|
HC ESTROGEN RECEPTOR
|
Facility
|
IP
|
$115.87
|
|
|
Service Code
|
CPT 84233
|
| Hospital Charge Code |
30100416
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.00 |
| Max. Negotiated Rate |
$104.28 |
| Rate for Payer: Aetna Commercial |
$98.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.32
|
| Rate for Payer: Cash Price |
$92.70
|
| Rate for Payer: Cofinity Commercial |
$81.11
|
| Rate for Payer: Cofinity Commercial |
$99.65
|
| Rate for Payer: Healthscope Commercial |
$104.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.49
|
| Rate for Payer: PHP Commercial |
$98.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.11
|
| Rate for Payer: Priority Health SBD |
$73.00
|
|
|
HC ESTROGEN RECEPTOR
|
Facility
|
OP
|
$115.87
|
|
|
Service Code
|
CPT 84233
|
| Hospital Charge Code |
30100416
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.07 |
| Max. Negotiated Rate |
$109.85 |
| Rate for Payer: Aetna Commercial |
$98.49
|
| Rate for Payer: Aetna Medicare |
$91.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$109.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$109.85
|
| Rate for Payer: BCBS Complete |
$50.48
|
| Rate for Payer: BCBS MAPPO |
$87.88
|
| Rate for Payer: BCBS Trust/PPO |
$68.82
|
| Rate for Payer: BCN Medicare Advantage |
$87.88
|
| Rate for Payer: Cash Price |
$92.70
|
| Rate for Payer: Cash Price |
$92.70
|
| Rate for Payer: Cofinity Commercial |
$99.65
|
| Rate for Payer: Cofinity Commercial |
$81.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.88
|
| Rate for Payer: Healthscope Commercial |
$104.28
|
| Rate for Payer: Mclaren Medicaid |
$48.07
|
| Rate for Payer: Mclaren Medicare |
$87.88
|
| Rate for Payer: Meridian Medicaid |
$50.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$92.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.49
|
| Rate for Payer: PACE Medicare |
$83.49
|
| Rate for Payer: PACE SWMI |
$87.88
|
| Rate for Payer: PHP Commercial |
$98.49
|
| Rate for Payer: PHP Medicare Advantage |
$87.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.11
|
| Rate for Payer: Priority Health Medicare |
$87.88
|
| Rate for Payer: Priority Health SBD |
$73.00
|
| Rate for Payer: Railroad Medicare Medicare |
$87.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.46
|
| Rate for Payer: UHC Core |
$109.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.88
|
| Rate for Payer: UHC Exchange |
$87.88
|
| Rate for Payer: UHC Medicare Advantage |
$90.52
|
| Rate for Payer: VA VA |
$87.88
|
|
|
HC ESTROGEN RECEPTOR-PROGESTERONE
|
Facility
|
OP
|
$116.69
|
|
|
Service Code
|
CPT 84234
|
| Hospital Charge Code |
30100417
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.49 |
| Max. Negotiated Rate |
$110.27 |
| Rate for Payer: Aetna Commercial |
$99.19
|
| Rate for Payer: Aetna Medicare |
$67.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.10
|
| Rate for Payer: BCBS Complete |
$37.27
|
| Rate for Payer: BCBS MAPPO |
$64.88
|
| Rate for Payer: BCBS Trust/PPO |
$50.81
|
| Rate for Payer: BCN Medicare Advantage |
$64.88
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Cofinity Commercial |
$81.68
|
| Rate for Payer: Cofinity Commercial |
$100.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.88
|
| Rate for Payer: Healthscope Commercial |
$105.02
|
| Rate for Payer: Mclaren Medicaid |
$35.49
|
| Rate for Payer: Mclaren Medicare |
$64.88
|
| Rate for Payer: Meridian Medicaid |
$37.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$68.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.19
|
| Rate for Payer: PACE Medicare |
$61.64
|
| Rate for Payer: PACE SWMI |
$64.88
|
| Rate for Payer: PHP Commercial |
$99.19
|
| Rate for Payer: PHP Medicare Advantage |
$64.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.68
|
| Rate for Payer: Priority Health Medicare |
$64.88
|
| Rate for Payer: Priority Health SBD |
$73.51
|
| Rate for Payer: Railroad Medicare Medicare |
$64.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.86
|
| Rate for Payer: UHC Core |
$110.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.88
|
| Rate for Payer: UHC Exchange |
$64.88
|
| Rate for Payer: UHC Medicare Advantage |
$66.83
|
| Rate for Payer: VA VA |
$64.88
|
|
|
HC ESTROGEN RECEPTOR-PROGESTERONE
|
Facility
|
IP
|
$116.69
|
|
|
Service Code
|
CPT 84234
|
| Hospital Charge Code |
30100417
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.51 |
| Max. Negotiated Rate |
$105.02 |
| Rate for Payer: Aetna Commercial |
$99.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.85
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Cofinity Commercial |
$81.68
|
| Rate for Payer: Cofinity Commercial |
$100.35
|
| Rate for Payer: Healthscope Commercial |
$105.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.19
|
| Rate for Payer: PHP Commercial |
$99.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.68
