|
HC FECAL LEUKOCYTE ASSESSMENT
|
Facility
|
OP
|
$52.80
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
30600110
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$47.52 |
| Rate for Payer: Aetna Commercial |
$44.88
|
| Rate for Payer: Aetna Medicare |
$4.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.34
|
| Rate for Payer: BCBS Complete |
$2.45
|
| Rate for Payer: BCBS MAPPO |
$4.27
|
| Rate for Payer: BCBS Trust/PPO |
$3.34
|
| Rate for Payer: BCN Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$42.24
|
| Rate for Payer: Cash Price |
$42.24
|
| Rate for Payer: Cofinity Commercial |
$45.41
|
| Rate for Payer: Cofinity Commercial |
$36.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.27
|
| Rate for Payer: Healthscope Commercial |
$47.52
|
| Rate for Payer: Mclaren Medicaid |
$2.34
|
| Rate for Payer: Mclaren Medicare |
$4.27
|
| Rate for Payer: Meridian Medicaid |
$2.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.88
|
| Rate for Payer: PACE Medicare |
$4.06
|
| Rate for Payer: PACE SWMI |
$4.27
|
| Rate for Payer: PHP Commercial |
$44.88
|
| Rate for Payer: PHP Medicare Advantage |
$4.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.96
|
| Rate for Payer: Priority Health Medicare |
$4.27
|
| Rate for Payer: Priority Health SBD |
$33.26
|
| Rate for Payer: Railroad Medicare Medicare |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.12
|
| Rate for Payer: UHC Core |
$7.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.27
|
| Rate for Payer: UHC Exchange |
$4.27
|
| Rate for Payer: UHC Medicare Advantage |
$4.40
|
| Rate for Payer: VA VA |
$4.27
|
|
|
HC FECAL LEUKOCYTE ASSESSMENT
|
Facility
|
IP
|
$52.80
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
30600110
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.26 |
| Max. Negotiated Rate |
$47.52 |
| Rate for Payer: Aetna Commercial |
$44.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.32
|
| Rate for Payer: Cash Price |
$42.24
|
| Rate for Payer: Cofinity Commercial |
$36.96
|
| Rate for Payer: Cofinity Commercial |
$45.41
|
| Rate for Payer: Healthscope Commercial |
$47.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.88
|
| Rate for Payer: PHP Commercial |
$44.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.96
|
| Rate for Payer: Priority Health SBD |
$33.26
|
|
|
HC FECAL MICROBIOTA INSTILLATION
|
Facility
|
OP
|
$1,281.69
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
36100568
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$364.26 |
| Max. Negotiated Rate |
$3,138.00 |
| Rate for Payer: Aetna Commercial |
$1,089.44
|
| Rate for Payer: Aetna Medicare |
$838.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$833.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,008.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,008.22
|
| Rate for Payer: BCBS Complete |
$463.30
|
| Rate for Payer: BCBS MAPPO |
$806.58
|
| Rate for Payer: BCBS Trust/PPO |
$364.26
|
| Rate for Payer: BCN Medicare Advantage |
$806.58
|
| Rate for Payer: Cash Price |
$1,025.35
|
| Rate for Payer: Cash Price |
$1,025.35
|
| Rate for Payer: Cofinity Commercial |
$1,102.25
|
| Rate for Payer: Cofinity Commercial |
$897.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$806.58
|
| Rate for Payer: Healthscope Commercial |
$1,153.52
|
| Rate for Payer: Mclaren Medicaid |
$441.20
|
| Rate for Payer: Mclaren Medicare |
$806.58
|
| Rate for Payer: Meridian Medicaid |
$463.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$927.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,089.44
|
| Rate for Payer: PACE Medicare |
$766.25
|
| Rate for Payer: PACE SWMI |
$806.58
|
| Rate for Payer: PHP Commercial |
$1,089.44
|
| Rate for Payer: PHP Medicare Advantage |
$806.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$441.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$897.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,519.41
|
| Rate for Payer: Priority Health Medicare |
$806.58
|
| Rate for Payer: Priority Health Narrow Network |
$2,015.53
|
