|
HC GABAPENTIN LEVEL NEURONTIN
|
Facility
|
IP
|
$47.94
|
|
|
Service Code
|
CPT 80171
|
| Hospital Charge Code |
30100160
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.20 |
| Max. Negotiated Rate |
$43.15 |
| Rate for Payer: Aetna Commercial |
$40.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.16
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Cofinity Commercial |
$41.23
|
| Rate for Payer: Healthscope Commercial |
$43.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.75
|
| Rate for Payer: PHP Commercial |
$40.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.56
|
| Rate for Payer: Priority Health SBD |
$30.20
|
|
|
HC GABAPENTIN LEVEL NEURONTIN
|
Facility
|
OP
|
$47.94
|
|
|
Service Code
|
CPT 80171
|
| Hospital Charge Code |
30100160
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$43.15 |
| Rate for Payer: Aetna Commercial |
$40.75
|
| Rate for Payer: Aetna Medicare |
$22.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.09
|
| Rate for Payer: BCBS Complete |
$12.45
|
| Rate for Payer: BCBS MAPPO |
$21.67
|
| Rate for Payer: BCBS Trust/PPO |
$16.97
|
| Rate for Payer: BCN Medicare Advantage |
$21.67
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Cofinity Commercial |
$41.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.67
|
| Rate for Payer: Healthscope Commercial |
$43.15
|
| Rate for Payer: Mclaren Medicaid |
$11.85
|
| Rate for Payer: Mclaren Medicare |
$21.67
|
| Rate for Payer: Meridian Medicaid |
$12.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.75
|
| Rate for Payer: PACE Medicare |
$20.59
|
| Rate for Payer: PACE SWMI |
$21.67
|
| Rate for Payer: PHP Commercial |
$40.75
|
| Rate for Payer: PHP Medicare Advantage |
$21.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.56
|
| Rate for Payer: Priority Health Medicare |
$21.67
|
| Rate for Payer: Priority Health SBD |
$30.20
|
| Rate for Payer: Railroad Medicare Medicare |
$21.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.00
|
| Rate for Payer: UHC Core |
$21.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.67
|
| Rate for Payer: UHC Exchange |
$21.67
|
| Rate for Payer: UHC Medicare Advantage |
$22.32
|
| Rate for Payer: VA VA |
$21.67
|
|
|
HC GADOBUTROL INJ 0.1 ML
|
Facility
|
IP
|
$2.12
|
|
|
Service Code
|
HCPCS A9585
|
| Hospital Charge Code |
25500003
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.38
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cofinity Commercial |
$1.48
|
| Rate for Payer: Cofinity Commercial |
$1.82
|
| Rate for Payer: Healthscope Commercial |
$1.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.80
|
| Rate for Payer: PHP Commercial |
$1.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.48
|
| Rate for Payer: Priority Health SBD |
$1.34
|
|
|
HC GADOBUTROL INJ 0.1 ML
|
Facility
|
OP
|
$2.12
|
|
|
Service Code
|
HCPCS A9585
|
| Hospital Charge Code |
25500003
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.38
|
| Rate for Payer: BCBS Complete |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$0.37
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cofinity Commercial |
$1.48
|
| Rate for Payer: Cofinity Commercial |
$1.82
|
| Rate for Payer: Healthscope Commercial |
$1.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.80
|
| Rate for Payer: PHP Commercial |
$1.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.48
|
| Rate for Payer: Priority Health SBD |
$1.34
|
|
|
HC GADOLINIUM PER ML
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
HCPCS A9579
|
| Hospital Charge Code |
63600015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna Commercial |
$54.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.60
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cofinity Commercial |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$55.04
|
| Rate for Payer: Healthscope Commercial |
$57.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.40
