|
HC BIRCH IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200029
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC BIRCH IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200029
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
|
|
HC BIVENTRICULAR DELIVERY SYSTEM
|
Facility
|
OP
|
$2,038.69
|
|
| Hospital Charge Code |
27200114
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$815.48 |
| Max. Negotiated Rate |
$1,834.82 |
| Rate for Payer: Aetna Commercial |
$1,732.89
|
| Rate for Payer: Aetna Medicare |
$1,019.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,325.15
|
| Rate for Payer: BCBS Complete |
$815.48
|
| Rate for Payer: Cash Price |
$1,630.95
|
| Rate for Payer: Cofinity Commercial |
$1,427.08
|
| Rate for Payer: Cofinity Commercial |
$1,753.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,427.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,630.95
|
| Rate for Payer: Healthscope Commercial |
$1,834.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,732.89
|
| Rate for Payer: PHP Commercial |
$1,732.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,325.15
|
| Rate for Payer: Priority Health SBD |
$1,284.37
|
|
|
HC BIVENTRICULAR DELIVERY SYSTEM
|
Facility
|
IP
|
$2,038.69
|
|
| Hospital Charge Code |
27200114
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,284.37 |
| Max. Negotiated Rate |
$1,834.82 |
| Rate for Payer: Aetna Commercial |
$1,732.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,325.15
|
| Rate for Payer: Cash Price |
$1,630.95
|
| Rate for Payer: Cofinity Commercial |
$1,427.08
|
| Rate for Payer: Cofinity Commercial |
$1,753.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,427.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,630.95
|
| Rate for Payer: Healthscope Commercial |
$1,834.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,732.89
|
| Rate for Payer: PHP Commercial |
$1,732.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,325.15
|
| Rate for Payer: Priority Health SBD |
$1,284.37
|
|
|
HC BI V PACEMAKER
|
Facility
|
OP
|
$27,936.42
|
|
|
Service Code
|
HCPCS C2621
|
| Hospital Charge Code |
27500001
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,174.57 |
| Max. Negotiated Rate |
$25,142.78 |
| Rate for Payer: Aetna Commercial |
$23,745.96
|
| Rate for Payer: Aetna Medicare |
$13,968.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,158.67
|
| Rate for Payer: BCBS Complete |
$11,174.57
|
| Rate for Payer: Cash Price |
$22,349.14
|
| Rate for Payer: Cofinity Commercial |
$19,555.49
|
| Rate for Payer: Cofinity Commercial |
$24,025.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$19,555.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,349.14
|
| Rate for Payer: Healthscope Commercial |
$25,142.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23,745.96
|
| Rate for Payer: PHP Commercial |
$23,745.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,158.67
|
| Rate for Payer: Priority Health SBD |
$17,599.94
|
|
|
HC BI V PACEMAKER
|
Facility
|
IP
|
$27,936.42
|
|
|
Service Code
|
HCPCS C2621
|
| Hospital Charge Code |
27500001
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$17,599.94 |
| Max. Negotiated Rate |
$25,142.78 |
| Rate for Payer: Aetna Commercial |
$23,745.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,158.67
|
| Rate for Payer: Cash Price |
$22,349.14
|
| Rate for Payer: Cofinity Commercial |
$19,555.49
|
| Rate for Payer: Cofinity Commercial |
$24,025.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$19,555.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,349.14
|
| Rate for Payer: Healthscope Commercial |
$25,142.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23,745.96
|
| Rate for Payer: PHP Commercial |
$23,745.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,158.67
|
| Rate for Payer: Priority Health SBD |
$17,599.94
|
|
|
HC BK VIRUS PCR, QUANT
|
Facility
|
IP
|
$113.40
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
30600289
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$71.44 |
| Max. Negotiated Rate |
$102.06 |
| Rate for Payer: Aetna Commercial |
$96.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.71
|
| Rate for Payer: Cash Price |
$90.72
|
| Rate for Payer: Cofinity Commercial |
$79.38
|
| Rate for Payer: Cofinity Commercial |
$97.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.72
|
| Rate for Payer: Healthscope Commercial |
$102.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.39
|
| Rate for Payer: PHP Commercial |
$96.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.71
|
| Rate for Payer: Priority Health SBD |
$71.44
|
|
|
HC BK VIRUS PCR, QUANT
|
Facility
|
OP
|
$113.40
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
30600289
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.96 |