| Rate for Payer: Priority Health SBD |
$807.46
|
| Rate for Payer: Railroad Medicare Medicare |
$806.58
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$806.58
|
| Rate for Payer: UHC Medicare Advantage |
$830.78
|
| Rate for Payer: VA VA |
$806.58
|
|
|
HC FECAL MICROBIOTA INSTILLATION
|
Facility
|
IP
|
$1,281.69
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
36100568
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$807.46 |
| Max. Negotiated Rate |
$1,153.52 |
| Rate for Payer: Aetna Commercial |
$1,089.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$833.10
|
| Rate for Payer: Cash Price |
$1,025.35
|
| Rate for Payer: Cofinity Commercial |
$1,102.25
|
| Rate for Payer: Cofinity Commercial |
$897.18
|
| Rate for Payer: Healthscope Commercial |
$1,153.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,089.44
|
| Rate for Payer: PHP Commercial |
$1,089.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$897.18
|
| Rate for Payer: Priority Health SBD |
$807.46
|
|
|
HC FECAL OCCULT BLOOD IMMUNOASSAY
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
CPT 82274
|
| Hospital Charge Code |
30100123
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna Medicare |
$16.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.90
|
| Rate for Payer: BCBS Complete |
$9.14
|
| Rate for Payer: BCBS MAPPO |
$15.92
|
| Rate for Payer: BCBS Trust/PPO |
$12.47
|
| Rate for Payer: BCN Medicare Advantage |
$15.92
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Cofinity Commercial |
$21.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.92
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Mclaren Medicaid |
$8.71
|
| Rate for Payer: Mclaren Medicare |
$15.92
|
| Rate for Payer: Meridian Medicaid |
$9.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.01
|
| Rate for Payer: PACE Medicare |
$15.12
|
| Rate for Payer: PACE SWMI |
$15.92
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: PHP Medicare Advantage |
$15.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.42
|
| Rate for Payer: Priority Health Medicare |
$15.92
|
| Rate for Payer: Priority Health SBD |
$19.28
|
| Rate for Payer: Railroad Medicare Medicare |
$15.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.10
|
| Rate for Payer: UHC Core |
$27.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.92
|
| Rate for Payer: UHC Exchange |
$15.92
|
| Rate for Payer: UHC Medicare Advantage |
$16.40
|
| Rate for Payer: VA VA |
$15.92
|
|
|
HC FECAL OCCULT BLOOD IMMUNOASSAY
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
CPT 82274
|
| Hospital Charge Code |
30100123
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.89
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$21.42
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.01
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.42
|
| Rate for Payer: Priority Health SBD |
$19.28
|
|
|
HC FECAL OCCULT BLOOD PEROXIDASE
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
30100121
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: Aetna Medicare |
$4.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.48
|
| Rate for Payer: BCBS Complete |
$2.52
|
| Rate for Payer: BCBS MAPPO |
$4.38
|
| Rate for Payer: BCBS Trust/PPO |
$3.44
|
| Rate for Payer: BCN Medicare Advantage |
$4.38
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.38
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Mclaren Medicaid |
$2.40
|
| Rate for Payer: Mclaren Medicare |
$4.38
|
| Rate for Payer: Meridian Medicaid |
$2.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: PACE Medicare |
$4.16
|
| Rate for Payer: PACE SWMI |
$4.38
|
| Rate for Payer: PHP Commercial |
$25.50
|
| Rate for Payer: PHP Medicare Advantage |
$4.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health Medicare |
$4.38
|
| Rate for Payer: Priority Health SBD |
$18.90
|
| Rate for Payer: Railroad Medicare Medicare |
$4.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.26
|
| Rate for Payer: UHC Core |
$5.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.38