|
| Rate for Payer: Priority Health SBD |
$73.51
|
|
|
HC ESTRONE
|
Facility
|
OP
|
$65.28
|
|
|
Service Code
|
CPT 82679
|
| Hospital Charge Code |
30100196
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$58.75 |
| Rate for Payer: Aetna Commercial |
$55.49
|
| Rate for Payer: Aetna Medicare |
$25.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.19
|
| Rate for Payer: BCBS Complete |
$14.33
|
| Rate for Payer: BCBS MAPPO |
$24.95
|
| Rate for Payer: BCBS Trust/PPO |
$19.54
|
| Rate for Payer: BCN Medicare Advantage |
$24.95
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$56.14
|
| Rate for Payer: Cofinity Commercial |
$45.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.95
|
| Rate for Payer: Healthscope Commercial |
$58.75
|
| Rate for Payer: Mclaren Medicaid |
$13.65
|
| Rate for Payer: Mclaren Medicare |
$24.95
|
| Rate for Payer: Meridian Medicaid |
$14.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.49
|
| Rate for Payer: PACE Medicare |
$23.70
|
| Rate for Payer: PACE SWMI |
$24.95
|
| Rate for Payer: PHP Commercial |
$55.49
|
| Rate for Payer: PHP Medicare Advantage |
$24.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.70
|
| Rate for Payer: Priority Health Medicare |
$24.95
|
| Rate for Payer: Priority Health SBD |
$41.13
|
| Rate for Payer: Railroad Medicare Medicare |
$24.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.94
|
| Rate for Payer: UHC Core |
$42.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.95
|
| Rate for Payer: UHC Exchange |
$24.95
|
| Rate for Payer: UHC Medicare Advantage |
$25.70
|
| Rate for Payer: VA VA |
$24.95
|
|
|
HC ESTRONE
|
Facility
|
IP
|
$65.28
|
|
|
Service Code
|
CPT 82679
|
| Hospital Charge Code |
30100196
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.13 |
| Max. Negotiated Rate |
$58.75 |
| Rate for Payer: Aetna Commercial |
$55.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.43
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$56.14
|
| Rate for Payer: Healthscope Commercial |
$58.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.49
|
| Rate for Payer: PHP Commercial |
$55.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.70
|
| Rate for Payer: Priority Health SBD |
$41.13
|
|
|
HC ETHANOL CONFIRM URINE
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100614
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.22 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.50
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$105.00
|
| Rate for Payer: Cofinity Commercial |
$129.00
|
| Rate for Payer: Healthscope Commercial |
$135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.50
|
| Rate for Payer: PHP Commercial |
$127.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health SBD |
$94.50
|
| Rate for Payer: UHC Core |
$28.22
|
|
|
HC ETHANOL CONFIRM URINE
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100614
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.50
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$105.00
|
| Rate for Payer: Cofinity Commercial |
$129.00
|
| Rate for Payer: Healthscope Commercial |
$135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.50
|
| Rate for Payer: PHP Commercial |
$127.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health SBD |
$94.50
|
|
|
HC ETHOSUXIMIDE/ZARONTIN LEVEL
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 80168
|
| Hospital Charge Code |
30100029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna Commercial |
$47.60
|
| Rate for Payer: Aetna Medicare |
$16.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.42
|
| Rate for Payer: BCBS Complete |
$9.39
|
| Rate for Payer: BCBS MAPPO |
$16.34
|
| Rate for Payer: BCBS Trust/PPO |
$12.80
|
| Rate for Payer: BCN Medicare Advantage |
$16.34
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$48.16
|
| Rate for Payer: Cofinity Commercial |
$39.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.34
|
| Rate for Payer: Healthscope Commercial |
$50.40
|
| Rate for Payer: Mclaren Medicaid |
$8.94
|
| Rate for Payer: Mclaren Medicare |
$16.34
|
| Rate for Payer: Meridian Medicaid |
$9.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.60
|
| Rate for Payer: PACE Medicare |
$15.52
|
| Rate for Payer: PACE SWMI |
$16.34
|
| Rate for Payer: PHP Commercial |
$47.60
|
| Rate for Payer: PHP Medicare Advantage |
$16.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.20
|
| Rate for Payer: Priority Health Medicare |
$16.34
|
| Rate for Payer: Priority Health SBD |
$35.28
|
| Rate for Payer: Railroad Medicare Medicare |
$16.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.61
|
| Rate for Payer: UHC Core |
$27.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.34
|
| Rate for Payer: UHC Exchange |
$16.34
|
| Rate for Payer: UHC Medicare Advantage |
$16.83
|
| Rate for Payer: VA VA |