|
| Rate for Payer: PHP Commercial |
$54.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.80
|
| Rate for Payer: Priority Health SBD |
$40.32
|
|
|
HC GADOLINIUM PER ML
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
HCPCS A9579
|
| Hospital Charge Code |
63600015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna Commercial |
$54.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.60
|
| Rate for Payer: BCBS Complete |
$25.60
|
| Rate for Payer: BCBS Trust/PPO |
$1.64
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cofinity Commercial |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$55.04
|
| Rate for Payer: Healthscope Commercial |
$57.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.40
|
| Rate for Payer: PHP Commercial |
$54.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.80
|
| Rate for Payer: Priority Health SBD |
$40.32
|
|
|
HC GAIT TRAINING EA 15 MIN
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
42000023
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.65 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: BCBS Complete |
$36.72
|
| Rate for Payer: BCBS Trust/PPO |
$19.65
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.03
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.26
|
| Rate for Payer: Priority Health SBD |
$57.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.69
|
| Rate for Payer: UHC Exchange |
$28.81
|
|
|
HC GAIT TRAINING EA 15 MIN
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
42000023
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$57.83 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Cofinity Commercial |
$64.26
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.03
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.26
|
| Rate for Payer: Priority Health SBD |
$57.83
|
|
|
HC GALIUM 67 PER MCI
|
Facility
|
IP
|
$139.14
|
|
|
Service Code
|
HCPCS A9556
|
| Hospital Charge Code |
34300007
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$87.66 |
| Max. Negotiated Rate |
$125.23 |
| Rate for Payer: Aetna Commercial |
$118.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.44
|
| Rate for Payer: Cash Price |
$111.31
|
| Rate for Payer: Cofinity Commercial |
$119.66
|
| Rate for Payer: Cofinity Commercial |
$97.40
|
| Rate for Payer: Healthscope Commercial |
$125.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$118.27
|
| Rate for Payer: PHP Commercial |
$118.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.40
|
| Rate for Payer: Priority Health SBD |
$87.66
|
|
|
HC GALIUM 67 PER MCI
|
Facility
|
OP
|
$139.14
|
|
|
Service Code
|
HCPCS A9556
|
| Hospital Charge Code |
34300007
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$55.66 |
| Max. Negotiated Rate |
$125.23 |
| Rate for Payer: Aetna Commercial |
$118.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.44
|
| Rate for Payer: BCBS Complete |
$55.66
|
| Rate for Payer: BCBS Trust/PPO |
$70.39
|
| Rate for Payer: Cash Price |
$111.31
|
| Rate for Payer: Cash Price |
$111.31
|
| Rate for Payer: Cofinity Commercial |
$97.40
|
| Rate for Payer: Cofinity Commercial |
$119.66
|
| Rate for Payer: Healthscope Commercial |
$125.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$118.27
|
| Rate for Payer: PHP Commercial |
$118.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.40
|
| Rate for Payer: Priority Health SBD |
$87.66
|
|
|
HC GARAMYCIN GENTAMICIN INJ UP TO 80 MG
|
Facility
|
IP
|
$4.08
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
63600139
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.65
|
| Rate for Payer: Cash Price |
$3.26
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Cofinity Commercial |
$3.51
|
| Rate for Payer: Healthscope Commercial |
$3.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.47
|
| Rate for Payer: PHP Commercial |
$3.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.86