|
| Rate for Payer: UHC Exchange |
$4.38
|
| Rate for Payer: UHC Medicare Advantage |
$4.51
|
| Rate for Payer: VA VA |
$4.38
|
|
|
HC FECAL OCCULT BLOOD PEROXIDASE
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
30100121
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.50
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: PHP Commercial |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health SBD |
$18.90
|
|
|
HC FECAL PH
|
Facility
|
IP
|
$23.46
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
30100491
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$21.11 |
| Rate for Payer: Aetna Commercial |
$19.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.25
|
| Rate for Payer: Cash Price |
$18.77
|
| Rate for Payer: Cofinity Commercial |
$20.18
|
| Rate for Payer: Cofinity Commercial |
$16.42
|
| Rate for Payer: Healthscope Commercial |
$21.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.94
|
| Rate for Payer: PHP Commercial |
$19.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.42
|
| Rate for Payer: Priority Health SBD |
$14.78
|
|
|
HC FECAL PH
|
Facility
|
OP
|
$23.46
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
30100491
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$21.11 |
| Rate for Payer: Aetna Commercial |
$19.94
|
| Rate for Payer: Aetna Medicare |
$3.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.48
|
| Rate for Payer: BCBS Complete |
$2.06
|
| Rate for Payer: BCBS MAPPO |
$3.58
|
| Rate for Payer: BCBS Trust/PPO |
$2.81
|
| Rate for Payer: BCN Medicare Advantage |
$3.58
|
| Rate for Payer: Cash Price |
$18.77
|
| Rate for Payer: Cash Price |
$18.77
|
| Rate for Payer: Cofinity Commercial |
$16.42
|
| Rate for Payer: Cofinity Commercial |
$20.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.58
|
| Rate for Payer: Healthscope Commercial |
$21.11
|
| Rate for Payer: Mclaren Medicaid |
$1.96
|
| Rate for Payer: Mclaren Medicare |
$3.58
|
| Rate for Payer: Meridian Medicaid |
$2.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.94
|
| Rate for Payer: PACE Medicare |
$3.40
|
| Rate for Payer: PACE SWMI |
$3.58
|
| Rate for Payer: PHP Commercial |
$19.94
|
| Rate for Payer: PHP Medicare Advantage |
$3.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.42
|
| Rate for Payer: Priority Health Medicare |
$3.58
|
| Rate for Payer: Priority Health SBD |
$14.78
|
| Rate for Payer: Railroad Medicare Medicare |
$3.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.30
|
| Rate for Payer: UHC Core |
$6.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.58
|
| Rate for Payer: UHC Exchange |
$3.58
|
| Rate for Payer: UHC Medicare Advantage |
$3.69
|
| Rate for Payer: VA VA |
$3.58
|
|
|
HC FECAL REDUCING SUBSTANCE
|
Facility
|
OP
|
$50.30
|
|
|
Service Code
|
CPT 84376
|
| Hospital Charge Code |
30100427
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$45.27 |
| Rate for Payer: Aetna Commercial |
$42.76
|
| Rate for Payer: Aetna Medicare |
$5.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.88
|
| Rate for Payer: BCBS Complete |
$3.16
|
| Rate for Payer: BCBS MAPPO |
$5.50
|
| Rate for Payer: BCBS Trust/PPO |
$4.31
|
| Rate for Payer: BCN Medicare Advantage |
$5.50
|
| Rate for Payer: Cash Price |
$40.24
|
| Rate for Payer: Cash Price |
$40.24
|
| Rate for Payer: Cofinity Commercial |
$43.26
|
| Rate for Payer: Cofinity Commercial |
$35.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.50
|
| Rate for Payer: Healthscope Commercial |
$45.27
|
| Rate for Payer: Mclaren Medicaid |
$3.01
|
| Rate for Payer: Mclaren Medicare |
$5.50
|
| Rate for Payer: Meridian Medicaid |
$3.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.76
|
| Rate for Payer: PACE Medicare |
$5.22
|
| Rate for Payer: PACE SWMI |
$5.50
|
| Rate for Payer: PHP Commercial |
$42.76
|
| Rate for Payer: PHP Medicare Advantage |
$5.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.21
|
| Rate for Payer: Priority Health Medicare |
$5.50
|
| Rate for Payer: Priority Health SBD |
$31.69
|
