid |
$5.08
|
| Rate for Payer: VA VA |
$9.72
|
|
|
HC BDIAL FIBC
|
Facility
|
IP
|
$36.08
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
30500090
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$22.73 |
| Max. Negotiated Rate |
$32.47 |
| Rate for Payer: Aetna Commercial |
$30.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.45
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cofinity Advantage |
$25.26
|
| Rate for Payer: Cofinity Commercial |
$31.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.86
|
| Rate for Payer: Healthscope Commercial |
$32.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.06
|
| Rate for Payer: PHP Commercial |
$30.67
|
| Rate for Payer: Priority Health SBD |
$22.73
|
|
|
HC BDIAL FXIII
|
Facility
|
OP
|
$35.87
|
|
|
Service Code
|
CPT 85291
|
| Hospital Charge Code |
30500094
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$32.28 |
| Rate for Payer: Aetna Commercial |
$30.49
|
| Rate for Payer: Aetna Medicare |
$9.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.39
|
| Rate for Payer: BCBS Complete |
$5.00
|
| Rate for Payer: BCBS MAPPO |
$9.11
|
| Rate for Payer: BCBS Trust/PPO |
$9.71
|
| Rate for Payer: BCN Commercial |
$9.71
|
| Rate for Payer: BCN Medicare Advantage |
$9.11
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Advantage |
$25.11
|
| Rate for Payer: Cofinity Commercial |
$30.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.11
|
| Rate for Payer: Healthscope Commercial |
$32.28
|
| Rate for Payer: Mclaren Medicaid |
$4.76
|
| Rate for Payer: Mclaren Medicare |
$9.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.57
|
| Rate for Payer: Meridian Medicaid |
$9.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Nomi Health Commercial |
$13.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: PACE Medicare |
$8.65
|
| Rate for Payer: PACE SWMI |
$9.11
|
| Rate for Payer: PHP Commercial |
$30.49
|
| Rate for Payer: PHP Medicare Advantage |
$9.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.11
|
| Rate for Payer: Priority Health Medicare |
$9.11
|
| Rate for Payer: Priority Health SBD |
$22.60
|
| Rate for Payer: Priority Health Tiered Network |
$7.29
|
| Rate for Payer: Railroad Medicare Medicare |
$9.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.67
|
| Rate for Payer: UHC Core |
$13.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9.11
|
| Rate for Payer: UHC Exchange |
$13.67
|
| Rate for Payer: UHC Medicaid |
$4.76
|
| Rate for Payer: UHCCP Medicaid |
$4.76
|
| Rate for Payer: VA VA |
$9.11
|
|
|
HC BDIAL FXIII
|
Facility
|
IP
|
$35.87
|
|
|
Service Code
|
CPT 85291
|
| Hospital Charge Code |
30500094
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$22.60 |
| Max. Negotiated Rate |
$32.28 |
| Rate for Payer: Aetna Commercial |
$30.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.32
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Advantage |
$25.11
|
| Rate for Payer: Cofinity Commercial |
$30.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Healthscope Commercial |
$32.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: PHP Commercial |
$30.49
|
| Rate for Payer: Priority Health SBD |
$22.60
|
|
|
HC BDIAL PTIN
|
Facility
|
OP
|
$29.71
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
30500095
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$26.74 |
| Rate for Payer: Aetna Commercial |
$25.25
|
| Rate for Payer: Aetna Medicare |
$4.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.36
|
| Rate for Payer: BCBS Complete |
$2.36
|
| Rate for Payer: BCBS MAPPO |
$4.29
|
| Rate for Payer: BCBS Trust/PPO |
$4.58
|
| Rate for Payer: BCN Commercial |
$4.58
|
| Rate for Payer: BCN Medicare Advantage |
$4.29
|
| Rate for Payer: Cash Price |
$23.77
|
| Rate for Payer: Cash Price |
$23.77
|
| Rate for Payer: Cofinity Advantage |
$20.80
|
| Rate for Payer: Cofinity Commercial |
$25.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.29
|
| Rate for Payer: Healthscope Commercial |
$26.74
|
| Rate for Payer: Mclaren Medicaid |
$2.24
|
| Rate for Payer: Mclaren Medicare |
$4.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.50
|
| Rate for Payer: Meridian Medicaid |
$4.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.25
|
| Rate for Payer: Nomi Health Commercial |
$6.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.28
|
| Rate for Payer: PACE Medicare |
$4.08
|
| Rate for Payer: PACE SWMI |
$4.29
|
| Rate for Payer: PHP Commercial |
$25.25
|
| Rate for Payer: PHP Medicare Advantage |
$4.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.29
|
| Rate for Payer: Priority Health Medicare |
$4.29
|
| Rate for Payer: Priority Health SBD |
$18.72
|
| Rate for Payer: Priority Health Tiered Network |
$3.43
|
| Rate for Payer: Railroad Medicare Medicare |
$4.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.44
|
| Rate for Payer: UHC Core |
$6.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.29
|
| Rate for Payer: UHC Exchange |
$6.44
|
| Rate for Payer: UHC Medicaid |
$2.24
|
| Rate for Payer: UHCCP Medicaid |
$2.24
|
| Rate for Payer: VA VA |
$4.29
|
|
|
HC BDIAL PTIN
|
Facility
|
IP
|
$29.71
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
30500095
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$26.74 |
| Rate for Payer: Aetna Commercial |
$25.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.31
|
| Rate for Payer: Cash Price |
$23.77
|
| Rate for Payer: Cofinity Advantage |
$20.80
|
| Rate for Payer: Cofinity Commercial |
$25.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.77