| Max. Negotiated Rate |
$120.59 |
| Rate for Payer: Aetna Commercial |
$96.39
|
| Rate for Payer: Aetna Medicare |
$44.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.55
|
| Rate for Payer: BCBS Complete |
$24.11
|
| Rate for Payer: BCBS MAPPO |
$42.84
|
| Rate for Payer: BCN Medicare Advantage |
$42.84
|
| Rate for Payer: Cash Price |
$90.72
|
| Rate for Payer: Cash Price |
$90.72
|
| Rate for Payer: Cofinity Commercial |
$97.52
|
| Rate for Payer: Cofinity Commercial |
$79.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.84
|
| Rate for Payer: Healthscope Commercial |
$102.06
|
| Rate for Payer: Mclaren Medicaid |
$22.96
|
| Rate for Payer: Mclaren Medicare |
$42.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.98
|
| Rate for Payer: Meridian Medicaid |
$24.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.39
|
| Rate for Payer: PACE Medicare |
$40.70
|
| Rate for Payer: PACE SWMI |
$42.84
|
| Rate for Payer: PHP Commercial |
$96.39
|
| Rate for Payer: PHP Medicare Advantage |
$42.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.71
|
| Rate for Payer: Priority Health Medicare |
$42.84
|
| Rate for Payer: Priority Health SBD |
$71.44
|
| Rate for Payer: Railroad Medicare Medicare |
$42.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.84
|
| Rate for Payer: UHC Medicare Advantage |
$42.84
|
| Rate for Payer: UHCCP Medicaid |
$24.12
|
| Rate for Payer: VA VA |
$42.84
|
|
|
HC BLADDER IRRIGATION
|
Facility
|
IP
|
$279.85
|
|
| Hospital Charge Code |
45000032
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$176.31 |
| Max. Negotiated Rate |
$251.87 |
| Rate for Payer: Aetna Commercial |
$237.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.90
|
| Rate for Payer: Cash Price |
$223.88
|
| Rate for Payer: Cofinity Commercial |
$195.90
|
| Rate for Payer: Cofinity Commercial |
$240.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$195.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.88
|
| Rate for Payer: Healthscope Commercial |
$251.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.87
|
| Rate for Payer: PHP Commercial |
$237.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.90
|
| Rate for Payer: Priority Health SBD |
$176.31
|
|
|
HC BLADDER IRRIGATION
|
Facility
|
OP
|
$279.85
|
|
| Hospital Charge Code |
45000032
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.94 |
| Max. Negotiated Rate |
$251.87 |
| Rate for Payer: Aetna Commercial |
$237.87
|
| Rate for Payer: Aetna Medicare |
$139.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.90
|
| Rate for Payer: BCBS Complete |
$111.94
|
| Rate for Payer: Cash Price |
$223.88
|
| Rate for Payer: Cofinity Commercial |
$195.90
|
| Rate for Payer: Cofinity Commercial |
$240.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$195.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.88
|
| Rate for Payer: Healthscope Commercial |
$251.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.87
|
| Rate for Payer: PHP Commercial |
$237.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.90
|
| Rate for Payer: Priority Health SBD |
$176.31
|
|
|
HC BLADDER SCAN
|
Facility
|
IP
|
$153.14
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
45000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.48 |
| Max. Negotiated Rate |
$137.83 |
| Rate for Payer: Aetna Commercial |
$130.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.54
|
| Rate for Payer: Cash Price |
$122.51
|
| Rate for Payer: Cofinity Commercial |
$107.20
|
| Rate for Payer: Cofinity Commercial |
$131.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.51
|
| Rate for Payer: Healthscope Commercial |
$137.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.17
|
| Rate for Payer: PHP Commercial |
$130.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.54
|
| Rate for Payer: Priority Health SBD |
$96.48
|
|
|
HC BLADDER SCAN
|
Facility
|
OP
|
$153.14
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
45000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$163.07 |
| Rate for Payer: Aetna Commercial |
$130.17
|
| Rate for Payer: Aetna Medicare |
$60.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.41
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$57.93
|
| Rate for Payer: BCN Medicare Advantage |
$57.93
|
| Rate for Payer: Cash Price |
$122.51
|
| Rate for Payer: Cash Price |
$122.51
|
| Rate for Payer: Cofinity Commercial |
$131.70
|
| Rate for Payer: Cofinity Commercial |
$107.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.93
|
| Rate for Payer: Healthscope Commercial |
$137.83
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Mclaren Medicare |
$57.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.83
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.17
|
| Rate for Payer: PACE Medicare |