| Rate for Payer: Railroad Medicare Medicare |
$5.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.60
|
| Rate for Payer: UHC Core |
$9.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.50
|
| Rate for Payer: UHC Exchange |
$5.50
|
| Rate for Payer: UHC Medicare Advantage |
$5.66
|
| Rate for Payer: VA VA |
$5.50
|
|
|
HC FECAL REDUCING SUBSTANCE
|
Facility
|
IP
|
$50.30
|
|
|
Service Code
|
CPT 84376
|
| Hospital Charge Code |
30100427
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.69 |
| Max. Negotiated Rate |
$45.27 |
| Rate for Payer: Aetna Commercial |
$42.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.70
|
| Rate for Payer: Cash Price |
$40.24
|
| Rate for Payer: Cofinity Commercial |
$35.21
|
| Rate for Payer: Cofinity Commercial |
$43.26
|
| Rate for Payer: Healthscope Commercial |
$45.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.76
|
| Rate for Payer: PHP Commercial |
$42.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.21
|
| Rate for Payer: Priority Health SBD |
$31.69
|
|
|
HC FECAL WBC LACTOFERRIN
|
Facility
|
OP
|
$73.85
|
|
|
Service Code
|
CPT 83630
|
| Hospital Charge Code |
30100273
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$66.46 |
| Rate for Payer: Aetna Commercial |
$62.77
|
| Rate for Payer: Aetna Medicare |
$20.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.62
|
| Rate for Payer: BCBS Complete |
$11.32
|
| Rate for Payer: BCBS MAPPO |
$19.70
|
| Rate for Payer: BCBS Trust/PPO |
$15.43
|
| Rate for Payer: BCN Medicare Advantage |
$19.70
|
| Rate for Payer: Cash Price |
$59.08
|
| Rate for Payer: Cash Price |
$59.08
|
| Rate for Payer: Cofinity Commercial |
$51.70
|
| Rate for Payer: Cofinity Commercial |
$63.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.70
|
| Rate for Payer: Healthscope Commercial |
$66.46
|
| Rate for Payer: Mclaren Medicaid |
$10.78
|
| Rate for Payer: Mclaren Medicare |
$19.70
|
| Rate for Payer: Meridian Medicaid |
$11.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.77
|
| Rate for Payer: PACE Medicare |
$18.72
|
| Rate for Payer: PACE SWMI |
$19.70
|
| Rate for Payer: PHP Commercial |
$62.77
|
| Rate for Payer: PHP Medicare Advantage |
$19.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.70
|
| Rate for Payer: Priority Health Medicare |
$19.70
|
| Rate for Payer: Priority Health SBD |
$46.53
|
| Rate for Payer: Railroad Medicare Medicare |
$19.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.64
|
| Rate for Payer: UHC Core |
$33.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.70
|
| Rate for Payer: UHC Exchange |
$19.70
|
| Rate for Payer: UHC Medicare Advantage |
$20.29
|
| Rate for Payer: VA VA |
$19.70
|
|
|
HC FECAL WBC LACTOFERRIN
|
Facility
|
IP
|
$73.85
|
|
|
Service Code
|
CPT 83630
|
| Hospital Charge Code |
30100273
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.53 |
| Max. Negotiated Rate |
$66.46 |
| Rate for Payer: Aetna Commercial |
$62.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.00
|
| Rate for Payer: Cash Price |
$59.08
|
| Rate for Payer: Cofinity Commercial |
$51.70
|
| Rate for Payer: Cofinity Commercial |
$63.51
|
| Rate for Payer: Healthscope Commercial |
$66.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.77
|
| Rate for Payer: PHP Commercial |
$62.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.70
|
| Rate for Payer: Priority Health SBD |
$46.53
|
|
|
HC FELBAMATE (FELBATOL)
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100470
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: BCBS Complete |
$10.71
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$14.60
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$42.84
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Mclaren Medicaid |
$10.20
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Medicaid |
$10.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health SBD |
$38.56
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.37
|
| Rate for Payer: UHC Core |
$23.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Exchange |
$18.64
