|
HC CRAB IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200037
|
|
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 CRE
|
Facility
|
IP
|
$1,453.22
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27200104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$915.53 |
| Max. Negotiated Rate |
$1,307.90 |
| Rate for Payer: Aetna Commercial |
$1,235.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$944.59
|
| Rate for Payer: Cash Price |
$1,162.58
|
| Rate for Payer: Cofinity Commercial |
$1,017.25
|
| Rate for Payer: Cofinity Commercial |
$1,249.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,017.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,162.58
|
| Rate for Payer: Healthscope Commercial |
$1,307.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,235.24
|
| Rate for Payer: PHP Commercial |
$1,235.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$944.59
|
| Rate for Payer: Priority Health SBD |
$915.53
|
|
|
HC CRE
|
Facility
|
OP
|
$1,453.22
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27200104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$581.29 |
| Max. Negotiated Rate |
$1,307.90 |
| Rate for Payer: Aetna Commercial |
$1,235.24
|
| Rate for Payer: Aetna Medicare |
$726.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$944.59
|
| Rate for Payer: BCBS Complete |
$581.29
|
| Rate for Payer: Cash Price |
$1,162.58
|
| Rate for Payer: Cofinity Commercial |
$1,017.25
|
| Rate for Payer: Cofinity Commercial |
$1,249.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,017.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,162.58
|
| Rate for Payer: Healthscope Commercial |
$1,307.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,235.24
|
| Rate for Payer: PHP Commercial |
$1,235.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$944.59
|
| Rate for Payer: Priority Health SBD |
$915.53
|
|
|
HC C REACTIVE PROTEIN
|
Facility
|
OP
|
$61.61
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
30200137
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$55.45 |
| Rate for Payer: Aetna Commercial |
$52.37
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.47
|
| Rate for Payer: BCBS Complete |
$2.92
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$49.29
|
| Rate for Payer: Cash Price |
$49.29
|
| Rate for Payer: Cofinity Commercial |
$52.98
|
| Rate for Payer: Cofinity Commercial |
$43.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$55.45
|
| Rate for Payer: Mclaren Medicaid |
$2.78
|
| Rate for Payer: Mclaren Medicare |
$5.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: Meridian Medicaid |
$2.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.37
|
| Rate for Payer: PACE Medicare |
$4.92
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$52.37
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.05
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: Priority Health SBD |
$38.81
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.18
|
| Rate for Payer: UHC Medicare Advantage |
$5.18
|
| Rate for Payer: UHCCP Medicaid |
$2.92
|
| Rate for Payer: VA VA |
$5.18
|
|
|
HC C REACTIVE PROTEIN
|
Facility
|
IP
|
$61.61
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
30200137
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$38.81 |
| Max. Negotiated Rate |
$55.45 |
| Rate for Payer: Aetna Commercial |
$52.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.05
|
| Rate for Payer: Cash Price |
$49.29
|
| Rate for Payer: Cofinity Commercial |
$43.13
|
| Rate for Payer: Cofinity Commercial |
$52.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.29
|
| Rate for Payer: Healthscope Commercial |
$55.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.37
|
| Rate for Payer: PHP Commercial |
$52.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.05
|
| Rate for Payer: Priority Health SBD |
$38.81
|
|
|
HC CREATE TEAR SAC DRAIN
|
Facility
|
OP
|
$5,158.30
|
|
|
Service Code
|
CPT 68720
|
| Hospital Charge Code |
76100308
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,971.29 |
| Max. Negotiated Rate |
$10,352.58 |
| Rate for Payer: Aetna Commercial |
$4,384.56
|
| Rate for Payer: Aetna Medicare |
$3,824.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,352.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,597.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,597.23
|
