|
HC CHLAMYDIA PNEUMONIAE CULTURE
|
Facility
|
IP
|
$81.60
|
|
|
Service Code
|
CPT 87110
|
| Hospital Charge Code |
30600088
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$51.41 |
| Max. Negotiated Rate |
$73.44 |
| Rate for Payer: Aetna Commercial |
$69.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.04
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$70.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.28
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.36
|
| Rate for Payer: PHP Commercial |
$69.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.04
|
| Rate for Payer: Priority Health SBD |
$51.41
|
|
|
HC CHLAMYDIA PNEUMONIAE CULTURE
|
Facility
|
OP
|
$81.60
|
|
|
Service Code
|
CPT 87110
|
| Hospital Charge Code |
30600088
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.51 |
| Max. Negotiated Rate |
$73.44 |
| Rate for Payer: Aetna Commercial |
$69.36
|
| Rate for Payer: Aetna Medicare |
$20.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.50
|
| Rate for Payer: BCBS Complete |
$11.03
|
| Rate for Payer: BCBS MAPPO |
$19.60
|
| Rate for Payer: BCN Medicare Advantage |
$19.60
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$57.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.60
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Mclaren Medicaid |
$10.51
|
| Rate for Payer: Mclaren Medicare |
$19.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.58
|
| Rate for Payer: Meridian Medicaid |
$11.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.36
|
| Rate for Payer: PACE Medicare |
$18.62
|
| Rate for Payer: PACE SWMI |
$19.60
|
| Rate for Payer: PHP Commercial |
$69.36
|
| Rate for Payer: PHP Medicare Advantage |
$19.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.04
|
| Rate for Payer: Priority Health Medicare |
$19.60
|
| Rate for Payer: Priority Health SBD |
$51.41
|
| Rate for Payer: Railroad Medicare Medicare |
$19.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.60
|
| Rate for Payer: UHC Medicare Advantage |
$19.60
|
| Rate for Payer: UHCCP Medicaid |
$11.03
|
| Rate for Payer: VA VA |
$19.60
|
|
|
HC CHLAMYDIA PNEUMONIAE CULTURE REF LAB
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
CPT 87140
|
| Hospital Charge Code |
30600090
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna Medicare |
$5.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.96
|
| Rate for Payer: BCBS Complete |
$3.13
|
| Rate for Payer: BCBS MAPPO |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.57
|
| 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: Cofinity Medicare Advantage |
$21.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.57
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Mclaren Medicaid |
$2.99
|
| Rate for Payer: Mclaren Medicare |
$5.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.85
|
| Rate for Payer: Meridian Medicaid |
$3.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: PACE Medicare |
$5.29
|
| Rate for Payer: PACE SWMI |
$5.57
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: PHP Medicare Advantage |
$5.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: Priority Health Medicare |
$5.57
|
| Rate for Payer: Priority Health SBD |
$19.28
|
| Rate for Payer: Railroad Medicare Medicare |
$5.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.57
|
| Rate for Payer: UHC Medicare Advantage |
$5.57
|
| Rate for Payer: UHCCP Medicaid |
$3.14
|
| Rate for Payer: VA VA |
$5.57
|
|
|
HC CHLAMYDIA PNEUMONIAE CULTURE REF LAB
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
CPT 87140
|
| Hospital Charge Code |
30600090
|
|
Hospital Revenue Code
|
306
|
| 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: Cofinity Medicare Advantage |
$21.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: Priority Health SBD |
$19.28
|
|
|
HC CHLORAMPHENICOL LEVEL
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 82415
|
| Hospital Charge Code |
30100151
|
|
Hospital Revenue Code
|
301
|
| 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 CHLORAMPHENICOL LEVEL
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 82415
|
| Hospital Charge Code |
30100151
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.03
|
| Rate for Payer: Aetna Medicare |