|
| Rate for Payer: Healthscope Commercial |
$26.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.28
|
| Rate for Payer: PHP Commercial |
$25.25
|
| Rate for Payer: Priority Health SBD |
$18.72
|
|
|
HC BDIAL SFM
|
Facility
|
OP
|
$254.98
|
|
|
Service Code
|
CPT 85366
|
| Hospital Charge Code |
30500089
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$42.08 |
| Max. Negotiated Rate |
$229.48 |
| Rate for Payer: Aetna Commercial |
$216.73
|
| Rate for Payer: Aetna Medicare |
$83.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.58
|
| Rate for Payer: BCBS Complete |
$44.19
|
| Rate for Payer: BCBS MAPPO |
$80.46
|
| Rate for Payer: BCBS Trust/PPO |
$85.79
|
| Rate for Payer: BCN Commercial |
$85.79
|
| Rate for Payer: BCN Medicare Advantage |
$80.46
|
| Rate for Payer: Cash Price |
$203.98
|
| Rate for Payer: Cash Price |
$203.98
|
| Rate for Payer: Cofinity Advantage |
$178.49
|
| Rate for Payer: Cofinity Commercial |
$219.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.46
|
| Rate for Payer: Healthscope Commercial |
$229.48
|
| Rate for Payer: Mclaren Medicaid |
$42.08
|
| Rate for Payer: Mclaren Medicare |
$80.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.48
|
| Rate for Payer: Meridian Medicaid |
$84.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$88.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.73
|
| Rate for Payer: Nomi Health Commercial |
$120.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.24
|
| Rate for Payer: PACE Medicare |
$76.44
|
| Rate for Payer: PACE SWMI |
$80.46
|
| Rate for Payer: PHP Commercial |
$216.73
|
| Rate for Payer: PHP Medicare Advantage |
$80.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$80.46
|
| Rate for Payer: Priority Health Medicare |
$80.46
|
| Rate for Payer: Priority Health SBD |
$160.64
|
| Rate for Payer: Priority Health Tiered Network |
$64.37
|
| Rate for Payer: Railroad Medicare Medicare |
$80.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.69
|
| Rate for Payer: UHC Core |
$120.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$80.46
|
| Rate for Payer: UHC Exchange |
$120.69
|
| Rate for Payer: UHC Medicaid |
$42.08
|
| Rate for Payer: UHCCP Medicaid |
$42.08
|
| Rate for Payer: VA VA |
$80.46
|
|
|
HC BDIAL SFM
|
Facility
|
IP
|
$254.98
|
|
|
Service Code
|
CPT 85366
|
| Hospital Charge Code |
30500089
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$160.64 |
| Max. Negotiated Rate |
$229.48 |
| Rate for Payer: Aetna Commercial |
$216.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.74
|
| Rate for Payer: Cash Price |
$203.98
|
| Rate for Payer: Cofinity Advantage |
$178.49
|
| Rate for Payer: Cofinity Commercial |
$219.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.98
|
| Rate for Payer: Healthscope Commercial |
$229.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.24
|
| Rate for Payer: PHP Commercial |
$216.73
|
| Rate for Payer: Priority Health SBD |
$160.64
|
|
|
HC BDIAL TT
|
Facility
|
IP
|
$25.60
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
30500087
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.13 |
| Max. Negotiated Rate |
$23.04 |
| Rate for Payer: Aetna Commercial |
$21.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.64
|
| Rate for Payer: Cash Price |
$20.48
|
| Rate for Payer: Cofinity Advantage |
$17.92
|
| Rate for Payer: Cofinity Commercial |
$22.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.48
|
| Rate for Payer: Healthscope Commercial |
$23.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.20
|
| Rate for Payer: PHP Commercial |
$21.76
|
| Rate for Payer: Priority Health SBD |
$16.13
|
|
|
HC BDIAL TT
|
Facility
|
OP
|
$25.60
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
30500087
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$23.04 |
| Rate for Payer: Aetna Commercial |
$21.76
|
| Rate for Payer: Aetna Medicare |
$6.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.21
|
| Rate for Payer: BCBS Complete |
$3.17
|
| Rate for Payer: BCBS MAPPO |
$5.77
|
| Rate for Payer: BCBS Trust/PPO |
$6.16
|
| Rate for Payer: BCN Commercial |
$6.16
|
| Rate for Payer: BCN Medicare Advantage |
$5.77
|
| Rate for Payer: Cash Price |
$20.48
|
| Rate for Payer: Cash Price |
$20.48
|
| Rate for Payer: Cofinity Advantage |
$17.92
|
| Rate for Payer: Cofinity Commercial |
$22.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.77
|
| Rate for Payer: Healthscope Commercial |
$23.04
|
| Rate for Payer: Mclaren Medicaid |
$3.02
|
| Rate for Payer: Mclaren Medicare |
$5.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.06
|
| Rate for Payer: Meridian Medicaid |
$6.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.76
|
| Rate for Payer: Nomi Health Commercial |
$8.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.20
|
| Rate for Payer: PACE Medicare |
$5.48
|
| Rate for Payer: PACE SWMI |
$5.77
|
| Rate for Payer: PHP Commercial |
$21.76
|
| Rate for Payer: PHP Medicare Advantage |
$5.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.77
|
| Rate for Payer: Priority Health Medicare |
$5.77
|
| Rate for Payer: Priority Health SBD |
$16.13
|
| Rate for Payer: Priority Health Tiered Network |
$4.62
|
| Rate for Payer: Railroad Medicare Medicare |
$5.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.66
|
| Rate for Payer: UHC Core |
$8.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.77
|
| Rate for Payer: UHC Exchange |
$8.66
|
| Rate for Payer: UHC Medicaid |
$3.02
|
| Rate for Payer: UHCCP Medicaid |
$3.02
|
| Rate for Payer: VA VA |
$5.77
|
|
