|
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
|
|
|
HC FENTANYL URINE.
|
Facility
|
OP
|
$95.40
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000152
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$95.77 |
| Rate for Payer: Aetna Commercial |
$81.09
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.01
|
| 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 |
$76.32
|
| Rate for Payer: Cash Price |
$76.32
|
| Rate for Payer: Cofinity Commercial |
$66.78
|
| Rate for Payer: Cofinity Commercial |
$82.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$85.86
|
| 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 |
$81.09
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$81.09
|
| 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 |
$66.78
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$60.10
|
| 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 FENTANYL URINE.
|
Facility
|
IP
|
$95.40
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000152
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.10 |
| Max. Negotiated Rate |
$85.86 |
| Rate for Payer: Aetna Commercial |
$81.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.01
|
| Rate for Payer: Cash Price |
$76.32
|
| Rate for Payer: Cofinity Commercial |
$66.78
|
| Rate for Payer: Cofinity Commercial |
$82.04
|
| Rate for Payer: Healthscope Commercial |
$85.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.09
|
| Rate for Payer: PHP Commercial |
$81.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.78
|
| Rate for Payer: Priority Health SBD |
$60.10
|
|
|
HC FERRITIN LEVEL
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
30100202
|
|
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 |
$52.63
|
| Rate for Payer: Cofinity Commercial |
$42.84
|
| 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 FERRITIN LEVEL
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
30100202
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.46 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna Medicare |
$14.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.04
|
| Rate for Payer: BCBS Complete |
$7.83
|
| Rate for Payer: BCBS MAPPO |
$13.63
|
| Rate for Payer: BCBS Trust/PPO |
$10.67
|
| Rate for Payer: BCN Medicare Advantage |
$13.63
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Cofinity Commercial |
$42.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.63
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Mclaren Medicaid |
$7.46
|
| Rate for Payer: Mclaren Medicare |
$13.63
|
| Rate for Payer: Meridian Medicaid |
$7.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: PACE Medicare |
$12.95
|
| Rate for Payer: PACE SWMI |
$13.63
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: PHP Medicare Advantage |
$13.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: Priority Health Medicare |
$13.63
|
| Rate for Payer: Priority Health SBD |
$38.56
|
| Rate for Payer: Railroad Medicare Medicare |
$13.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.36
|
| Rate for Payer: UHC Core |
$23.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.63
|
| Rate for Payer: UHC Exchange |
$13.63
|
| Rate for Payer: UHC Medicare Advantage |
$14.04
|
| Rate for Payer: VA VA |
$13.63
|
|
|
HC FETAL BIOPHYSICAL PROFILE
|
Facility
|
IP
|
$334.56
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
40200080
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$210.77 |
| Max. Negotiated Rate |
$301.10 |
| Rate for Payer: Aetna Commercial |
$284.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.46
|
| Rate for Payer: Cash Price |
$267.65
|
| Rate for Payer: Cofinity Commercial |
$234.19
|
| Rate for Payer: Cofinity Commercial |
$287.72
|
| Rate for Payer: Healthscope Commercial |
$301.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$284.38
|
| Rate for Payer: PHP Commercial |
$284.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.19
|
| Rate for Payer: Priority Health SBD |
$210.77
|
|
|
HC FETAL BIOPHYSICAL PROFILE
|
Facility
|
OP
|
$334.56
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
40200080
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$338.98 |
| Rate for Payer: Aetna Commercial |
$284.38
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$110.32