$55.03
|
| Rate for Payer: PACE SWMI |
$57.93
|
| Rate for Payer: PHP Commercial |
$130.17
|
| Rate for Payer: PHP Medicare Advantage |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.54
|
| Rate for Payer: Priority Health Medicare |
$57.93
|
| Rate for Payer: Priority Health SBD |
$96.48
|
| Rate for Payer: Railroad Medicare Medicare |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.93
|
| Rate for Payer: UHC Medicare Advantage |
$57.93
|
| Rate for Payer: UHCCP Medicaid |
$32.61
|
| Rate for Payer: VA VA |
$57.93
|
|
|
HC BLASTOMYCES ABS BY COMP FIX
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
30200230
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$48.20 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.73
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.03
|
| Rate for Payer: PHP Commercial |
$65.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.73
|
| Rate for Payer: Priority Health SBD |
$48.20
|
|
|
HC BLASTOMYCES ABS BY COMP FIX
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
30200230
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.91 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.03
|
| Rate for Payer: Aetna Medicare |
$13.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.12
|
| Rate for Payer: BCBS Complete |
$7.26
|
| Rate for Payer: BCBS MAPPO |
$12.90
|
| Rate for Payer: BCN Medicare Advantage |
$12.90
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.90
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Mclaren Medicaid |
$6.91
|
| Rate for Payer: Mclaren Medicare |
$12.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.54
|
| Rate for Payer: Meridian Medicaid |
$7.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.03
|
| Rate for Payer: PACE Medicare |
$12.26
|
| Rate for Payer: PACE SWMI |
$12.90
|
| Rate for Payer: PHP Commercial |
$65.03
|
| Rate for Payer: PHP Medicare Advantage |
$12.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.73
|
| Rate for Payer: Priority Health Medicare |
$12.90
|
| Rate for Payer: Priority Health SBD |
$48.20
|
| Rate for Payer: Railroad Medicare Medicare |
$12.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.90
|
| Rate for Payer: UHC Medicare Advantage |
$12.90
|
| Rate for Payer: UHCCP Medicaid |
$7.26
|
| Rate for Payer: VA VA |
$12.90
|
|
|
HC BLD DRAW CENTRAL/PERIPH VENOUS CATH
|
Facility
|
IP
|
$124.52
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
76100004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.45 |
| Max. Negotiated Rate |
$112.07 |
| Rate for Payer: Aetna Commercial |
$105.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.94
|
| Rate for Payer: Cash Price |
$99.62
|
| Rate for Payer: Cofinity Commercial |
$107.09
|
| Rate for Payer: Cofinity Commercial |
$87.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.62
|
| Rate for Payer: Healthscope Commercial |
$112.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.84
|
| Rate for Payer: PHP Commercial |
$105.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.94
|
| Rate for Payer: Priority Health SBD |
$78.45
|
|
|
HC BLD DRAW CENTRAL/PERIPH VENOUS CATH
|
Facility
|
OP
|
$124.52
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
76100004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.38 |
| Max. Negotiated Rate |
$353.86 |
| Rate for Payer: Aetna Commercial |
$105.84
|
| Rate for Payer: Aetna Medicare |
$130.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.14
|
| Rate for Payer: BCBS Complete |
$70.75
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| Rate for Payer: Cash Price |
$99.62
|
| Rate for Payer: Cash Price |
$99.62
|
| Rate for Payer: Cofinity Commercial |
$87.16
|
| Rate for Payer: Cofinity Commercial |
$107.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.71
|
| Rate for Payer: Healthscope Commercial |
$112.07
|
| Rate for Payer: Mclaren Medicaid |
$67.38
|
| Rate for Payer: Mclaren Medicare |
$125.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.00
|
| Rate for Payer: Meridian Medicaid |
$70.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.84
|
| Rate for Payer: PACE Medicare |
$119.42
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Commercial |
$105.84
|
| Rate for Payer: PHP Medicare Advantage |
$125.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.94
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: Priority Health SBD |
$78.45
|
| Rate for Payer: Railroad Medicare Medicare |
$125.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.71
|
| Rate for Payer: UHC Medicare Advantage |
$125.71
|
| Rate for Payer: UHCCP Medicaid |
$70.77
|
| Rate for Payer: VA VA |
$125.71
|
|
|
HC BLEEDING TIME
|
Facility
|
IP
|
$76.91
|
|
|
Service Code
|
CPT 85002
|
| Hospital Charge Code |
30500001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$48.45 |
