|
HC CRYOPRECIPITATE POOL CMPT3
|
Facility
|
OP
|
$248.80
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000047
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$33.23 |
| Max. Negotiated Rate |
$223.92 |
| Rate for Payer: Aetna Commercial |
$211.48
|
| Rate for Payer: Aetna Medicare |
$64.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.50
|
| Rate for Payer: BCBS Complete |
$34.89
|
| Rate for Payer: BCBS MAPPO |
$62.00
|
| Rate for Payer: BCN Medicare Advantage |
$62.00
|
| Rate for Payer: Cash Price |
$199.04
|
| Rate for Payer: Cash Price |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$213.97
|
| Rate for Payer: Cofinity Commercial |
$174.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.00
|
| Rate for Payer: Healthscope Commercial |
$223.92
|
| Rate for Payer: Mclaren Medicaid |
$33.23
|
| Rate for Payer: Mclaren Medicare |
$62.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.10
|
| Rate for Payer: Meridian Medicaid |
$34.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.48
|
| Rate for Payer: PACE Medicare |
$58.90
|
| Rate for Payer: PACE SWMI |
$62.00
|
| Rate for Payer: PHP Commercial |
$211.48
|
| Rate for Payer: PHP Medicare Advantage |
$62.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.72
|
| Rate for Payer: Priority Health Medicare |
$62.00
|
| Rate for Payer: Priority Health SBD |
$156.74
|
| Rate for Payer: Railroad Medicare Medicare |
$62.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.52
|
| Rate for Payer: UHC Core |
$184.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.00
|
| Rate for Payer: UHC Exchange |
$184.11
|
| Rate for Payer: UHC Medicare Advantage |
$62.00
|
| Rate for Payer: UHCCP Medicaid |
$34.91
|
| Rate for Payer: VA VA |
$62.00
|
|
|
HC CRYOPRECIPITATE POOL CMPT4
|
Facility
|
IP
|
$248.80
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000048
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$156.74 |
| Max. Negotiated Rate |
$223.92 |
| Rate for Payer: Aetna Commercial |
$211.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.72
|
| Rate for Payer: Cash Price |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$174.16
|
| Rate for Payer: Cofinity Commercial |
$213.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.04
|
| Rate for Payer: Healthscope Commercial |
$223.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.48
|
| Rate for Payer: PHP Commercial |
$211.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.72
|
| Rate for Payer: Priority Health SBD |
$156.74
|
|
|
HC CRYOPRECIPITATE POOL CMPT4
|
Facility
|
OP
|
$248.80
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000048
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$33.23 |
| Max. Negotiated Rate |
$223.92 |
| Rate for Payer: Aetna Commercial |
$211.48
|
| Rate for Payer: Aetna Medicare |
$64.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.50
|
| Rate for Payer: BCBS Complete |
$34.89
|
| Rate for Payer: BCBS MAPPO |
$62.00
|
| Rate for Payer: BCN Medicare Advantage |
$62.00
|
| Rate for Payer: Cash Price |
$199.04
|
| Rate for Payer: Cash Price |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$213.97
|
| Rate for Payer: Cofinity Commercial |
$174.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.00
|
| Rate for Payer: Healthscope Commercial |
$223.92
|
| Rate for Payer: Mclaren Medicaid |
$33.23
|
| Rate for Payer: Mclaren Medicare |
$62.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.10
|
| Rate for Payer: Meridian Medicaid |
$34.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.48
|
| Rate for Payer: PACE Medicare |
$58.90
|
| Rate for Payer: PACE SWMI |
$62.00
|
| Rate for Payer: PHP Commercial |
$211.48
|
| Rate for Payer: PHP Medicare Advantage |
$62.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.72
|
| Rate for Payer: Priority Health Medicare |
$62.00
|
| Rate for Payer: Priority Health SBD |
$156.74
|
| Rate for Payer: Railroad Medicare Medicare |
$62.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.52
|
| Rate for Payer: UHC Core |
$184.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.00
|
| Rate for Payer: UHC Exchange |
$184.11
|
| Rate for Payer: UHC Medicare Advantage |
$62.00
|
| Rate for Payer: UHCCP Medicaid |
$34.91
|
| Rate for Payer: VA VA |
$62.00
|
|
|
HC CRYOSURGERY ANAL LESION(S)
|
Facility
|
IP
|
$553.35
|
|
|
Service Code
|
CPT 46916
|
| Hospital Charge Code |
76100353
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$348.61 |
| Max. Negotiated Rate |
$498.01 |
| Rate for Payer: Aetna Commercial |
$470.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$359.68
|
| Rate for Payer: Cash Price |
$442.68
|
| Rate for Payer: Cofinity Commercial |
$387.35
|
| Rate for Payer: Cofinity Commercial |
$475.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$387.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$442.68