$13.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.84
|
| Rate for Payer: BCBS Complete |
$7.13
|
| Rate for Payer: BCBS MAPPO |
$12.67
|
| Rate for Payer: BCN Medicare Advantage |
$12.67
|
| 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 |
$12.67
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Mclaren Medicaid |
$6.79
|
| Rate for Payer: Mclaren Medicare |
$12.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.30
|
| Rate for Payer: Meridian Medicaid |
$7.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.03
|
| Rate for Payer: PACE Medicare |
$12.04
|
| Rate for Payer: PACE SWMI |
$12.67
|
| Rate for Payer: PHP Commercial |
$65.03
|
| Rate for Payer: PHP Medicare Advantage |
$12.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.73
|
| Rate for Payer: Priority Health Medicare |
$12.67
|
| Rate for Payer: Priority Health SBD |
$48.20
|
| Rate for Payer: Railroad Medicare Medicare |
$12.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.67
|
| Rate for Payer: UHC Medicare Advantage |
$12.67
|
| Rate for Payer: UHCCP Medicaid |
$7.13
|
| Rate for Payer: VA VA |
$12.67
|
|
|
HC CHLORIDE OTHER SOURCE
|
Facility
|
IP
|
$21.22
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
30100513
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.37 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Aetna Commercial |
$18.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.79
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$14.85
|
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$19.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.04
|
| Rate for Payer: PHP Commercial |
$18.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.79
|
| Rate for Payer: Priority Health SBD |
$13.37
|
|
|
HC CHLORIDE OTHER SOURCE
|
Facility
|
OP
|
$21.22
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
30100513
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Aetna Commercial |
$18.04
|
| Rate for Payer: Aetna Medicare |
$5.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.25
|
| Rate for Payer: BCBS Complete |
$2.81
|
| Rate for Payer: BCBS MAPPO |
$5.00
|
| Rate for Payer: BCN Medicare Advantage |
$5.00
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Cofinity Commercial |
$14.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.00
|
| Rate for Payer: Healthscope Commercial |
$19.10
|
| Rate for Payer: Mclaren Medicaid |
$2.68
|
| Rate for Payer: Mclaren Medicare |
$5.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.25
|
| Rate for Payer: Meridian Medicaid |
$2.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.04
|
| Rate for Payer: PACE Medicare |
$4.75
|
| Rate for Payer: PACE SWMI |
$5.00
|
| Rate for Payer: PHP Commercial |
$18.04
|
| Rate for Payer: PHP Medicare Advantage |
$5.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.79
|
| Rate for Payer: Priority Health Medicare |
$5.00
|
| Rate for Payer: Priority Health SBD |
$13.37
|
| Rate for Payer: Railroad Medicare Medicare |
$5.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.00
|
| Rate for Payer: UHC Medicare Advantage |
$5.00
|
| Rate for Payer: UHCCP Medicaid |
$2.81
|
| Rate for Payer: VA VA |
$5.00
|
|
|
HC CHLORIDE OTHER SOURCE
|
Facility
|
IP
|
$21.22
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
30100554
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.37 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Aetna Commercial |
$18.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.79
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$14.85
|
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$19.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.04
|
| Rate for Payer: PHP Commercial |
$18.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.79
|
| Rate for Payer: Priority Health SBD |
$13.37
|
|
|
HC CHLORIDE OTHER SOURCE
|
Facility
|
OP
|
$21.22
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
30100554
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Aetna Commercial |
$18.04
|
| Rate for Payer: Aetna Medicare |
$5.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.25
|
| Rate for Payer: BCBS Complete |
$2.81
|
| Rate for Payer: BCBS MAPPO |
$5.00
|
| Rate for Payer: BCN Medicare Advantage |