|
| Rate for Payer: Priority Health SBD |
$2.57
|
|
|
HC GARAMYCIN GENTAMICIN INJ UP TO 80 MG
|
Facility
|
OP
|
$4.08
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
63600139
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$7.93 |
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.65
|
| Rate for Payer: BCBS Complete |
$1.63
|
| Rate for Payer: BCBS Trust/PPO |
$7.93
|
| Rate for Payer: Cash Price |
$3.26
|
| Rate for Payer: Cash Price |
$3.26
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Cofinity Commercial |
$3.51
|
| Rate for Payer: Healthscope Commercial |
$3.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.47
|
| Rate for Payer: PHP Commercial |
$3.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.86
|
| Rate for Payer: Priority Health SBD |
$2.57
|
|
|
HC GAS DILUTION/WASHOUT VOLUMES
|
Facility
|
OP
|
$235.05
|
|
|
Service Code
|
CPT 94727
|
| Hospital Charge Code |
46000025
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$43.88 |
| Max. Negotiated Rate |
$436.07 |
| Rate for Payer: Aetna Commercial |
$199.79
|
| Rate for Payer: Aetna Medicare |
$144.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.74
|
| Rate for Payer: BCBS Complete |
$79.84
|
| Rate for Payer: BCBS MAPPO |
$138.99
|
| Rate for Payer: BCBS Trust/PPO |
$145.84
|
| Rate for Payer: BCN Medicare Advantage |
$138.99
|
| Rate for Payer: Cash Price |
$188.04
|
| Rate for Payer: Cash Price |
$188.04
|
| Rate for Payer: Cofinity Commercial |
$202.14
|
| Rate for Payer: Cofinity Commercial |
$164.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.99
|
| Rate for Payer: Healthscope Commercial |
$211.54
|
| Rate for Payer: Mclaren Medicaid |
$76.03
|
| Rate for Payer: Mclaren Medicare |
$138.99
|
| Rate for Payer: Meridian Medicaid |
$79.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$199.79
|
| Rate for Payer: PACE Medicare |
$132.04
|
| Rate for Payer: PACE SWMI |
$138.99
|
| Rate for Payer: PHP Commercial |
$199.79
|
| Rate for Payer: PHP Medicare Advantage |
$138.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$436.07
|
| Rate for Payer: Priority Health Medicare |
$138.99
|
| Rate for Payer: Priority Health Narrow Network |
$348.85
|
| Rate for Payer: Priority Health SBD |
$148.08
|
| Rate for Payer: Railroad Medicare Medicare |
$138.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.99
|
| Rate for Payer: UHC Exchange |
$43.88
|
| Rate for Payer: UHC Medicare Advantage |
$143.16
|
| Rate for Payer: VA VA |
$138.99
|
|
|
HC GAS DILUTION/WASHOUT VOLUMES
|
Facility
|
IP
|
$235.05
|
|
|
Service Code
|
CPT 94727
|
| Hospital Charge Code |
46000025
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$148.08 |
| Max. Negotiated Rate |
$211.54 |
| Rate for Payer: Aetna Commercial |
$199.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.78
|
| Rate for Payer: Cash Price |
$188.04
|
| Rate for Payer: Cofinity Commercial |
$164.54
|
| Rate for Payer: Cofinity Commercial |
$202.14
|
| Rate for Payer: Healthscope Commercial |
$211.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$199.79
|
| Rate for Payer: PHP Commercial |
$199.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.54
|
| Rate for Payer: Priority Health SBD |
$148.08
|
|
|
HC GASTRIC ASPIRATION
|
Facility
|
OP
|
$347.08
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
45000002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$20.96 |
| Max. Negotiated Rate |
$349.11 |
| Rate for Payer: Aetna Commercial |
$295.02
|
| Rate for Payer: Aetna Medicare |
$290.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$349.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$349.11
|
| Rate for Payer: BCBS Complete |
$160.42
|
| Rate for Payer: BCBS MAPPO |
$279.29
|
| Rate for Payer: BCBS Trust/PPO |
$175.07
|
| Rate for Payer: BCN Medicare Advantage |
$279.29
|
| Rate for Payer: Cash Price |
$277.66
|
| Rate for Payer: Cash Price |
$277.66
|