$16.34
|
|
|
HC ETHOSUXIMIDE/ZARONTIN LEVEL
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 80168
|
| Hospital Charge Code |
30100029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna Commercial |
$47.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.40
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$39.20
|
| Rate for Payer: Cofinity Commercial |
$48.16
|
| Rate for Payer: Healthscope Commercial |
$50.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.60
|
| Rate for Payer: PHP Commercial |
$47.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.20
|
| Rate for Payer: Priority Health SBD |
$35.28
|
|
|
HC ETHYLENE GLYCOL
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
CPT 82693
|
| Hospital Charge Code |
30100197
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$101.43 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna Commercial |
$136.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.65
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$112.70
|
| Rate for Payer: Cofinity Commercial |
$138.46
|
| Rate for Payer: Healthscope Commercial |
$144.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$136.85
|
| Rate for Payer: PHP Commercial |
$136.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.70
|
| Rate for Payer: Priority Health SBD |
$101.43
|
|
|
HC ETHYLENE GLYCOL
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
CPT 82693
|
| Hospital Charge Code |
30100197
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.15 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna Commercial |
$136.85
|
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.62
|
| Rate for Payer: BCBS Complete |
$8.56
|
| Rate for Payer: BCBS MAPPO |
$14.90
|
| Rate for Payer: BCBS Trust/PPO |
$11.67
|
| Rate for Payer: BCN Medicare Advantage |
$14.90
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$138.46
|
| Rate for Payer: Cofinity Commercial |
$112.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.90
|
| Rate for Payer: Healthscope Commercial |
$144.90
|
| Rate for Payer: Mclaren Medicaid |
$8.15
|
| Rate for Payer: Mclaren Medicare |
$14.90
|
| Rate for Payer: Meridian Medicaid |
$8.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$136.85
|
| Rate for Payer: PACE Medicare |
$14.16
|
| Rate for Payer: PACE SWMI |
$14.90
|
| Rate for Payer: PHP Commercial |
$136.85
|
| Rate for Payer: PHP Medicare Advantage |
$14.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.70
|
| Rate for Payer: Priority Health Medicare |
$14.90
|
| Rate for Payer: Priority Health SBD |
$101.43
|
| Rate for Payer: Railroad Medicare Medicare |
$14.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.88
|
| Rate for Payer: UHC Core |
$25.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.90
|
| Rate for Payer: UHC Exchange |
$14.90
|
| Rate for Payer: UHC Medicare Advantage |
$15.35
|
| Rate for Payer: VA VA |
$14.90
|
|
|
HC ETHYL GLUCURONIDE SCREEN W/REFLEX, URINE
|
Facility
|
IP
|
$125.90
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100749
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$79.32 |
| Max. Negotiated Rate |
$113.31 |
| Rate for Payer: Aetna Commercial |
$107.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.84
|
| Rate for Payer: Cash Price |
$100.72
|
| Rate for Payer: Cofinity Commercial |
$108.27
|
| Rate for Payer: Cofinity Commercial |
$88.13
|
| Rate for Payer: Healthscope Commercial |
$113.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.02
|
| Rate for Payer: PHP Commercial |
$107.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.13
|
| Rate for Payer: Priority Health SBD |
$79.32
|
|
|
HC ETHYL GLUCURONIDE SCREEN W/REFLEX, URINE
|
Facility
|
OP
|
$125.90
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100749
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$113.31 |
| Rate for Payer: Aetna Commercial |
$107.02
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.84
|
| 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 |
$100.72
|
| Rate for Payer: Cash Price |
$100.72
|
| Rate for Payer: Cofinity Commercial |
$108.27
|
| Rate for Payer: Cofinity Commercial |
$88.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$113.31
|
| 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 |
$107.02
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$107.02
|
| 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 |
$88.13
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$79.32
|
| 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 ETONOGESTREL IMPLANT SYSTEM
|
Facility
|
OP
|
$1,516.09
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
63600148
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$606.44 |
| Max. Negotiated Rate |
$3,218.85 |
| Rate for Payer: Aetna Commercial |
$1,288.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$985.46
|
| Rate for Payer: BCBS Complete |