$5.00
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Cofinity Commercial |
$14.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.00
|
| Rate for Payer: Healthscope Commercial |
$19.10
|
| Rate for Payer: Mclaren Medicaid |
$2.68
|
| Rate for Payer: Mclaren Medicare |
$5.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.25
|
| Rate for Payer: Meridian Medicaid |
$2.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.04
|
| Rate for Payer: PACE Medicare |
$4.75
|
| Rate for Payer: PACE SWMI |
$5.00
|
| Rate for Payer: PHP Commercial |
$18.04
|
| Rate for Payer: PHP Medicare Advantage |
$5.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.79
|
| Rate for Payer: Priority Health Medicare |
$5.00
|
| Rate for Payer: Priority Health SBD |
$13.37
|
| Rate for Payer: Railroad Medicare Medicare |
$5.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.00
|
| Rate for Payer: UHC Medicare Advantage |
$5.00
|
| Rate for Payer: UHCCP Medicaid |
$2.81
|
| Rate for Payer: VA VA |
$5.00
|
|
|
HC CHLORIDE SERUM
|
Facility
|
OP
|
$21.64
|
|
|
Service Code
|
CPT 82435
|
| Hospital Charge Code |
30100152
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$19.48 |
| Rate for Payer: Aetna Commercial |
$18.39
|
| Rate for Payer: Aetna Medicare |
$4.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.75
|
| Rate for Payer: BCBS Complete |
$2.59
|
| Rate for Payer: BCBS MAPPO |
$4.60
|
| Rate for Payer: BCN Medicare Advantage |
$4.60
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cofinity Commercial |
$18.61
|
| Rate for Payer: Cofinity Commercial |
$15.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.60
|
| Rate for Payer: Healthscope Commercial |
$19.48
|
| Rate for Payer: Mclaren Medicaid |
$2.47
|
| Rate for Payer: Mclaren Medicare |
$4.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.83
|
| Rate for Payer: Meridian Medicaid |
$2.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.39
|
| Rate for Payer: PACE Medicare |
$4.37
|
| Rate for Payer: PACE SWMI |
$4.60
|
| Rate for Payer: PHP Commercial |
$18.39
|
| Rate for Payer: PHP Medicare Advantage |
$4.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.07
|
| Rate for Payer: Priority Health Medicare |
$4.60
|
| Rate for Payer: Priority Health SBD |
$13.63
|
| Rate for Payer: Railroad Medicare Medicare |
$4.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.60
|
| Rate for Payer: UHC Medicare Advantage |
$4.60
|
| Rate for Payer: UHCCP Medicaid |
$2.59
|
| Rate for Payer: VA VA |
$4.60
|
|
|
HC CHLORIDE SERUM
|
Facility
|
IP
|
$21.64
|
|
|
Service Code
|
CPT 82435
|
| Hospital Charge Code |
30100152
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$19.48 |
| Rate for Payer: Aetna Commercial |
$18.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.07
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cofinity Commercial |
$15.15
|
| Rate for Payer: Cofinity Commercial |
$18.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.31
|
| Rate for Payer: Healthscope Commercial |
$19.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.39
|
| Rate for Payer: PHP Commercial |
$18.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.07
|
| Rate for Payer: Priority Health SBD |
$13.63
|
|
|
HC CHLORIDE URINE
|
Facility
|
OP
|
$38.66
|
|
|
Service Code
|
CPT 82436
|
| Hospital Charge Code |
30100153
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$34.79 |
| Rate for Payer: Aetna Commercial |
$32.86
|
| Rate for Payer: Aetna Medicare |
$5.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.19
|
| Rate for Payer: BCBS Complete |
$3.24
|
| Rate for Payer: BCBS MAPPO |
$5.75
|
| Rate for Payer: BCN Medicare Advantage |
$5.75
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cofinity Commercial |
$33.25
|
| Rate for Payer: Cofinity Commercial |
$27.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.75
|
| Rate for Payer: Healthscope Commercial |
$34.79
|
| Rate for Payer: Mclaren Medicaid |
$3.08
|
| Rate for Payer: Mclaren Medicare |
$5.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.04
|
| Rate for Payer: Meridian Medicaid |
$3.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.86
|
| Rate for Payer: PACE Medicare |
$5.46
|
| Rate for Payer: PACE SWMI |