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$267.65
|
| Rate for Payer: Cash Price |
$267.65
|
| Rate for Payer: Cofinity Commercial |
$287.72
|
| Rate for Payer: Cofinity Commercial |
$234.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$301.10
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$284.38
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$284.38
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.98
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$271.18
|
| Rate for Payer: Priority Health SBD |
$210.77
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$116.57
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC FETAL FIBRONECTIN
|
Facility
|
IP
|
$426.70
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
30100203
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$268.82 |
| Max. Negotiated Rate |
$384.03 |
| Rate for Payer: Aetna Commercial |
$362.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.36
|
| Rate for Payer: Cash Price |
$341.36
|
| Rate for Payer: Cofinity Commercial |
$298.69
|
| Rate for Payer: Cofinity Commercial |
$366.96
|
| Rate for Payer: Healthscope Commercial |
$384.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$362.70
|
| Rate for Payer: PHP Commercial |
$362.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.69
|
| Rate for Payer: Priority Health SBD |
$268.82
|
|
|
HC FETAL FIBRONECTIN
|
Facility
|
OP
|
$426.70
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
30100203
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.23 |
| Max. Negotiated Rate |
$384.03 |
| Rate for Payer: Aetna Commercial |
$362.70
|
| Rate for Payer: Aetna Medicare |
$66.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.51
|
| Rate for Payer: BCBS Complete |
$37.00
|
| Rate for Payer: BCBS MAPPO |
$64.41
|
| Rate for Payer: BCBS Trust/PPO |
$50.44
|
| Rate for Payer: BCN Medicare Advantage |
$64.41
|
| Rate for Payer: Cash Price |
$341.36
|
| Rate for Payer: Cash Price |
$341.36
|
| Rate for Payer: Cofinity Commercial |
$366.96
|
| Rate for Payer: Cofinity Commercial |
$298.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.41
|
| Rate for Payer: Healthscope Commercial |
$384.03
|
| Rate for Payer: Mclaren Medicaid |
$35.23
|
| Rate for Payer: Mclaren Medicare |
$64.41
|
| Rate for Payer: Meridian Medicaid |
$37.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$67.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$362.70
|
| Rate for Payer: PACE Medicare |
$61.19
|
| Rate for Payer: PACE SWMI |
$64.41
|
| Rate for Payer: PHP Commercial |
$362.70
|
| Rate for Payer: PHP Medicare Advantage |
$64.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.69
|
| Rate for Payer: Priority Health Medicare |
$64.41
|
| Rate for Payer: Priority Health SBD |
$268.82
|
| Rate for Payer: Railroad Medicare Medicare |
$64.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.29
|
| Rate for Payer: UHC Core |
$109.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.41
|
| Rate for Payer: UHC Exchange |
$64.41
|
| Rate for Payer: UHC Medicare Advantage |
$66.34
|
| Rate for Payer: VA VA |
$64.41
|
|
|
HC FETAL PULSE OXIMETRY
|
Facility
|
OP
|
$299.27
|
|
| Hospital Charge Code |
27200122
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.71 |
| Max. Negotiated Rate |
$269.34 |
| Rate for Payer: Aetna Commercial |
$254.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.53
|
| Rate for Payer: BCBS Complete |
$119.71
|
| Rate for Payer: Cash Price |
$239.42
|
| Rate for Payer: Cofinity Commercial |
$209.49
|
| Rate for Payer: Cofinity Commercial |
$257.37
|
| Rate for Payer: Healthscope Commercial |
$269.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$254.38
|
| Rate for Payer: PHP Commercial |
$254.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.49
|
| Rate for Payer: Priority Health SBD |
$188.54
|
|
|
HC FETAL PULSE OXIMETRY
|
Facility
|
IP
|
$299.27
|
|
| Hospital Charge Code |
27200122
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.54 |
| Max. Negotiated Rate |
$269.34 |
| Rate for Payer: Aetna Commercial |
$254.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.53
|
| Rate for Payer: Cash Price |
$239.42
|
| Rate for Payer: Cofinity Commercial |
$209.49
|