| Rate for Payer: Cofinity Commercial |
$242.96
|
| Rate for Payer: Cofinity Commercial |
$298.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.29
|
| Rate for Payer: Healthscope Commercial |
$312.37
|
| Rate for Payer: Mclaren Medicaid |
$152.77
|
| Rate for Payer: Mclaren Medicare |
$279.29
|
| Rate for Payer: Meridian Medicaid |
$160.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$293.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$321.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$295.02
|
| Rate for Payer: PACE Medicare |
$265.33
|
| Rate for Payer: PACE SWMI |
$279.29
|
| Rate for Payer: PHP Commercial |
$295.02
|
| Rate for Payer: PHP Medicare Advantage |
$279.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.96
|
| Rate for Payer: Priority Health Medicare |
$279.29
|
| Rate for Payer: Priority Health SBD |
$218.66
|
| Rate for Payer: Railroad Medicare Medicare |
$279.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.29
|
| Rate for Payer: UHC Exchange |
$20.96
|
| Rate for Payer: UHC Medicare Advantage |
$287.67
|
| Rate for Payer: VA VA |
$279.29
|
|
|
HC GASTRIC ASPIRATION
|
Facility
|
IP
|
$347.08
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
45000002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$218.66 |
| Max. Negotiated Rate |
$312.37 |
| Rate for Payer: Aetna Commercial |
$295.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.60
|
| Rate for Payer: Cash Price |
$277.66
|
| Rate for Payer: Cofinity Commercial |
$242.96
|
| Rate for Payer: Cofinity Commercial |
$298.49
|
| Rate for Payer: Healthscope Commercial |
$312.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$295.02
|
| Rate for Payer: PHP Commercial |
$295.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.96
|
| Rate for Payer: Priority Health SBD |
$218.66
|
|
|
HC GASTRIC/COLON CLIPPING
|
Facility
|
OP
|
$382.76
|
|
| Hospital Charge Code |
27200124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.10 |
| Max. Negotiated Rate |
$344.48 |
| Rate for Payer: Aetna Commercial |
$325.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.79
|
| Rate for Payer: BCBS Complete |
$153.10
|
| Rate for Payer: Cash Price |
$306.21
|
| Rate for Payer: Cofinity Commercial |
$267.93
|
| Rate for Payer: Cofinity Commercial |
$329.17
|
| Rate for Payer: Healthscope Commercial |
$344.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$325.35
|
| Rate for Payer: PHP Commercial |
$325.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.93
|
| Rate for Payer: Priority Health SBD |
$241.14
|
|
|
HC GASTRIC/COLON CLIPPING
|
Facility
|
IP
|
$382.76
|
|
| Hospital Charge Code |
27200124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.14 |
| Max. Negotiated Rate |
$344.48 |
| Rate for Payer: Aetna Commercial |
$325.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.79
|
| Rate for Payer: Cash Price |
$306.21
|
| Rate for Payer: Cofinity Commercial |
$267.93
|
| Rate for Payer: Cofinity Commercial |
$329.17
|
| Rate for Payer: Healthscope Commercial |
$344.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$325.35
|
| Rate for Payer: PHP Commercial |
$325.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.93
|
| Rate for Payer: Priority Health SBD |
$241.14
|
|
|
HC GASTRIC EMPTYING WITH SMALL BOWEL AND COLON TRANSIT MULTI DAYS
|
Facility
|
IP
|
$1,416.93
|
|
|
Service Code
|
CPT 78266
|
| Hospital Charge Code |
34100079
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$892.67 |
| Max. Negotiated Rate |
$1,275.24 |
| Rate for Payer: Aetna Commercial |
$1,204.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$921.00
|
| Rate for Payer: Cash Price |
$1,133.54
|
| Rate for Payer: Cofinity Commercial |
$1,218.56
|
| Rate for Payer: Cofinity Commercial |
$991.85
|
| Rate for Payer: Healthscope Commercial |
$1,275.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,204.39
|
| Rate for Payer: PHP Commercial |