|
| Rate for Payer: Healthscope Commercial |
$498.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$470.35
|
| Rate for Payer: PHP Commercial |
$470.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.68
|
| Rate for Payer: Priority Health SBD |
$348.61
|
|
|
HC CRYOSURGERY ANAL LESION(S)
|
Facility
|
OP
|
$553.35
|
|
|
Service Code
|
CPT 46916
|
| Hospital Charge Code |
76100353
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna Commercial |
$470.35
|
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$359.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Cash Price |
$442.68
|
| Rate for Payer: Cash Price |
$442.68
|
| Rate for Payer: Cofinity Commercial |
$475.88
|
| Rate for Payer: Cofinity Commercial |
$387.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$387.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$442.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$498.01
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$470.35
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$470.35
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.68
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health SBD |
$348.61
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$109.10
|
| Rate for Payer: VA VA |
$193.79
|
|
|
HC CRYPTOCOCCAL ANTIGEN FLUID
|
Facility
|
OP
|
$46.82
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
30200210
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$45.24 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna Medicare |
$16.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.09
|
| Rate for Payer: BCBS Complete |
$9.04
|
| Rate for Payer: BCBS MAPPO |
$16.07
|
| Rate for Payer: BCN Medicare Advantage |
$16.07
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Cofinity Commercial |
$32.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.07
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Mclaren Medicaid |
$8.61
|
| Rate for Payer: Mclaren Medicare |
$16.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.87
|
| Rate for Payer: Meridian Medicaid |
$9.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: PACE Medicare |
$15.27
|
| Rate for Payer: PACE SWMI |
$16.07
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: PHP Medicare Advantage |
$16.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health Medicare |
$16.07
|
| Rate for Payer: Priority Health SBD |
$29.50
|
| Rate for Payer: Railroad Medicare Medicare |
$16.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.07
|
| Rate for Payer: UHC Medicare Advantage |
$16.07
|
| Rate for Payer: UHCCP Medicaid |
$9.05
|
| Rate for Payer: VA VA |
$16.07
|
|
|
HC CRYPTOCOCCAL ANTIGEN FLUID
|
Facility
|
IP
|
$46.82
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
30200210
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.50 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.43
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$32.77
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health SBD |
$29.50
|
|
|
HC CRYPTOCOCCUS NEOFORMANS GATTII
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600265
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health SBD |
$32.77
|
|
|
HC CRYPTOCOCCUS NEOFORMANS GATTII
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600265
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$98.77 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$32.77
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$19.76
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC CRYPTOSPORIDIUM SCREEN
|
Facility
|
OP
|
$45.78
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
30600120
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$41.20 |
| Rate for Payer: Aetna Commercial |
$38.91
|
| Rate for Payer: Aetna Medicare |
$14.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.27
|
| Rate for Payer: BCBS Complete |
$7.78
|
| Rate for Payer: BCBS MAPPO |
$13.82
|
| Rate for Payer: BCN Medicare Advantage |
$13.82
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Commercial |
$39.37
|
| Rate for Payer: Cofinity Commercial |
$32.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.82
|
| Rate for Payer: Healthscope Commercial |
$41.20
|
| Rate for Payer: Mclaren Medicaid |
$7.41
|
| Rate for Payer: Mclaren Medicare |
$13.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.51
|
| Rate for Payer: Meridian Medicaid |
$7.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: PACE Medicare |
$13.13
|
| Rate for Payer: PACE SWMI |
$13.82
|
| Rate for Payer: PHP Commercial |
$38.91
|
| Rate for Payer: PHP Medicare Advantage |
$13.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.76
|
| Rate for Payer: Priority Health Medicare |
$13.82
|
| Rate for Payer: Priority Health SBD |