| Rate for Payer: Cofinity Commercial |
$257.37
|
| Rate for Payer: Healthscope Commercial |
$269.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$254.38
|
| Rate for Payer: PHP Commercial |
$254.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.49
|
| Rate for Payer: Priority Health SBD |
$188.54
|
|
|
HC FETAL SCREEN ROSETTE
|
Facility
|
OP
|
$72.60
|
|
|
Service Code
|
CPT 85461
|
| Hospital Charge Code |
30500047
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$65.34 |
| Rate for Payer: Aetna Commercial |
$61.71
|
| Rate for Payer: Aetna Medicare |
$9.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.70
|
| Rate for Payer: BCBS Complete |
$5.38
|
| Rate for Payer: BCBS MAPPO |
$9.36
|
| Rate for Payer: BCBS Trust/PPO |
$7.33
|
| Rate for Payer: BCN Medicare Advantage |
$9.36
|
| Rate for Payer: Cash Price |
$58.08
|
| Rate for Payer: Cash Price |
$58.08
|
| Rate for Payer: Cofinity Commercial |
$50.82
|
| Rate for Payer: Cofinity Commercial |
$62.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.36
|
| Rate for Payer: Healthscope Commercial |
$65.34
|
| Rate for Payer: Mclaren Medicaid |
$5.12
|
| Rate for Payer: Mclaren Medicare |
$9.36
|
| Rate for Payer: Meridian Medicaid |
$5.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.71
|
| Rate for Payer: PACE Medicare |
$8.89
|
| Rate for Payer: PACE SWMI |
$9.36
|
| Rate for Payer: PHP Commercial |
$61.71
|
| Rate for Payer: PHP Medicare Advantage |
$9.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.82
|
| Rate for Payer: Priority Health Medicare |
$9.36
|
| Rate for Payer: Priority Health SBD |
$45.74
|
| Rate for Payer: Railroad Medicare Medicare |
$9.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.23
|
| Rate for Payer: UHC Core |
$11.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.36
|
| Rate for Payer: UHC Exchange |
$9.36
|
| Rate for Payer: UHC Medicare Advantage |
$9.64
|
| Rate for Payer: VA VA |
$9.36
|
|
|
HC FETAL SCREEN ROSETTE
|
Facility
|
IP
|
$72.60
|
|
|
Service Code
|
CPT 85461
|
| Hospital Charge Code |
30500047
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$45.74 |
| Max. Negotiated Rate |
$65.34 |
| Rate for Payer: Aetna Commercial |
$61.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.19
|
| Rate for Payer: Cash Price |
$58.08
|
| Rate for Payer: Cofinity Commercial |
$50.82
|
| Rate for Payer: Cofinity Commercial |
$62.44
|
| Rate for Payer: Healthscope Commercial |
$65.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.71
|
| Rate for Payer: PHP Commercial |
$61.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.82
|
| Rate for Payer: Priority Health SBD |
$45.74
|
|
|
HC FETUS EACH ADDL GESTATION
|
Facility
|
OP
|
$202.59
|
|
|
Service Code
|
CPT 74713
|
| Hospital Charge Code |
61000084
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$81.04 |
| Max. Negotiated Rate |
$220.43 |
| Rate for Payer: Aetna Commercial |
$172.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.68
|
| Rate for Payer: BCBS Complete |
$81.04
|
| Rate for Payer: BCBS Trust/PPO |
$198.02
|
| Rate for Payer: Cash Price |
$162.07
|
| Rate for Payer: Cash Price |
$162.07
|
| Rate for Payer: Cofinity Commercial |
$141.81
|
| Rate for Payer: Cofinity Commercial |
$174.23
|
| Rate for Payer: Healthscope Commercial |
$182.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.20
|
| Rate for Payer: PHP Commercial |
$172.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.81
|
| Rate for Payer: Priority Health SBD |
$127.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.43
|
| Rate for Payer: UHC Exchange |
$200.39
|
|
|
HC FETUS EACH ADDL GESTATION
|
Facility
|
IP
|
$202.59
|
|
|
Service Code
|
CPT 74713
|
| Hospital Charge Code |
61000084
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$127.63 |
| Max. Negotiated Rate |
$182.33 |
| Rate for Payer: Aetna Commercial |
$172.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.68
|
| Rate for Payer: Cash Price |
$162.07
|
| Rate for Payer: Cofinity Commercial |
$141.81
|
| Rate for Payer: Cofinity Commercial |
$174.23
|
| Rate for Payer: Healthscope Commercial |
$182.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.20
|
| Rate for Payer: PHP Commercial |
$172.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.81