$1,204.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$991.85
|
| Rate for Payer: Priority Health SBD |
$892.67
|
|
|
HC GASTRIC EMPTYING WITH SMALL BOWEL AND COLON TRANSIT MULTI DAYS
|
Facility
|
OP
|
$1,416.93
|
|
|
Service Code
|
CPT 78266
|
| Hospital Charge Code |
34100079
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$263.07 |
| Max. Negotiated Rate |
$1,275.24 |
| Rate for Payer: Aetna Commercial |
$1,204.39
|
| Rate for Payer: Aetna Medicare |
$500.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$921.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$601.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$601.18
|
| Rate for Payer: BCBS Complete |
$276.25
|
| Rate for Payer: BCBS MAPPO |
$480.94
|
| Rate for Payer: BCBS Trust/PPO |
$604.55
|
| Rate for Payer: BCN Medicare Advantage |
$480.94
|
| Rate for Payer: Cash Price |
$1,133.54
|
| Rate for Payer: Cash Price |
$1,133.54
|
| Rate for Payer: Cofinity Commercial |
$991.85
|
| Rate for Payer: Cofinity Commercial |
$1,218.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$480.94
|
| Rate for Payer: Healthscope Commercial |
$1,275.24
|
| Rate for Payer: Mclaren Medicaid |
$263.07
|
| Rate for Payer: Mclaren Medicare |
$480.94
|
| Rate for Payer: Meridian Medicaid |
$276.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$504.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$553.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,204.39
|
| Rate for Payer: PACE Medicare |
$456.89
|
| Rate for Payer: PACE SWMI |
$480.94
|
| Rate for Payer: PHP Commercial |
$1,204.39
|
| Rate for Payer: PHP Medicare Advantage |
$480.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$263.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$991.85
|
| Rate for Payer: Priority Health Medicare |
$480.94
|
| Rate for Payer: Priority Health SBD |
$892.67
|
| Rate for Payer: Railroad Medicare Medicare |
$480.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$441.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$480.94
|
| Rate for Payer: UHC Exchange |
$401.12
|
| Rate for Payer: UHC Medicare Advantage |
$495.37
|
| Rate for Payer: VA VA |
$480.94
|
|
|
HC GASTRIC EMPTYING WITH SMALL BOWEL TRANSIT
|
Facility
|
IP
|
$1,475.98
|
|
|
Service Code
|
CPT 78265
|
| Hospital Charge Code |
34100080
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$929.87 |
| Max. Negotiated Rate |
$1,328.38 |
| Rate for Payer: Aetna Commercial |
$1,254.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$959.39
|
| Rate for Payer: Cash Price |
$1,180.78
|
| Rate for Payer: Cofinity Commercial |
$1,033.19
|
| Rate for Payer: Cofinity Commercial |
$1,269.34
|
| Rate for Payer: Healthscope Commercial |
$1,328.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,254.58
|
| Rate for Payer: PHP Commercial |
$1,254.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,033.19
|
| Rate for Payer: Priority Health SBD |
$929.87
|
|
|
HC GASTRIC EMPTYING WITH SMALL BOWEL TRANSIT
|
Facility
|
OP
|
$1,475.98
|
|
|
Service Code
|
CPT 78265
|
| Hospital Charge Code |
34100080
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.74 |
| Max. Negotiated Rate |
$1,328.38 |
| Rate for Payer: Aetna Commercial |
$1,254.58
|
| Rate for Payer: Aetna Medicare |
$381.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$959.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.74
|
| Rate for Payer: BCBS Complete |
$210.80
|
| Rate for Payer: BCBS MAPPO |
$366.99
|
| Rate for Payer: BCBS Trust/PPO |
$527.32
|
| Rate for Payer: BCN Medicare Advantage |
$366.99
|
| Rate for Payer: Cash Price |
$1,180.78
|
| Rate for Payer: Cash Price |
$1,180.78
|
| Rate for Payer: Cofinity Commercial |
$1,269.34
|
| Rate for Payer: Cofinity Commercial |
$1,033.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.99
|
| Rate for Payer: Healthscope Commercial |
$1,328.38
|
| Rate for Payer: Mclaren Medicaid |
$200.74
|