$606.44
|
| Rate for Payer: BCBS Trust/PPO |
$3,218.85
|
| Rate for Payer: Cash Price |
$1,212.87
|
| Rate for Payer: Cash Price |
$1,212.87
|
| Rate for Payer: Cofinity Commercial |
$1,303.84
|
| Rate for Payer: Cofinity Commercial |
$1,061.26
|
| Rate for Payer: Healthscope Commercial |
$1,364.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,288.68
|
| Rate for Payer: PHP Commercial |
$1,288.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,061.26
|
| Rate for Payer: Priority Health SBD |
$955.14
|
|
|
HC ETONOGESTREL IMPLANT SYSTEM
|
Facility
|
IP
|
$1,516.09
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
63600148
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$955.14 |
| Max. Negotiated Rate |
$1,364.48 |
| Rate for Payer: Aetna Commercial |
$1,288.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$985.46
|
| Rate for Payer: Cash Price |
$1,212.87
|
| Rate for Payer: Cofinity Commercial |
$1,061.26
|
| Rate for Payer: Cofinity Commercial |
$1,303.84
|
| Rate for Payer: Healthscope Commercial |
$1,364.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,288.68
|
| Rate for Payer: PHP Commercial |
$1,288.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,061.26
|
| Rate for Payer: Priority Health SBD |
$955.14
|
|
|
HC EUFLEXXA INJ PER DOSE
|
Facility
|
IP
|
$295.09
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
63600145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$185.91 |
| Max. Negotiated Rate |
$265.58 |
| Rate for Payer: Aetna Commercial |
$250.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.81
|
| Rate for Payer: Cash Price |
$236.07
|
| Rate for Payer: Cofinity Commercial |
$253.78
|
| Rate for Payer: Cofinity Commercial |
$206.56
|
| Rate for Payer: Healthscope Commercial |
$265.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$250.83
|
| Rate for Payer: PHP Commercial |
$250.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.56
|
| Rate for Payer: Priority Health SBD |
$185.91
|
|
|
HC EUFLEXXA INJ PER DOSE
|
Facility
|
OP
|
$295.09
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
63600145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.63 |
| Max. Negotiated Rate |
$376.87 |
| Rate for Payer: Aetna Commercial |
$250.83
|
| Rate for Payer: Aetna Medicare |
$132.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$159.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$159.12
|
| Rate for Payer: BCBS Complete |
$73.12
|
| Rate for Payer: BCBS MAPPO |
$127.30
|
| Rate for Payer: BCBS Trust/PPO |
$376.87
|
| Rate for Payer: BCN Medicare Advantage |
$127.30
|
| Rate for Payer: Cash Price |
$236.07
|
| Rate for Payer: Cash Price |
$236.07
|
| Rate for Payer: Cofinity Commercial |
$206.56
|
| Rate for Payer: Cofinity Commercial |
$253.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.30
|
| Rate for Payer: Healthscope Commercial |
$265.58
|
| Rate for Payer: Mclaren Medicaid |
$69.63
|
| Rate for Payer: Mclaren Medicare |
$127.30
|
| Rate for Payer: Meridian Medicaid |
$73.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$133.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$250.83
|
| Rate for Payer: PACE Medicare |
$120.94
|
| Rate for Payer: PACE SWMI |
$127.30
|
| Rate for Payer: PHP Commercial |
$250.83
|
| Rate for Payer: PHP Medicare Advantage |
$127.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.56
|
| Rate for Payer: Priority Health Medicare |
$127.30
|
| Rate for Payer: Priority Health SBD |
$185.91
|
| Rate for Payer: Railroad Medicare Medicare |
$127.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.30
|
| Rate for Payer: UHC Medicare Advantage |
$131.12
|
| Rate for Payer: VA VA |
$127.30
|
|
|
HC EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
OP
|
$90.38
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
76100113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.76 |
| Max. Negotiated Rate |
$351.10 |
| Rate for Payer: Aetna Commercial |
$76.82
|
| Rate for Payer: Aetna Medicare |
$118.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$142.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$142.08
|
| Rate for Payer: BCBS Complete |
$65.29
|
| Rate for Payer: BCBS MAPPO |
$113.66
|
| Rate for Payer: BCBS Trust/PPO |
$53.40
|
| Rate for Payer: BCN Medicare Advantage |
$113.66
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cofinity Commercial |
$63.27
|
| Rate for Payer: Cofinity Commercial |
$77.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.66
|
| Rate for Payer: Healthscope Commercial |
$81.34
|
| Rate for Payer: Mclaren Medicaid |
$62.17
|
| Rate for Payer: Mclaren Medicare |
$113.66
|
| Rate for Payer: Meridian Medicaid |
$65.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.82
|
| Rate for Payer: PACE Medicare |
$107.98
|
| Rate for Payer: PACE SWMI |
$113.66
|
| Rate for Payer: PHP Commercial |
$76.82