|
| Rate for Payer: UHC Medicare Advantage |
$19.20
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC FELBAMATE (FELBATOL)
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100470
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.56 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.78
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$42.84
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: Priority Health SBD |
$38.56
|
|
|
HC FEMOSTOP
|
Facility
|
IP
|
$470.40
|
|
| Hospital Charge Code |
62200003
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$296.35 |
| Max. Negotiated Rate |
$423.36 |
| Rate for Payer: Aetna Commercial |
$399.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.76
|
| Rate for Payer: Cash Price |
$376.32
|
| Rate for Payer: Cofinity Commercial |
$329.28
|
| Rate for Payer: Cofinity Commercial |
$404.54
|
| Rate for Payer: Healthscope Commercial |
$423.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$399.84
|
| Rate for Payer: PHP Commercial |
$399.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.28
|
| Rate for Payer: Priority Health SBD |
$296.35
|
|
|
HC FEMOSTOP
|
Facility
|
OP
|
$470.40
|
|
| Hospital Charge Code |
62200003
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$188.16 |
| Max. Negotiated Rate |
$423.36 |
| Rate for Payer: Aetna Commercial |
$399.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.76
|
| Rate for Payer: BCBS Complete |
$188.16
|
| Rate for Payer: Cash Price |
$376.32
|
| Rate for Payer: Cofinity Commercial |
$329.28
|
| Rate for Payer: Cofinity Commercial |
$404.54
|
| Rate for Payer: Healthscope Commercial |
$423.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$399.84
|
| Rate for Payer: PHP Commercial |
$399.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.28
|
| Rate for Payer: Priority Health SBD |
$296.35
|
|
|
HC FEMUR 1 VIEW
|
Facility
|
IP
|
$349.51
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
32000315
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$220.19 |
| Max. Negotiated Rate |
$314.56 |
| Rate for Payer: Aetna Commercial |
$297.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.18
|
| Rate for Payer: Cash Price |
$279.61
|
| Rate for Payer: Cofinity Commercial |
$244.66
|
| Rate for Payer: Cofinity Commercial |
$300.58
|
| Rate for Payer: Healthscope Commercial |
$314.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.08
|
| Rate for Payer: PHP Commercial |
$297.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.66
|
| Rate for Payer: Priority Health SBD |
$220.19
|
|
|
HC FEMUR 1 VIEW
|
Facility
|
OP
|
$349.51
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
32000315
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.81 |
| Max. Negotiated Rate |
$314.56 |
| Rate for Payer: Aetna Commercial |
$297.08
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.08
|
| Rate for Payer: BCBS Complete |
$46.45
|
| Rate for Payer: BCBS MAPPO |
$80.86
|
| Rate for Payer: BCBS Trust/PPO |
$35.30
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$279.61
|
| Rate for Payer: Cash Price |
$279.61
|
| Rate for Payer: Cofinity Commercial |
$300.58
|
| Rate for Payer: Cofinity Commercial |
$244.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$314.56
|
| Rate for Payer: Mclaren Medicaid |
$44.23
|
| Rate for Payer: Mclaren Medicare |
$80.86
|
| Rate for Payer: Meridian Medicaid |
$46.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.08
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$297.08
|
| Rate for Payer: PHP Medicare Advantage |
$80.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$260.51
|
| Rate for Payer: Priority Health Medicare |
$80.86
|
| Rate for Payer: Priority Health Narrow Network |
$208.41
|
| Rate for Payer: Priority Health SBD |
$220.19
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$28.81
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC FEMUR 2 VIEWS
|
Facility
|
IP
|
$349.51
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
32000316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$220.19 |