$28.84
|
| Rate for Payer: Railroad Medicare Medicare |
$13.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.82
|
| Rate for Payer: UHC Medicare Advantage |
$13.82
|
| Rate for Payer: UHCCP Medicaid |
$7.78
|
| Rate for Payer: VA VA |
$13.82
|
|
|
HC CRYPTOSPORIDIUM SCREEN
|
Facility
|
IP
|
$45.78
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
30600120
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.84 |
| Max. Negotiated Rate |
$41.20 |
| Rate for Payer: Aetna Commercial |
$38.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.76
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Commercial |
$32.05
|
| Rate for Payer: Cofinity Commercial |
$39.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Healthscope Commercial |
$41.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: PHP Commercial |
$38.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.76
|
| Rate for Payer: Priority Health SBD |
$28.84
|
|
|
HC CRYSTALS BODY FLUID
|
Facility
|
OP
|
$47.24
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
30000002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$42.52 |
| Rate for Payer: Aetna Commercial |
$40.15
|
| Rate for Payer: Aetna Medicare |
$7.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.16
|
| Rate for Payer: BCBS Complete |
$4.13
|
| Rate for Payer: BCBS MAPPO |
$7.33
|
| Rate for Payer: BCN Medicare Advantage |
$7.33
|
| Rate for Payer: Cash Price |
$37.79
|
| Rate for Payer: Cash Price |
$37.79
|
| Rate for Payer: Cofinity Commercial |
$40.63
|
| Rate for Payer: Cofinity Commercial |
$33.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.33
|
| Rate for Payer: Healthscope Commercial |
$42.52
|
| Rate for Payer: Mclaren Medicaid |
$3.93
|
| Rate for Payer: Mclaren Medicare |
$7.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.70
|
| Rate for Payer: Meridian Medicaid |
$4.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.15
|
| Rate for Payer: PACE Medicare |
$6.96
|
| Rate for Payer: PACE SWMI |
$7.33
|
| Rate for Payer: PHP Commercial |
$40.15
|
| Rate for Payer: PHP Medicare Advantage |
$7.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.71
|
| Rate for Payer: Priority Health Medicare |
$7.33
|
| Rate for Payer: Priority Health SBD |
$29.76
|
| Rate for Payer: Railroad Medicare Medicare |
$7.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.33
|
| Rate for Payer: UHC Medicare Advantage |
$7.33
|
| Rate for Payer: UHCCP Medicaid |
$4.13
|
| Rate for Payer: VA VA |
$7.33
|
|
|
HC CRYSTALS BODY FLUID
|
Facility
|
IP
|
$47.24
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
30000002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.76 |
| Max. Negotiated Rate |
$42.52 |
| Rate for Payer: Aetna Commercial |
$40.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.71
|
| Rate for Payer: Cash Price |
$37.79
|
| Rate for Payer: Cofinity Commercial |
$33.07
|
| Rate for Payer: Cofinity Commercial |
$40.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.79
|
| Rate for Payer: Healthscope Commercial |
$42.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.15
|
| Rate for Payer: PHP Commercial |
$40.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.71
|
| Rate for Payer: Priority Health SBD |
$29.76
|
|
|
HC C-SECTION (OB SURGERY)
|
Facility
|
IP
|
$2,996.16
|
|
| Hospital Charge Code |
36000024
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,887.58 |
| Max. Negotiated Rate |
$2,696.54 |
| Rate for Payer: Aetna Commercial |
$2,546.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,947.50
|
| Rate for Payer: Cash Price |
$2,396.93
|
| Rate for Payer: Cofinity Commercial |
$2,097.31
|
| Rate for Payer: Cofinity Commercial |
$2,576.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,097.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,396.93
|
| Rate for Payer: Healthscope Commercial |
$2,696.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,546.74
|
| Rate for Payer: PHP Commercial |
$2,546.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,947.50
|
| Rate for Payer: Priority Health SBD |
$1,887.58
|
|
|
HC C-SECTION (OB SURGERY)
|
Facility
|
OP
|
$2,996.16
|
|
| Hospital Charge Code |
36000024
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,198.46 |
| Max. Negotiated Rate |
$2,696.54 |
| Rate for Payer: Aetna Commercial |
$2,546.74
|
| Rate for Payer: Aetna Medicare |
$1,498.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,947.50
|
| Rate for Payer: BCBS Complete |
$1,198.46
|
| Rate for Payer: Cash Price |
$2,396.93
|
| Rate for Payer: Cofinity Commercial |
$2,097.31
|
| Rate for Payer: Cofinity Commercial |
$2,576.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,097.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,396.93
|
| Rate for Payer: Healthscope Commercial |