| Rate for Payer: Mclaren Medicare |
$366.99
|
| Rate for Payer: Meridian Medicaid |
$210.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$385.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$422.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,254.58
|
| Rate for Payer: PACE Medicare |
$348.64
|
| Rate for Payer: PACE SWMI |
$366.99
|
| Rate for Payer: PHP Commercial |
$1,254.58
|
| Rate for Payer: PHP Medicare Advantage |
$366.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,033.19
|
| Rate for Payer: Priority Health Medicare |
$366.99
|
| Rate for Payer: Priority Health SBD |
$929.87
|
| Rate for Payer: Railroad Medicare Medicare |
$366.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$387.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.99
|
| Rate for Payer: UHC Exchange |
$352.66
|
| Rate for Payer: UHC Medicare Advantage |
$378.00
|
| Rate for Payer: VA VA |
$366.99
|
|
|
HC GASTRIN LEVEL
|
Facility
|
IP
|
$41.82
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
30100220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.35 |
| Max. Negotiated Rate |
$37.64 |
| Rate for Payer: Aetna Commercial |
$35.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.18
|
| Rate for Payer: Cash Price |
$33.46
|
| Rate for Payer: Cofinity Commercial |
$29.27
|
| Rate for Payer: Cofinity Commercial |
$35.97
|
| Rate for Payer: Healthscope Commercial |
$37.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.55
|
| Rate for Payer: PHP Commercial |
$35.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.27
|
| Rate for Payer: Priority Health SBD |
$26.35
|
|
|
HC GASTRIN LEVEL
|
Facility
|
OP
|
$41.82
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
30100220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$37.64 |
| Rate for Payer: Aetna Commercial |
$35.55
|
| Rate for Payer: Aetna Medicare |
$18.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.04
|
| Rate for Payer: BCBS Complete |
$10.13
|
| Rate for Payer: BCBS MAPPO |
$17.63
|
| Rate for Payer: BCBS Trust/PPO |
$13.80
|
| Rate for Payer: BCN Medicare Advantage |
$17.63
|
| Rate for Payer: Cash Price |
$33.46
|
| Rate for Payer: Cash Price |
$33.46
|
| Rate for Payer: Cofinity Commercial |
$29.27
|
| Rate for Payer: Cofinity Commercial |
$35.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.63
|
| Rate for Payer: Healthscope Commercial |
$37.64
|
| Rate for Payer: Mclaren Medicaid |
$9.64
|
| Rate for Payer: Mclaren Medicare |
$17.63
|
| Rate for Payer: Meridian Medicaid |
$10.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.55
|
| Rate for Payer: PACE Medicare |
$16.75
|
| Rate for Payer: PACE SWMI |
$17.63
|
| Rate for Payer: PHP Commercial |
$35.55
|
| Rate for Payer: PHP Medicare Advantage |
$17.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.27
|
| Rate for Payer: Priority Health Medicare |
$17.63
|
| Rate for Payer: Priority Health SBD |
$26.35
|
| Rate for Payer: Railroad Medicare Medicare |
$17.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.16
|
| Rate for Payer: UHC Core |
$29.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.63
|
| Rate for Payer: UHC Exchange |
$17.63
|
| Rate for Payer: UHC Medicare Advantage |
$18.16
|
| Rate for Payer: VA VA |
$17.63
|
|
|
HC GASTROGRAFIN PER ML
|
Facility
|
IP
|
$3.41
|
|
|
Service Code
|
HCPCS Q9963
|
| Hospital Charge Code |
63600010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$3.07 |
| Rate for Payer: Aetna Commercial |
$2.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.22
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cofinity Commercial |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.93
|
| Rate for Payer: Healthscope Commercial |
$3.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.90
|
| Rate for Payer: PHP Commercial |
$2.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.39
|
| Rate for Payer: Priority Health SBD |
$2.15
|
|