| Max. Negotiated Rate |
$314.56 |
| Rate for Payer: Aetna Commercial |
$297.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.18
|
| Rate for Payer: Cash Price |
$279.61
|
| Rate for Payer: Cofinity Commercial |
$244.66
|
| Rate for Payer: Cofinity Commercial |
$300.58
|
| Rate for Payer: Healthscope Commercial |
$314.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.08
|
| Rate for Payer: PHP Commercial |
$297.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.66
|
| Rate for Payer: Priority Health SBD |
$220.19
|
|
|
HC FEMUR 2 VIEWS
|
Facility
|
OP
|
$349.51
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
32000316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.04 |
| Max. Negotiated Rate |
$314.56 |
| Rate for Payer: Aetna Commercial |
$297.08
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.08
|
| Rate for Payer: BCBS Complete |
$46.45
|
| Rate for Payer: BCBS MAPPO |
$80.86
|
| Rate for Payer: BCBS Trust/PPO |
$44.68
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$279.61
|
| Rate for Payer: Cash Price |
$279.61
|
| Rate for Payer: Cofinity Commercial |
$300.58
|
| Rate for Payer: Cofinity Commercial |
$244.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$314.56
|
| Rate for Payer: Mclaren Medicaid |
$44.23
|
| Rate for Payer: Mclaren Medicare |
$80.86
|
| Rate for Payer: Meridian Medicaid |
$46.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.08
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$297.08
|
| Rate for Payer: PHP Medicare Advantage |
$80.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$260.51
|
| Rate for Payer: Priority Health Medicare |
$80.86
|
| Rate for Payer: Priority Health Narrow Network |
$208.41
|
| Rate for Payer: Priority Health SBD |
$220.19
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$35.04
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC FENTANYL SERUM LVL
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
30100564
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.32 |
| Max. Negotiated Rate |
$179.10 |
| Rate for Payer: Aetna Commercial |
$169.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.35
|
| Rate for Payer: BCBS Complete |
$79.60
|
| Rate for Payer: Cash Price |
$159.20
|
| Rate for Payer: Cash Price |
$159.20
|
| Rate for Payer: Cofinity Commercial |
$171.14
|
| Rate for Payer: Cofinity Commercial |
$139.30
|
| Rate for Payer: Healthscope Commercial |
$179.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.15
|
| Rate for Payer: PHP Commercial |
$169.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.30
|
| Rate for Payer: Priority Health SBD |
$125.37
|
| Rate for Payer: UHC Core |
$29.32
|
|
|
HC FENTANYL SERUM LVL
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
30100564
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$125.37 |
| Max. Negotiated Rate |
$179.10 |
| Rate for Payer: Aetna Commercial |
$169.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.35
|
| Rate for Payer: Cash Price |
$159.20
|
| Rate for Payer: Cofinity Commercial |
$139.30
|
| Rate for Payer: Cofinity Commercial |
$171.14
|
| Rate for Payer: Healthscope Commercial |
$179.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.15
|
| Rate for Payer: PHP Commercial |
$169.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.30
|
| Rate for Payer: Priority Health SBD |
$125.37
|
|
|
HC FENTANYL UR
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
30100609
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$144.90 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna Commercial |
$195.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.50
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cofinity Commercial |
$197.80
|
| Rate for Payer: Cofinity Commercial |
$161.00
|
| Rate for Payer: Healthscope Commercial |
$207.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$195.50
|
| Rate for Payer: PHP Commercial |
$195.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.00
|
| Rate for Payer: Priority Health SBD |
$144.90
|
|