$2,696.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,546.74
|
| Rate for Payer: PHP Commercial |
$2,546.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,947.50
|
| Rate for Payer: Priority Health SBD |
$1,887.58
|
|
|
HC C-SECTION W/STERIL (OB SURGERY
|
Facility
|
OP
|
$3,679.58
|
|
| Hospital Charge Code |
36000025
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,471.83 |
| Max. Negotiated Rate |
$3,311.62 |
| Rate for Payer: Aetna Commercial |
$3,127.64
|
| Rate for Payer: Aetna Medicare |
$1,839.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,391.73
|
| Rate for Payer: BCBS Complete |
$1,471.83
|
| Rate for Payer: Cash Price |
$2,943.66
|
| Rate for Payer: Cofinity Commercial |
$2,575.71
|
| Rate for Payer: Cofinity Commercial |
$3,164.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,575.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,943.66
|
| Rate for Payer: Healthscope Commercial |
$3,311.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,127.64
|
| Rate for Payer: PHP Commercial |
$3,127.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,391.73
|
| Rate for Payer: Priority Health SBD |
$2,318.14
|
|
|
HC C-SECTION W/STERIL (OB SURGERY
|
Facility
|
IP
|
$3,679.58
|
|
| Hospital Charge Code |
36000025
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,318.14 |
| Max. Negotiated Rate |
$3,311.62 |
| Rate for Payer: Aetna Commercial |
$3,127.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,391.73
|
| Rate for Payer: Cash Price |
$2,943.66
|
| Rate for Payer: Cofinity Commercial |
$2,575.71
|
| Rate for Payer: Cofinity Commercial |
$3,164.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,575.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,943.66
|
| Rate for Payer: Healthscope Commercial |
$3,311.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,127.64
|
| Rate for Payer: PHP Commercial |
$3,127.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,391.73
|
| Rate for Payer: Priority Health SBD |
$2,318.14
|
|
|
HC CSF LACTATE
|
Facility
|
IP
|
$21.85
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
30100482
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$19.66 |
| Rate for Payer: Aetna Commercial |
$18.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.20
|
| Rate for Payer: Cash Price |
$17.48
|
| Rate for Payer: Cofinity Commercial |
$15.29
|
| Rate for Payer: Cofinity Commercial |
$18.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.48
|
| Rate for Payer: Healthscope Commercial |
$19.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.57
|
| Rate for Payer: PHP Commercial |
$18.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.20
|
| Rate for Payer: Priority Health SBD |
$13.77
|
|
|
HC CSF LACTATE
|
Facility
|
OP
|
$21.85
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
30100482
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$32.57 |
| Rate for Payer: Aetna Commercial |
$18.57
|
| Rate for Payer: Aetna Medicare |
$12.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.46
|
| Rate for Payer: BCBS Complete |
$6.51
|
| Rate for Payer: BCBS MAPPO |
$11.57
|
| Rate for Payer: BCN Medicare Advantage |
$11.57
|
| Rate for Payer: Cash Price |
$17.48
|
| Rate for Payer: Cash Price |
$17.48
|
| Rate for Payer: Cofinity Commercial |
$18.79
|
| Rate for Payer: Cofinity Commercial |
$15.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.57
|
| Rate for Payer: Healthscope Commercial |
$19.66
|
| Rate for Payer: Mclaren Medicaid |
$6.20
|
| Rate for Payer: Mclaren Medicare |
$11.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.15
|
| Rate for Payer: Meridian Medicaid |
$6.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.57
|
| Rate for Payer: PACE Medicare |
$10.99
|
| Rate for Payer: PACE SWMI |
$11.57
|
| Rate for Payer: PHP Commercial |
$18.57
|
| Rate for Payer: PHP Medicare Advantage |
$11.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.20
|
| Rate for Payer: Priority Health Medicare |
$11.57
|
| Rate for Payer: Priority Health SBD |
$13.77
|
| Rate for Payer: Railroad Medicare Medicare |
$11.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.57
|
| Rate for Payer: UHC Medicare Advantage |
$11.57
|
| Rate for Payer: UHCCP Medicaid |
$6.51
|
| Rate for Payer: VA VA |
$11.57
|
|
|
HC CSU OBSERVATION PER HOUR
|
Facility
|
IP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200016
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$130.57 |
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.30
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$101.56
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$130.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: PHP Commercial |
$123.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health SBD |
$91.40
|
|
|
HC CSU OBSERVATION PER HOUR