|
| Rate for Payer: PHP Medicare Advantage |
$113.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$351.10
|
| Rate for Payer: Priority Health Medicare |
$113.66
|
| Rate for Payer: Priority Health Narrow Network |
$280.88
|
| Rate for Payer: Priority Health SBD |
$56.94
|
| Rate for Payer: Railroad Medicare Medicare |
$113.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.66
|
| Rate for Payer: UHC Exchange |
$31.76
|
| Rate for Payer: UHC Medicare Advantage |
$117.07
|
| Rate for Payer: VA VA |
$113.66
|
|
|
HC EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
IP
|
$90.38
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
76100113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$56.94 |
| Max. Negotiated Rate |
$81.34 |
| Rate for Payer: Aetna Commercial |
$76.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.75
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cofinity Commercial |
$63.27
|
| Rate for Payer: Cofinity Commercial |
$77.73
|
| Rate for Payer: Healthscope Commercial |
$81.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.82
|
| Rate for Payer: PHP Commercial |
$76.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.27
|
| Rate for Payer: Priority Health SBD |
$56.94
|
|
|
HC EVAL APHASIA PER HR
|
Facility
|
OP
|
$256.60
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
44400013
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$94.30 |
| Max. Negotiated Rate |
$230.94 |
| Rate for Payer: Aetna Commercial |
$218.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.79
|
| Rate for Payer: BCBS Complete |
$102.64
|
| Rate for Payer: BCBS Trust/PPO |
$97.00
|
| Rate for Payer: Cash Price |
$205.28
|
| Rate for Payer: Cash Price |
$205.28
|
| Rate for Payer: Cofinity Commercial |
$220.68
|
| Rate for Payer: Cofinity Commercial |
$179.62
|
| Rate for Payer: Healthscope Commercial |
$230.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$218.11
|
| Rate for Payer: PHP Commercial |
$218.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.62
|
| Rate for Payer: Priority Health SBD |
$161.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.73
|
| Rate for Payer: UHC Exchange |
$94.30
|
|
|
HC EVAL APHASIA PER HR
|
Facility
|
IP
|
$256.60
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
44400013
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$161.66 |
| Max. Negotiated Rate |
$230.94 |
| Rate for Payer: Aetna Commercial |
$218.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.79
|
| Rate for Payer: Cash Price |
$205.28
|
| Rate for Payer: Cofinity Commercial |
$179.62
|
| Rate for Payer: Cofinity Commercial |
$220.68
|
| Rate for Payer: Healthscope Commercial |
$230.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$218.11
|
| Rate for Payer: PHP Commercial |
$218.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.62
|
| Rate for Payer: Priority Health SBD |
$161.66
|
|
|
HC EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
CPT 92621
|
| Hospital Charge Code |
76100496
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Aetna Commercial |
$33.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.35
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$27.30
|
| Rate for Payer: Cofinity Commercial |
$33.54
|
| Rate for Payer: Healthscope Commercial |
$35.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.15
|
| Rate for Payer: PHP Commercial |
$33.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health SBD |
$24.57
|
|
|
HC EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 92621
|
| Hospital Charge Code |
76100496
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Aetna Commercial |
$33.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.35
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$33.54
|
| Rate for Payer: Cofinity Commercial |
$27.30
|
| Rate for Payer: Healthscope Commercial |
$35.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.15
|
| Rate for Payer: PHP Commercial |
$33.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health SBD |
$24.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.81
|
| Rate for Payer: UHC Exchange |
$18.01
|
|
|
HC EVAL ORAL SPEECH ADDL 30 MIN
|
Facility
|
IP
|
$114.40
|
|
|
Service Code
|
CPT 92608
|
| Hospital Charge Code |
44400015
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$72.07 |
| Max. Negotiated Rate |
$102.96 |
| Rate for Payer: Aetna Commercial |
$97.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.36
|
| Rate for Payer: Cash Price |
$91.52
|
| Rate for Payer: Cofinity Commercial |
$80.08
|
| Rate for Payer: Cofinity Commercial |
$98.38
|
| Rate for Payer: Healthscope Commercial |
$102.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.24
|
| Rate for Payer: PHP Commercial |
$97.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.08
|
| Rate for Payer: Priority Health SBD |
$72.07
|
|