$5.75
|
| Rate for Payer: PHP Commercial |
$32.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.13
|
| Rate for Payer: Priority Health Medicare |
$5.75
|
| Rate for Payer: Priority Health SBD |
$24.36
|
| Rate for Payer: Railroad Medicare Medicare |
$5.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.75
|
| Rate for Payer: UHC Medicare Advantage |
$5.75
|
| Rate for Payer: UHCCP Medicaid |
$3.24
|
| Rate for Payer: VA VA |
$5.75
|
|
|
HC CHLORIDE URINE
|
Facility
|
IP
|
$38.66
|
|
|
Service Code
|
CPT 82436
|
| Hospital Charge Code |
30100153
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.36 |
| Max. Negotiated Rate |
$34.79 |
| Rate for Payer: Aetna Commercial |
$32.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.13
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cofinity Commercial |
$27.06
|
| Rate for Payer: Cofinity Commercial |
$33.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.93
|
| Rate for Payer: Healthscope Commercial |
$34.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.86
|
| Rate for Payer: PHP Commercial |
$32.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.13
|
| Rate for Payer: Priority Health SBD |
$24.36
|
|
|
HC CHLOROZINE BATH
|
Facility
|
OP
|
$4.48
|
|
| Hospital Charge Code |
27000094
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$4.03 |
| Rate for Payer: Aetna Commercial |
$3.81
|
| Rate for Payer: Aetna Medicare |
$2.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.91
|
| Rate for Payer: BCBS Complete |
$1.79
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Cofinity Commercial |
$3.14
|
| Rate for Payer: Cofinity Commercial |
$3.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.58
|
| Rate for Payer: Healthscope Commercial |
$4.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.81
|
| Rate for Payer: PHP Commercial |
$3.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.91
|
| Rate for Payer: Priority Health SBD |
$2.82
|
|
|
HC CHLOROZINE BATH
|
Facility
|
IP
|
$4.48
|
|
| Hospital Charge Code |
27000094
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$4.03 |
| Rate for Payer: Aetna Commercial |
$3.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.91
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Cofinity Commercial |
$3.14
|
| Rate for Payer: Cofinity Commercial |
$3.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.58
|
| Rate for Payer: Healthscope Commercial |
$4.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.81
|
| Rate for Payer: PHP Commercial |
$3.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.91
|
| Rate for Payer: Priority Health SBD |
$2.82
|
|
|
HC CHOLANGIOGRAPHY INJ INCLD GUIDE EXISTING ACCESS
|
Facility
|
IP
|
$572.34
|
|
|
Service Code
|
CPT 47531
|
| Hospital Charge Code |
36100488
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$360.57 |
| Max. Negotiated Rate |
$515.11 |
| Rate for Payer: Aetna Commercial |
$486.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.02
|
| Rate for Payer: Cash Price |
$457.87
|
| Rate for Payer: Cofinity Commercial |
$400.64
|
| Rate for Payer: Cofinity Commercial |
$492.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$400.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$457.87
|
| Rate for Payer: Healthscope Commercial |
$515.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$486.49
|
| Rate for Payer: PHP Commercial |
$486.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$372.02
|
| Rate for Payer: Priority Health SBD |
$360.57
|
|
|
HC CHOLANGIOGRAPHY INJ INCLD GUIDE EXISTING ACCESS
|
Facility
|
OP
|
$572.34
|
|
|
Service Code
|
CPT 47531
|
| Hospital Charge Code |
36100488
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$360.57 |
| Max. Negotiated Rate |
$9,688.38 |
| Rate for Payer: Aetna Commercial |
$486.49
|
| Rate for Payer: Aetna Medicare |
$3,579.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,302.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,302.27
|
| Rate for Payer: BCBS Complete |
$1,937.06
|
| Rate for Payer: BCBS MAPPO |
$3,441.82
|
| Rate for Payer: BCN Medicare Advantage |
$3,441.82
|
| Rate for Payer: Cash Price |
$457.87
|
| Rate for Payer: Cash Price |
$457.87
|
| Rate for Payer: Cofinity Commercial |