|
| Rate for Payer: Priority Health SBD |
$127.63
|
|
|
HC FETUS SINGLE OR FIRST GESTATION
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
CPT 74712
|
| Hospital Charge Code |
61000083
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$119.26 |
| Max. Negotiated Rate |
$472.16 |
| Rate for Payer: Aetna Commercial |
$260.10
|
| Rate for Payer: Aetna Medicare |
$226.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.54
|
| Rate for Payer: BCBS Complete |
$125.24
|
| Rate for Payer: BCBS MAPPO |
$218.03
|
| Rate for Payer: BCBS Trust/PPO |
$472.16
|
| Rate for Payer: BCN Medicare Advantage |
$218.03
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$214.20
|
| Rate for Payer: Cofinity Commercial |
$263.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.03
|
| Rate for Payer: Healthscope Commercial |
$275.40
|
| Rate for Payer: Mclaren Medicaid |
$119.26
|
| Rate for Payer: Mclaren Medicare |
$218.03
|
| Rate for Payer: Meridian Medicaid |
$125.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$260.10
|
| Rate for Payer: PACE Medicare |
$207.13
|
| Rate for Payer: PACE SWMI |
$218.03
|
| Rate for Payer: PHP Commercial |
$260.10
|
| Rate for Payer: PHP Medicare Advantage |
$218.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.20
|
| Rate for Payer: Priority Health Medicare |
$218.03
|
| Rate for Payer: Priority Health SBD |
$192.78
|
| Rate for Payer: Railroad Medicare Medicare |
$218.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$453.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.03
|
| Rate for Payer: UHC Exchange |
$412.58
|
| Rate for Payer: UHC Medicare Advantage |
$224.57
|
| Rate for Payer: VA VA |
$218.03
|
|
|
HC FETUS SINGLE OR FIRST GESTATION
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
CPT 74712
|
| Hospital Charge Code |
61000083
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$192.78 |
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Aetna Commercial |
$260.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.90
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$263.16
|
| Rate for Payer: Cofinity Commercial |
$214.20
|
| Rate for Payer: Healthscope Commercial |
$275.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$260.10
|
| Rate for Payer: PHP Commercial |
$260.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.20
|
| Rate for Payer: Priority Health SBD |
$192.78
|
|
|
HC FFR DEVICE
|
Facility
|
OP
|
$2,055.39
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$822.16 |
| Max. Negotiated Rate |
$1,849.85 |
| Rate for Payer: Aetna Commercial |
$1,747.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,336.00
|
| Rate for Payer: BCBS Complete |
$822.16
|
| Rate for Payer: Cash Price |
$1,644.31
|
| Rate for Payer: Cofinity Commercial |
$1,438.77
|
| Rate for Payer: Cofinity Commercial |
$1,767.64
|
| Rate for Payer: Healthscope Commercial |
$1,849.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,747.08
|
| Rate for Payer: PHP Commercial |
$1,747.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,438.77
|
| Rate for Payer: Priority Health SBD |
$1,294.90
|
|
|
HC FFR DEVICE
|
Facility
|
IP
|
$2,055.39
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,294.90 |
| Max. Negotiated Rate |
$1,849.85 |
| Rate for Payer: Aetna Commercial |
$1,747.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,336.00
|
| Rate for Payer: Cash Price |
$1,644.31
|
| Rate for Payer: Cofinity Commercial |
$1,438.77
|
| Rate for Payer: Cofinity Commercial |
$1,767.64
|
| Rate for Payer: Healthscope Commercial |
$1,849.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,747.08
|
| Rate for Payer: PHP Commercial |
$1,747.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,438.77
|
| Rate for Payer: Priority Health SBD |
$1,294.90
|
|
|
HC FFR MEASUREMENT
|
Facility
|
IP
|
$3,802.52
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
48100027
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,395.59 |
| Max. Negotiated Rate |
$3,422.27 |
| Rate for Payer: Aetna Commercial |
$3,232.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,471.64
|
| Rate for Payer: Cash Price |
$3,042.02
|
| Rate for Payer: Cofinity Commercial |
$2,661.76
|
| Rate for Payer: Cofinity Commercial |
$3,270.17
|