| Rate for Payer: BCBS Complete |
$2,069.85
|
| Rate for Payer: BCBS MAPPO |
$3,677.78
|
| Rate for Payer: BCN Medicare Advantage |
$3,677.78
|
| Rate for Payer: Cash Price |
$4,126.64
|
| Rate for Payer: Cash Price |
$4,126.64
|
| Rate for Payer: Cofinity Commercial |
$4,436.14
|
| Rate for Payer: Cofinity Commercial |
$3,610.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,610.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,126.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,677.78
|
| Rate for Payer: Healthscope Commercial |
$4,642.47
|
| Rate for Payer: Mclaren Medicaid |
$1,971.29
|
| Rate for Payer: Mclaren Medicare |
$3,677.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,861.67
|
| Rate for Payer: Meridian Medicaid |
$2,069.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,229.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,384.56
|
| Rate for Payer: PACE Medicare |
$3,493.89
|
| Rate for Payer: PACE SWMI |
$3,677.78
|
| Rate for Payer: PHP Commercial |
$4,384.56
|
| Rate for Payer: PHP Medicare Advantage |
$3,677.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,971.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,352.89
|
| Rate for Payer: Priority Health Medicare |
$3,677.78
|
| Rate for Payer: Priority Health SBD |
$3,249.73
|
| Rate for Payer: Railroad Medicare Medicare |
$3,677.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,352.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,677.78
|
| Rate for Payer: UHC Medicare Advantage |
$3,677.78
|
| Rate for Payer: UHCCP Medicaid |
$2,070.59
|
| Rate for Payer: VA VA |
$3,677.78
|
|
|
HC CREATE TEAR SAC DRAIN
|
Facility
|
IP
|
$5,158.30
|
|
|
Service Code
|
CPT 68720
|
| Hospital Charge Code |
76100308
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,249.73 |
| Max. Negotiated Rate |
$4,642.47 |
| Rate for Payer: Aetna Commercial |
$4,384.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,352.89
|
| Rate for Payer: Cash Price |
$4,126.64
|
| Rate for Payer: Cofinity Commercial |
$3,610.81
|
| Rate for Payer: Cofinity Commercial |
$4,436.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,610.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,126.64
|
| Rate for Payer: Healthscope Commercial |
$4,642.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,384.56
|
| Rate for Payer: PHP Commercial |
$4,384.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,352.89
|
| Rate for Payer: Priority Health SBD |
$3,249.73
|
|
|
HC CREATININE CLEARANCE
|
Facility
|
IP
|
$76.91
|
|
|
Service Code
|
CPT 82575
|
| Hospital Charge Code |
30100182
|
|
Hospital Revenue Code
|
301
|
| 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 CREATININE CLEARANCE
|
Facility
|
OP
|
$76.91
|
|
|
Service Code
|
CPT 82575
|
| Hospital Charge Code |
30100182
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$69.22 |
| Rate for Payer: Aetna Commercial |
$65.37
|
| Rate for Payer: Aetna Medicare |
$9.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.82
|
| Rate for Payer: BCBS Complete |
$5.32
|
| Rate for Payer: BCBS MAPPO |
$9.46
|
| Rate for Payer: BCN Medicare Advantage |
$9.46
|
| 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 |
$9.46
|
| Rate for Payer: Healthscope Commercial |
$69.22
|
| Rate for Payer: Mclaren Medicaid |
$5.07
|
| Rate for Payer: Mclaren Medicare |
$9.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.93
|
| Rate for Payer: Meridian Medicaid |
$5.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.37
|
| Rate for Payer: PACE Medicare |
$8.99
|
| Rate for Payer: PACE SWMI |
$9.46
|
| Rate for Payer: PHP Commercial |
$65.37
|
| Rate for Payer: PHP Medicare Advantage |
$9.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.99
|
| Rate for Payer: Priority Health Medicare |
$9.46
|
| Rate for Payer: Priority Health SBD |
$48.45
|
| Rate for Payer: Railroad Medicare Medicare |
$9.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.46
|
| Rate for Payer: UHC Medicare Advantage |
$9.46
|
| Rate for Payer: UHCCP Medicaid |
$5.33
|
| Rate for Payer: VA VA |
$9.46
|
|
|
HC CREATININE SERUM
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
30100180
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$5.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.40
|
| Rate for Payer: BCBS Complete |
$2.88
|
| Rate for Payer: BCBS MAPPO |
$5.12
|
| Rate for Payer: BCN Medicare Advantage |