|
Facility
|
OP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200016
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$58.03 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: Aetna Medicare |
$72.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.30
|
| Rate for Payer: BCBS Complete |
$58.03
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$101.56
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$130.57
|
| Rate for Payer: Meridian Medicaid |
$1,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: PHP Commercial |
$123.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health SBD |
$91.40
|
| Rate for Payer: UHC Core |
$107.36
|
| Rate for Payer: UHC Exchange |
$107.36
|
|
|
HC CSU R&B
|
Facility
|
IP
|
$7,308.69
|
|
| Hospital Charge Code |
21000002
|
|
Hospital Revenue Code
|
210
|
| Min. Negotiated Rate |
$4,604.47 |
| Max. Negotiated Rate |
$6,577.82 |
| Rate for Payer: Aetna Commercial |
$6,212.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,750.65
|
| Rate for Payer: Cash Price |
$5,846.95
|
| Rate for Payer: Cofinity Commercial |
$5,116.08
|
| Rate for Payer: Cofinity Commercial |
$6,285.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,116.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,846.95
|
| Rate for Payer: Healthscope Commercial |
$6,577.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,212.39
|
| Rate for Payer: PHP Commercial |
$6,212.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,750.65
|
| Rate for Payer: Priority Health SBD |
$4,604.47
|
|
|
HC CT ABDOMEN AND PELVIS W CON
|
Facility
|
IP
|
$3,709.64
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
35200027
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,337.07 |
| Max. Negotiated Rate |
$3,338.68 |
| Rate for Payer: Aetna Commercial |
$3,153.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,411.27
|
| Rate for Payer: Cash Price |
$2,967.71
|
| Rate for Payer: Cofinity Commercial |
$2,596.75
|
| Rate for Payer: Cofinity Commercial |
$3,190.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,596.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,967.71
|
| Rate for Payer: Healthscope Commercial |
$3,338.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,153.19
|
| Rate for Payer: PHP Commercial |
$3,153.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,411.27
|
| Rate for Payer: Priority Health SBD |
$2,337.07
|
|
|
HC CT ABDOMEN AND PELVIS W CON
|
Facility
|
OP
|
$3,709.64
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
35200027
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$3,338.68 |
| Rate for Payer: Aetna Commercial |
$3,153.19
|
| Rate for Payer: Aetna Medicare |
$362.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,411.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| Rate for Payer: Cash Price |
$2,967.71
|
| Rate for Payer: Cash Price |
$2,967.71
|
| Rate for Payer: Cofinity Commercial |
$3,190.29
|
| Rate for Payer: Cofinity Commercial |
$2,596.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,596.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,967.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$3,338.68
|
| Rate for Payer: Mclaren Medicaid |
$186.69
|
| Rate for Payer: Mclaren Medicare |
$348.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.71
|
| Rate for Payer: Meridian Medicaid |
$196.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,153.19
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$3,153.19
|
| Rate for Payer: PHP Medicare Advantage |
$348.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,411.27
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health SBD |
$2,337.07
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$980.43
|
| Rate for Payer: UHC Core |
$2,745.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$2,745.13
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$196.09
|
| Rate for Payer: VA VA |
$348.30
|
|
|
HC CT ABDOMEN AND PELVIS WO CON
|
Facility
|
IP
|
$2,502.26
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
35200026
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,576.42 |
| Max. Negotiated Rate |
$2,252.03 |
| Rate for Payer: Aetna Commercial |
$2,126.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,626.47
|
| Rate for Payer: Cash Price |
$2,001.81
|
| Rate for Payer: Cofinity Commercial |
$1,751.58
|
| Rate for Payer: Cofinity Commercial |
$2,151.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,751.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,001.81
|
| Rate for Payer: Healthscope Commercial |
$2,252.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,126.92
|
| Rate for Payer: PHP Commercial |
$2,126.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,626.47
|
| Rate for Payer: Priority Health SBD |
$1,576.42
|
|