| Max. Negotiated Rate |
$69.22 |
| Rate for Payer: Aetna Commercial |
$65.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.99
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cofinity Commercial |
$53.84
|
| Rate for Payer: Cofinity Commercial |
$66.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.53
|
| Rate for Payer: Healthscope Commercial |
$69.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.37
|
| Rate for Payer: PHP Commercial |
$65.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.99
|
| Rate for Payer: Priority Health SBD |
$48.45
|
|
|
HC BLEEDING TIME
|
Facility
|
OP
|
$76.91
|
|
|
Service Code
|
CPT 85002
|
| Hospital Charge Code |
30500001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$69.22 |
| Rate for Payer: Aetna Commercial |
$65.37
|
| Rate for Payer: Aetna Medicare |
$5.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.03
|
| Rate for Payer: BCBS Complete |
$2.71
|
| Rate for Payer: BCBS MAPPO |
$4.82
|
| Rate for Payer: BCN Medicare Advantage |
$4.82
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cofinity Commercial |
$66.14
|
| Rate for Payer: Cofinity Commercial |
$53.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.82
|
| Rate for Payer: Healthscope Commercial |
$69.22
|
| Rate for Payer: Mclaren Medicaid |
$2.58
|
| Rate for Payer: Mclaren Medicare |
$4.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.06
|
| Rate for Payer: Meridian Medicaid |
$2.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.37
|
| Rate for Payer: PACE Medicare |
$4.58
|
| Rate for Payer: PACE SWMI |
$4.82
|
| Rate for Payer: PHP Commercial |
$65.37
|
| Rate for Payer: PHP Medicare Advantage |
$4.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.99
|
| Rate for Payer: Priority Health Medicare |
$4.82
|
| Rate for Payer: Priority Health SBD |
$48.45
|
| Rate for Payer: Railroad Medicare Medicare |
$4.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.82
|
| Rate for Payer: UHC Medicare Advantage |
$4.82
|
| Rate for Payer: UHCCP Medicaid |
$2.71
|
| Rate for Payer: VA VA |
$4.82
|
|
|
HC BLOOD CULTURE
|
Facility
|
OP
|
$97.70
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
30600072
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$87.93 |
| Rate for Payer: Aetna Commercial |
$83.05
|
| Rate for Payer: Aetna Medicare |
$10.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.90
|
| Rate for Payer: BCBS Complete |
$5.81
|
| Rate for Payer: BCBS MAPPO |
$10.32
|
| Rate for Payer: BCN Medicare Advantage |
$10.32
|
| Rate for Payer: Cash Price |
$78.16
|
| Rate for Payer: Cash Price |
$78.16
|
| Rate for Payer: Cofinity Commercial |
$84.02
|
| Rate for Payer: Cofinity Commercial |
$68.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.32
|
| Rate for Payer: Healthscope Commercial |
$87.93
|
| Rate for Payer: Mclaren Medicaid |
$5.53
|
| Rate for Payer: Mclaren Medicare |
$10.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.84
|
| Rate for Payer: Meridian Medicaid |
$5.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.05
|
| Rate for Payer: PACE Medicare |
$9.80
|
| Rate for Payer: PACE SWMI |
$10.32
|
| Rate for Payer: PHP Commercial |
$83.05
|
| Rate for Payer: PHP Medicare Advantage |
$10.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.51
|
| Rate for Payer: Priority Health Medicare |
$10.32
|
| Rate for Payer: Priority Health SBD |
$61.55
|
| Rate for Payer: Railroad Medicare Medicare |
$10.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.32
|
| Rate for Payer: UHC Medicare Advantage |
$10.32
|
| Rate for Payer: UHCCP Medicaid |
$5.81
|
| Rate for Payer: VA VA |
$10.32
|
|
|
HC BLOOD CULTURE
|
Facility
|
IP
|
$97.70
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
30600072
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$61.55 |
| Max. Negotiated Rate |
$87.93 |
| Rate for Payer: Aetna Commercial |
$83.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.51
|
| Rate for Payer: Cash Price |
$78.16
|
| Rate for Payer: Cofinity Commercial |
$68.39
|
| Rate for Payer: Cofinity Commercial |
$84.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.16
|
| Rate for Payer: Healthscope Commercial |
$87.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.05
|
| Rate for Payer: PHP Commercial |
$83.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.51
|
| Rate for Payer: Priority Health SBD |
$61.55
|
|
|
HC BLOOD DRAW IMPLANTED DEVICE
|
Facility
|
IP
|
$167.77
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
76100003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.70 |
| Max. Negotiated Rate |
$150.99 |
| Rate for Payer: Aetna Commercial |
$142.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.05
|
| Rate for Payer: Cash Price |
$134.22
|
| Rate for Payer: Cofinity Commercial |
$117.44