$5.12
|
| 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 |
$5.12
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Mclaren Medicaid |
$2.74
|
| Rate for Payer: Mclaren Medicare |
$5.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.38
|
| Rate for Payer: Meridian Medicaid |
$2.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: PACE Medicare |
$4.86
|
| Rate for Payer: PACE SWMI |
$5.12
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: PHP Medicare Advantage |
$5.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health Medicare |
$5.12
|
| Rate for Payer: Priority Health SBD |
$13.11
|
| Rate for Payer: Railroad Medicare Medicare |
$5.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.12
|
| Rate for Payer: UHC Medicare Advantage |
$5.12
|
| Rate for Payer: UHCCP Medicaid |
$2.88
|
| Rate for Payer: VA VA |
$5.12
|
|
|
HC CREATININE SERUM
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
30100180
|
|
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 CREATININE URINE/OTHER SOURCE
|
Facility
|
OP
|
$38.66
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
30100181
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$34.79 |
| Rate for Payer: Aetna Commercial |
$32.86
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.47
|
| Rate for Payer: BCBS Complete |
$2.92
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| 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 |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$34.79
|
| Rate for Payer: Mclaren Medicaid |
$2.78
|
| Rate for Payer: Mclaren Medicare |
$5.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: Meridian Medicaid |
$2.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.86
|
| Rate for Payer: PACE Medicare |
$4.92
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$32.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.13
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: Priority Health SBD |
$24.36
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.18
|
| Rate for Payer: UHC Medicare Advantage |
$5.18
|
| Rate for Payer: UHCCP Medicaid |
$2.92
|
| Rate for Payer: VA VA |
$5.18
|
|
|
HC CREATININE URINE/OTHER SOURCE
|
Facility
|
IP
|
$38.66
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
30100181
|
|
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 CREATININE, WHOLE BLOOD
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
30100761
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$5.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.40
|
| Rate for Payer: BCBS Complete |
$2.88
|
| Rate for Payer: BCBS MAPPO |
$5.12
|
| Rate for Payer: BCN Medicare Advantage |
$5.12
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.12
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Mclaren Medicaid |
$2.74
|
| Rate for Payer: Mclaren Medicare |
$5.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.38
|
| Rate for Payer: Meridian Medicaid |
$2.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.34
|
| Rate for Payer: PACE Medicare |
$4.86
|
| Rate for Payer: PACE SWMI |
$5.12
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: PHP Medicare Advantage |
$5.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.26
|
| Rate for Payer: Priority Health Medicare |
$5.12
|
| Rate for Payer: Priority Health SBD |
$12.85
|
| Rate for Payer: Railroad Medicare Medicare |
$5.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.12
|
| Rate for Payer: UHC Medicare Advantage |
$5.12
|
| Rate for Payer: UHCCP Medicaid |
$2.88
|
| Rate for Payer: VA VA |
$5.12
|
|
|
HC CREATININE, WHOLE BLOOD
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
30100761
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.26
|
| Rate for Payer: Priority Health SBD |
$12.85
|
|
|
HC CRITIC AID 6.5 OZ
|
Facility
|
OP
|
$39.99
|
|
| Hospital Charge Code |
27100008
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$35.99 |
| Rate for Payer: Aetna Commercial |
$33.99
|
| Rate for Payer: Aetna Medicare |
$20.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.99
|
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: Cash Price |
$31.99
|
| Rate for Payer: Cofinity Commercial |
$27.99
|
| Rate for Payer: Cofinity Commercial |
$34.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.99
|
| Rate for Payer: Healthscope Commercial |
$35.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.99