| Rate for Payer: Healthscope Commercial |
$3,422.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,232.14
|
| Rate for Payer: PHP Commercial |
$3,232.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,661.76
|
| Rate for Payer: Priority Health SBD |
$2,395.59
|
|
|
HC FFR MEASUREMENT
|
Facility
|
OP
|
$3,802.52
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
48100027
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$603.28 |
| Max. Negotiated Rate |
$3,422.27 |
| Rate for Payer: Aetna Commercial |
$3,232.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,471.64
|
| Rate for Payer: BCBS Complete |
$1,521.01
|
| Rate for Payer: BCBS Trust/PPO |
$603.28
|
| Rate for Payer: Cash Price |
$3,042.02
|
| Rate for Payer: Cash Price |
$3,042.02
|
| Rate for Payer: Cofinity Commercial |
$2,661.76
|
| Rate for Payer: Cofinity Commercial |
$3,270.17
|
| Rate for Payer: Healthscope Commercial |
$3,422.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,232.14
|
| Rate for Payer: PHP Commercial |
$3,232.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,661.76
|
| Rate for Payer: Priority Health SBD |
$2,395.59
|
| Rate for Payer: UHC Core |
$878.00
|
|
|
HC FFR MEASUREMENT ADD VESS
|
Facility
|
OP
|
$824.08
|
|
|
Service Code
|
CPT 93572
|
| Hospital Charge Code |
48100028
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$285.51 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$700.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$535.65
|
| Rate for Payer: BCBS Complete |
$329.63
|
| Rate for Payer: BCBS Trust/PPO |
$285.51
|
| Rate for Payer: Cash Price |
$659.26
|
| Rate for Payer: Cash Price |
$659.26
|
| Rate for Payer: Cofinity Commercial |
$708.71
|
| Rate for Payer: Cofinity Commercial |
$576.86
|
| Rate for Payer: Healthscope Commercial |
$741.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$700.47
|
| Rate for Payer: PHP Commercial |
$700.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.86
|
| Rate for Payer: Priority Health SBD |
$519.17
|
| Rate for Payer: UHC Core |
$878.00
|
|
|
HC FFR MEASUREMENT ADD VESS
|
Facility
|
IP
|
$824.08
|
|
|
Service Code
|
CPT 93572
|
| Hospital Charge Code |
48100028
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$519.17 |
| Max. Negotiated Rate |
$741.67 |
| Rate for Payer: Aetna Commercial |
$700.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$535.65
|
| Rate for Payer: Cash Price |
$659.26
|
| Rate for Payer: Cofinity Commercial |
$576.86
|
| Rate for Payer: Cofinity Commercial |
$708.71
|
| Rate for Payer: Healthscope Commercial |
$741.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$700.47
|
| Rate for Payer: PHP Commercial |
$700.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.86
|
| Rate for Payer: Priority Health SBD |
$519.17
|
|
|
HC FIBEROPTIC IABP KIT
|
Facility
|
OP
|
$2,623.95
|
|
| Hospital Charge Code |
27200301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,049.58 |
| Max. Negotiated Rate |
$2,361.56 |
| Rate for Payer: Aetna Commercial |
$2,230.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,705.57
|
| Rate for Payer: BCBS Complete |
$1,049.58
|
| Rate for Payer: Cash Price |
$2,099.16
|
| Rate for Payer: Cofinity Commercial |
$2,256.60
|
| Rate for Payer: Cofinity Commercial |
$1,836.76
|
| Rate for Payer: Healthscope Commercial |
$2,361.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,230.36
|
| Rate for Payer: PHP Commercial |
$2,230.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,836.76
|
| Rate for Payer: Priority Health SBD |
$1,653.09
|
|
|
HC FIBEROPTIC IABP KIT
|
Facility
|
IP
|
$2,623.95
|
|
| Hospital Charge Code |
27200301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,653.09 |
| Max. Negotiated Rate |
$2,361.56 |
| Rate for Payer: Aetna Commercial |
$2,230.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,705.57
|
| Rate for Payer: Cash Price |
$2,099.16
|
| Rate for Payer: Cofinity Commercial |
$1,836.76
|
| Rate for Payer: Cofinity Commercial |
$2,256.60
|
| Rate for Payer: Healthscope Commercial |
$2,361.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,230.36
|
| Rate for Payer: PHP Commercial |
$2,230.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,836.76
|
| Rate for Payer: Priority Health SBD |
$1,653.09
|
|