$400.64
|
| Rate for Payer: Cofinity Commercial |
$492.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$400.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$457.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,441.82
|
| Rate for Payer: Healthscope Commercial |
$515.11
|
| Rate for Payer: Mclaren Medicaid |
$1,844.82
|
| Rate for Payer: Mclaren Medicare |
$3,441.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,613.91
|
| Rate for Payer: Meridian Medicaid |
$1,937.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,958.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$486.49
|
| Rate for Payer: PACE Medicare |
$3,269.73
|
| Rate for Payer: PACE SWMI |
$3,441.82
|
| Rate for Payer: PHP Commercial |
$486.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,441.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,844.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$372.02
|
| Rate for Payer: Priority Health Medicare |
$3,441.82
|
| Rate for Payer: Priority Health SBD |
$360.57
|
| Rate for Payer: Railroad Medicare Medicare |
$3,441.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,688.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,441.82
|
| Rate for Payer: UHC Medicare Advantage |
$3,441.82
|
| Rate for Payer: UHCCP Medicaid |
$1,937.74
|
| Rate for Payer: VA VA |
$3,441.82
|
|
|
HC CHOLANGIOGRAPHY INJ INCLD GUIDE NEW ACCESS
|
Facility
|
OP
|
$3,683.04
|
|
|
Service Code
|
CPT 47532
|
| Hospital Charge Code |
36100489
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,844.82 |
| Max. Negotiated Rate |
$9,688.38 |
| Rate for Payer: Aetna Commercial |
$3,130.58
|
| Rate for Payer: Aetna Medicare |
$3,579.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,393.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,302.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,302.27
|
| Rate for Payer: BCBS Complete |
$1,937.06
|
| Rate for Payer: BCBS MAPPO |
$3,441.82
|
| Rate for Payer: BCN Medicare Advantage |
$3,441.82
|
| Rate for Payer: Cash Price |
$2,946.43
|
| Rate for Payer: Cash Price |
$2,946.43
|
| Rate for Payer: Cofinity Commercial |
$3,167.41
|
| Rate for Payer: Cofinity Commercial |
$2,578.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,578.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,946.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,441.82
|
| Rate for Payer: Healthscope Commercial |
$3,314.74
|
| Rate for Payer: Mclaren Medicaid |
$1,844.82
|
| Rate for Payer: Mclaren Medicare |
$3,441.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,613.91
|
| Rate for Payer: Meridian Medicaid |
$1,937.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,958.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,130.58
|
| Rate for Payer: PACE Medicare |
$3,269.73
|
| Rate for Payer: PACE SWMI |
$3,441.82
|
| Rate for Payer: PHP Commercial |
$3,130.58
|
| Rate for Payer: PHP Medicare Advantage |
$3,441.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,844.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,393.98
|
| Rate for Payer: Priority Health Medicare |
$3,441.82
|
| Rate for Payer: Priority Health SBD |
$2,320.32
|
| Rate for Payer: Railroad Medicare Medicare |
$3,441.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,688.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,441.82
|
| Rate for Payer: UHC Medicare Advantage |
$3,441.82
|
| Rate for Payer: UHCCP Medicaid |
$1,937.74
|
| Rate for Payer: VA VA |
$3,441.82
|
|
|
HC CHOLANGIOGRAPHY INJ INCLD GUIDE NEW ACCESS
|
Facility
|
IP
|
$3,683.04
|
|
|
Service Code
|
CPT 47532
|
| Hospital Charge Code |
36100489
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,320.32 |
| Max. Negotiated Rate |
$3,314.74 |
| Rate for Payer: Aetna Commercial |
$3,130.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,393.98
|
| Rate for Payer: Cash Price |
$2,946.43
|
| Rate for Payer: Cofinity Commercial |
$2,578.13
|
| Rate for Payer: Cofinity Commercial |
$3,167.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,578.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,946.43
|
| Rate for Payer: Healthscope Commercial |
$3,314.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,130.58
|
| Rate for Payer: PHP Commercial |