|
| Rate for Payer: PHP Commercial |
$33.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.99
|
| Rate for Payer: Priority Health SBD |
$25.19
|
|
|
HC CRITIC AID 6.5 OZ
|
Facility
|
IP
|
$39.99
|
|
| Hospital Charge Code |
27100008
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.19 |
| Max. Negotiated Rate |
$35.99 |
| Rate for Payer: Aetna Commercial |
$33.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.99
|
| Rate for Payer: Cash Price |
$31.99
|
| Rate for Payer: Cofinity Commercial |
$27.99
|
| Rate for Payer: Cofinity Commercial |
$34.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.99
|
| Rate for Payer: Healthscope Commercial |
$35.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.99
|
| Rate for Payer: PHP Commercial |
$33.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.99
|
| Rate for Payer: Priority Health SBD |
$25.19
|
|
|
HC CRITICAL CARE R&B
|
Facility
|
IP
|
$6,337.46
|
|
| Hospital Charge Code |
20000001
|
|
Hospital Revenue Code
|
200
|
| Min. Negotiated Rate |
$3,992.60 |
| Max. Negotiated Rate |
$5,703.71 |
| Rate for Payer: Aetna Commercial |
$5,386.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,119.35
|
| Rate for Payer: Cash Price |
$5,069.97
|
| Rate for Payer: Cofinity Commercial |
$4,436.22
|
| Rate for Payer: Cofinity Commercial |
$5,450.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,436.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,069.97
|
| Rate for Payer: Healthscope Commercial |
$5,703.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,386.84
|
| Rate for Payer: PHP Commercial |
$5,386.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,119.35
|
| Rate for Payer: Priority Health SBD |
$3,992.60
|
|
|
HC CRMP 5 IGG WB
|
Facility
|
OP
|
$160.14
|
|
|
Service Code
|
CPT 84182
|
| Hospital Charge Code |
30100640
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.66 |
| Max. Negotiated Rate |
$144.13 |
| Rate for Payer: Aetna Commercial |
$136.12
|
| Rate for Payer: Aetna Medicare |
$30.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.51
|
| Rate for Payer: BCBS Complete |
$16.44
|
| Rate for Payer: BCBS MAPPO |
$29.21
|
| Rate for Payer: BCN Medicare Advantage |
$29.21
|
| Rate for Payer: Cash Price |
$128.11
|
| Rate for Payer: Cash Price |
$128.11
|
| Rate for Payer: Cofinity Commercial |
$137.72
|
| Rate for Payer: Cofinity Commercial |
$112.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$112.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.21
|
| Rate for Payer: Healthscope Commercial |
$144.13
|
| Rate for Payer: Mclaren Medicaid |
$15.66
|
| Rate for Payer: Mclaren Medicare |
$29.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.67
|
| Rate for Payer: Meridian Medicaid |
$16.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.12
|
| Rate for Payer: PACE Medicare |
$27.75
|
| Rate for Payer: PACE SWMI |
$29.21
|
| Rate for Payer: PHP Commercial |
$136.12
|
| Rate for Payer: PHP Medicare Advantage |
$29.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.09
|
| Rate for Payer: Priority Health Medicare |
$29.21
|
| Rate for Payer: Priority Health SBD |
$100.89
|
| Rate for Payer: Railroad Medicare Medicare |
$29.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.21
|
| Rate for Payer: UHC Medicare Advantage |
$29.21
|
| Rate for Payer: UHCCP Medicaid |
$16.45
|
| Rate for Payer: VA VA |
$29.21
|
|
|
HC CRMP 5 IGG WB
|
Facility
|
IP
|
$160.14
|
|
|
Service Code
|
CPT 84182
|
| Hospital Charge Code |
30100640
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.89 |
| Max. Negotiated Rate |
$144.13 |
| Rate for Payer: Aetna Commercial |
$136.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.09
|
| Rate for Payer: Cash Price |
$128.11
|
| Rate for Payer: Cofinity Commercial |
$112.10
|
| Rate for Payer: Cofinity Commercial |
$137.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$112.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.11
|
| Rate for Payer: Healthscope Commercial |
$144.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.12
|
| Rate for Payer: PHP Commercial |
$136.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.09
|
| Rate for Payer: Priority Health SBD |
$100.89
|
|
|
HC CRMP 5 IGG WESTERN BLOT
|
Facility
|
OP
|
$158.10
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200180
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$142.29 |