|
| Rate for Payer: Cofinity Commercial |
$144.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$117.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.22
|
| Rate for Payer: Healthscope Commercial |
$150.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.60
|
| Rate for Payer: PHP Commercial |
$142.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.05
|
| Rate for Payer: Priority Health SBD |
$105.70
|
|
|
HC BLOOD DRAW IMPLANTED DEVICE
|
Facility
|
OP
|
$167.77
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
76100003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.38 |
| Max. Negotiated Rate |
$353.86 |
| Rate for Payer: Aetna Commercial |
$142.60
|
| Rate for Payer: Aetna Medicare |
$130.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.14
|
| Rate for Payer: BCBS Complete |
$70.75
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| Rate for Payer: Cash Price |
$134.22
|
| Rate for Payer: Cash Price |
$134.22
|
| Rate for Payer: Cofinity Commercial |
$144.28
|
| Rate for Payer: Cofinity Commercial |
$117.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$117.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.71
|
| Rate for Payer: Healthscope Commercial |
$150.99
|
| Rate for Payer: Mclaren Medicaid |
$67.38
|
| Rate for Payer: Mclaren Medicare |
$125.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.00
|
| Rate for Payer: Meridian Medicaid |
$70.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.60
|
| Rate for Payer: PACE Medicare |
$119.42
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Commercial |
$142.60
|
| Rate for Payer: PHP Medicare Advantage |
$125.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.05
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: Priority Health SBD |
$105.70
|
| Rate for Payer: Railroad Medicare Medicare |
$125.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.71
|
| Rate for Payer: UHC Medicare Advantage |
$125.71
|
| Rate for Payer: UHCCP Medicaid |
$70.77
|
| Rate for Payer: VA VA |
$125.71
|
|
|
HC BLOOD GAS PKG, CALC O2 SAT
|
Facility
|
OP
|
$176.97
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
30100216
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.97 |
| Max. Negotiated Rate |
$159.27 |
| Rate for Payer: Aetna Commercial |
$150.42
|
| Rate for Payer: Aetna Medicare |
$27.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.59
|
| Rate for Payer: BCBS Complete |
$14.67
|
| Rate for Payer: BCBS MAPPO |
$26.07
|
| Rate for Payer: BCN Medicare Advantage |
$26.07
|
| Rate for Payer: Cash Price |
$141.58
|
| Rate for Payer: Cash Price |
$141.58
|
| Rate for Payer: Cofinity Commercial |
$152.19
|
| Rate for Payer: Cofinity Commercial |
$123.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.07
|
| Rate for Payer: Healthscope Commercial |
$159.27
|
| Rate for Payer: Mclaren Medicaid |
$13.97
|
| Rate for Payer: Mclaren Medicare |
$26.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.37
|
| Rate for Payer: Meridian Medicaid |
$14.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.42
|
| Rate for Payer: PACE Medicare |
$24.77
|
| Rate for Payer: PACE SWMI |
$26.07
|
| Rate for Payer: PHP Commercial |
$150.42
|
| Rate for Payer: PHP Medicare Advantage |
$26.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.03
|
| Rate for Payer: Priority Health Medicare |
$26.07
|
| Rate for Payer: Priority Health SBD |
$111.49
|
| Rate for Payer: Railroad Medicare Medicare |
$26.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.07
|
| Rate for Payer: UHC Medicare Advantage |
$26.07
|
| Rate for Payer: UHCCP Medicaid |
$14.68
|
| Rate for Payer: VA VA |
$26.07
|
|
|
HC BLOOD GAS PKG, CALC O2 SAT
|
Facility
|
IP
|
$176.97
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
30100216
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$111.49 |
| Max. Negotiated Rate |
$159.27 |
| Rate for Payer: Aetna Commercial |
$150.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.03
|
| Rate for Payer: Cash Price |
$141.58
|
| Rate for Payer: Cofinity Commercial |
$123.88
|
| Rate for Payer: Cofinity Commercial |
$152.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.58
|
| Rate for Payer: Healthscope Commercial |
$159.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.42
|
| Rate for Payer: PHP Commercial |
$150.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.03
|
| Rate for Payer: Priority Health SBD |
$111.49
|
|
|
HC BLOOD GAS PKG & DIRECT O2 SAT
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
30100218
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$118.44 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.20
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$131.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.20
|
| Rate for Payer: Priority Health SBD |
$118.44
|
|