$3,130.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,393.98
|
| Rate for Payer: Priority Health SBD |
$2,320.32
|
|
|
HC CHOLESTEROL
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
30100155
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.11 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health SBD |
$13.11
|
|
|
HC CHOLESTEROL
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
30100155
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$4.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.44
|
| Rate for Payer: BCBS Complete |
$2.45
|
| Rate for Payer: BCBS MAPPO |
$4.35
|
| Rate for Payer: BCN Medicare Advantage |
$4.35
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.35
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Mclaren Medicaid |
$2.33
|
| Rate for Payer: Mclaren Medicare |
$4.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.57
|
| Rate for Payer: Meridian Medicaid |
$2.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: PACE Medicare |
$4.13
|
| Rate for Payer: PACE SWMI |
$4.35
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: PHP Medicare Advantage |
$4.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health Medicare |
$4.35
|
| Rate for Payer: Priority Health SBD |
$13.11
|
| Rate for Payer: Railroad Medicare Medicare |
$4.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.35
|
| Rate for Payer: UHC Medicare Advantage |
$4.35
|
| Rate for Payer: UHCCP Medicaid |
$2.45
|
| Rate for Payer: VA VA |
$4.35
|
|
|
HC CHOLESTEROL, TOTAL LMPP
|
Facility
|
IP
|
$15.61
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
30100688
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Aetna Commercial |
$13.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.15
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$10.93
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$14.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: PHP Commercial |
$13.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health SBD |
$9.83
|
|
|
HC CHOLESTEROL, TOTAL LMPP
|
Facility
|
OP
|
$15.61
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
30100688
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Aetna Commercial |
$13.27
|
| Rate for Payer: Aetna Medicare |
$4.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.44
|
| Rate for Payer: BCBS Complete |
$2.45
|
| Rate for Payer: BCBS MAPPO |
$4.35
|
| Rate for Payer: BCN Medicare Advantage |
$4.35
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Cofinity Commercial |
$10.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.35
|
| Rate for Payer: Healthscope Commercial |
$14.05
|
| Rate for Payer: Mclaren Medicaid |
$2.33
|
| Rate for Payer: Mclaren Medicare |
$4.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.57
|
| Rate for Payer: Meridian Medicaid |
$2.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: PACE Medicare |
$4.13
|
| Rate for Payer: PACE SWMI |
$4.35
|
| Rate for Payer: PHP Commercial |
$13.27
|
| Rate for Payer: PHP Medicare Advantage |
$4.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health Medicare |
$4.35
|
| Rate for Payer: Priority Health SBD |
$9.83
|
| Rate for Payer: Railroad Medicare Medicare |
$4.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.35
|
| Rate for Payer: UHC Medicare Advantage |
$4.35
|
| Rate for Payer: UHCCP Medicaid |
$2.45
|
| Rate for Payer: VA VA |
$4.35
|
|
|
HC CHOLETEC PER STUDY
|
Facility
|
IP
|
$463.94
|
|
|
Service Code
|
HCPCS A9537
|
| Hospital Charge Code |
34300003
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$292.28 |
| Max. Negotiated Rate |
$417.55 |
| Rate for Payer: Aetna Commercial |
$394.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.56
|
| Rate for Payer: Cash Price |
$371.15
|
| Rate for Payer: Cofinity Commercial |
$324.76
|
| Rate for Payer: Cofinity Commercial |
$398.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$324.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.15
|
| Rate for Payer: Healthscope Commercial |
$417.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.35
|
| Rate for Payer: PHP Commercial |
$394.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.56
|
| Rate for Payer: Priority Health SBD |
$292.28
|
|