| Rate for Payer: Aetna Commercial |
$134.38
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$126.48
|
| Rate for Payer: Cash Price |
$126.48
|
| Rate for Payer: Cofinity Commercial |
$135.97
|
| Rate for Payer: Cofinity Commercial |
$110.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$110.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$142.29
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.38
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$134.38
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.77
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$99.60
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.78
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC CRMP 5 IGG WESTERN BLOT
|
Facility
|
IP
|
$158.10
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200180
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$99.60 |
| Max. Negotiated Rate |
$142.29 |
| Rate for Payer: Aetna Commercial |
$134.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.77
|
| Rate for Payer: Cash Price |
$126.48
|
| Rate for Payer: Cofinity Commercial |
$110.67
|
| Rate for Payer: Cofinity Commercial |
$135.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$110.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.48
|
| Rate for Payer: Healthscope Commercial |
$142.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.38
|
| Rate for Payer: PHP Commercial |
$134.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.77
|
| Rate for Payer: Priority Health SBD |
$99.60
|
|
|
HC CROSSMATCH COOMBS
|
Facility
|
IP
|
$184.62
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
30200352
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$116.31 |
| Max. Negotiated Rate |
$166.16 |
| Rate for Payer: Aetna Commercial |
$156.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.00
|
| Rate for Payer: Cash Price |
$147.70
|
| Rate for Payer: Cofinity Commercial |
$129.23
|
| Rate for Payer: Cofinity Commercial |
$158.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.70
|
| Rate for Payer: Healthscope Commercial |
$166.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.93
|
| Rate for Payer: PHP Commercial |
$156.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.00
|
| Rate for Payer: Priority Health SBD |
$116.31
|
|
|
HC CROSSMATCH COOMBS
|
Facility
|
OP
|
$184.62
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
30200352
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$89.58 |
| Max. Negotiated Rate |
$470.43 |
| Rate for Payer: Aetna Commercial |
$156.93
|
| Rate for Payer: Aetna Medicare |
$173.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$208.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$208.90
|
| Rate for Payer: BCBS Complete |
$94.06
|
| Rate for Payer: BCBS MAPPO |
$167.12
|
| Rate for Payer: BCN Medicare Advantage |
$167.12
|
| Rate for Payer: Cash Price |
$147.70
|
| Rate for Payer: Cash Price |
$147.70
|
| Rate for Payer: Cofinity Commercial |
$158.77
|
| Rate for Payer: Cofinity Commercial |
$129.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.12
|
| Rate for Payer: Healthscope Commercial |
$166.16
|
| Rate for Payer: Mclaren Medicaid |
$89.58
|
| Rate for Payer: Mclaren Medicare |
$167.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.48
|
| Rate for Payer: Meridian Medicaid |
$94.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.93
|
| Rate for Payer: PACE Medicare |
$158.76
|
| Rate for Payer: PACE SWMI |
$167.12
|
| Rate for Payer: PHP Commercial |
$156.93
|
| Rate for Payer: PHP Medicare Advantage |
$167.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.00
|
| Rate for Payer: Priority Health Medicare |
$167.12
|
| Rate for Payer: Priority Health SBD |
$116.31
|
| Rate for Payer: Railroad Medicare Medicare |
$167.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$470.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.12
|
| Rate for Payer: UHC Medicare Advantage |
$167.12
|
| Rate for Payer: UHCCP Medicaid |
$94.09
|
| Rate for Payer: VA VA |
$167.12
|
|
|
HC CROSSMATCH ELECTRONIC
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT 86923
|
| Hospital Charge Code |
30200380
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$39.32 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$43.69
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health SBD |
$39.32
|
|
