|
HC LINE DELIVERY EXTRA
|
Facility
|
OP
|
$123.75
|
|
| Hospital Charge Code |
27000660
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$111.38 |
| Rate for Payer: Aetna Commercial |
$105.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.44
|
| Rate for Payer: BCBS Complete |
$49.50
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cofinity Commercial |
$106.42
|
| Rate for Payer: Cofinity Commercial |
$86.62
|
| Rate for Payer: Healthscope Commercial |
$111.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$105.19
|
| Rate for Payer: PHP Commercial |
$105.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.62
|
| Rate for Payer: Priority Health SBD |
$77.96
|
|
|
HC LINE DELIVERY EXTRA
|
Facility
|
IP
|
$123.75
|
|
| Hospital Charge Code |
27000660
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$77.96 |
| Max. Negotiated Rate |
$111.38 |
| Rate for Payer: Aetna Commercial |
$105.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.44
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cofinity Commercial |
$106.42
|
| Rate for Payer: Cofinity Commercial |
$86.62
|
| Rate for Payer: Healthscope Commercial |
$111.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$105.19
|
| Rate for Payer: PHP Commercial |
$105.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.62
|
| Rate for Payer: Priority Health SBD |
$77.96
|
|
|
HC LINE ISOLATOR (PRESSURE TRANSDUC)
|
Facility
|
IP
|
$90.00
|
|
| Hospital Charge Code |
27000673
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$56.70 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.50
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$63.00
|
| Rate for Payer: Cofinity Commercial |
$77.40
|
| Rate for Payer: Healthscope Commercial |
$81.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.50
|
| Rate for Payer: PHP Commercial |
$76.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: Priority Health SBD |
$56.70
|
|
|
HC LINE ISOLATOR (PRESSURE TRANSDUC)
|
Facility
|
OP
|
$90.00
|
|
| Hospital Charge Code |
27000673
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.50
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$63.00
|
| Rate for Payer: Cofinity Commercial |
$77.40
|
| Rate for Payer: Healthscope Commercial |
$81.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.50
|
| Rate for Payer: PHP Commercial |
$76.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: Priority Health SBD |
$56.70
|
|
|
HC LINE VACUUM
|
Facility
|
OP
|
$13.50
|
|
| Hospital Charge Code |
27000665
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Aetna Commercial |
$11.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.78
|
| Rate for Payer: BCBS Complete |
$5.40
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cofinity Commercial |
$11.61
|
| Rate for Payer: Cofinity Commercial |
$9.45
|
| Rate for Payer: Healthscope Commercial |
$12.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.48
|
| Rate for Payer: PHP Commercial |
$11.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.45
|
| Rate for Payer: Priority Health SBD |
$8.50
|
|
|
HC LINE VACUUM
|
Facility
|
IP
|
$13.50
|
|
| Hospital Charge Code |
27000665
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Aetna Commercial |
$11.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.78
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cofinity Commercial |
$11.61
|
| Rate for Payer: Cofinity Commercial |
$9.45
|
| Rate for Payer: Healthscope Commercial |
$12.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.48
|
| Rate for Payer: PHP Commercial |
$11.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.45
|
| Rate for Payer: Priority Health SBD |
$8.50
|
|
|
HC LIPASE
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
30100279
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna Medicare |
$7.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.61
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS MAPPO |
$6.89
|
| Rate for Payer: BCBS Trust/PPO |
$5.40
|
| Rate for Payer: BCN Medicare Advantage |
$6.89
|
| 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: Health Alliance Plan Medicare Advantage |
$6.89
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Mclaren Medicaid |
$3.77
|
| Rate for Payer: Mclaren Medicare |
$6.89
|
| Rate for Payer: Meridian Medicaid |
$3.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.01
|
| Rate for Payer: PACE Medicare |
$6.55
|
| Rate for Payer: PACE SWMI |
$6.89
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: PHP Medicare Advantage |
$6.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.42
|
| Rate for Payer: Priority Health Medicare |
$6.89
|
| Rate for Payer: Priority Health SBD |
$19.28
|
| Rate for Payer: Railroad Medicare Medicare |
$6.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.27
|
| Rate for Payer: UHC Core |
$11.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.89
|
| Rate for Payer: UHC Exchange |
$6.89
|
| Rate for Payer: UHC Medicare Advantage |
$7.10
|
| Rate for Payer: VA VA |
$6.89
|
|
|
HC LIPASE
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
30100279
|
|
Hospital Revenue Code
|
301
|
| 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: Healthscope Commercial |
$27.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.01
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.42
|
| Rate for Payer: Priority Health SBD |
$19.28
|
|
|
HC LIPASE BF
|
Facility
|
IP
|
$56.18
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
30100713
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.39 |
| Max. Negotiated Rate |
$50.56 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.52
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cofinity Commercial |
$39.33
|
| Rate for Payer: Cofinity Commercial |
$48.31
|
| Rate for Payer: Healthscope Commercial |
$50.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.75
|
| Rate for Payer: PHP Commercial |
$47.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.33
|
| Rate for Payer: Priority Health SBD |
$35.39
|
|
|
HC LIPASE BF
|
Facility
|
OP
|
$56.18
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
30100713
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$50.56 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: Aetna Medicare |
$7.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.61
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS MAPPO |
$6.89
|
| Rate for Payer: BCBS Trust/PPO |
$5.40
|
| Rate for Payer: BCN Medicare Advantage |
$6.89
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cofinity Commercial |
$39.33
|
| Rate for Payer: Cofinity Commercial |
$48.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.89
|
| Rate for Payer: Healthscope Commercial |
$50.56
|
| Rate for Payer: Mclaren Medicaid |
$3.77
|
| Rate for Payer: Mclaren Medicare |
$6.89
|
| Rate for Payer: Meridian Medicaid |
$3.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.75
|
| Rate for Payer: PACE Medicare |
$6.55
|
| Rate for Payer: PACE SWMI |
$6.89
|
| Rate for Payer: PHP Commercial |
$47.75
|
| Rate for Payer: PHP Medicare Advantage |
$6.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.33
|
| Rate for Payer: Priority Health Medicare |
$6.89
|
| Rate for Payer: Priority Health SBD |
$35.39
|
| Rate for Payer: Railroad Medicare Medicare |
$6.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.27
|
| Rate for Payer: UHC Core |
$11.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.89
|
| Rate for Payer: UHC Exchange |
$6.89
|
| Rate for Payer: UHC Medicare Advantage |
$7.10
|
| Rate for Payer: VA VA |
$6.89
|
|
|
HC LIPID PANEL
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
30100015
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.32 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$13.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.74
|
| Rate for Payer: BCBS Complete |
$7.69
|
| Rate for Payer: BCBS MAPPO |
$13.39
|
| Rate for Payer: BCBS Trust/PPO |
$12.09
|
| Rate for Payer: BCN Medicare Advantage |
$13.39
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.39
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$7.32
|
| Rate for Payer: Mclaren Medicare |
$13.39
|
| Rate for Payer: Meridian Medicaid |
$7.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Medicare |
$12.72
|
| Rate for Payer: PACE SWMI |
$13.39
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$13.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health Medicare |
$13.39
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: Railroad Medicare Medicare |
$13.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.07
|
| Rate for Payer: UHC Core |
$22.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.39
|
| Rate for Payer: UHC Exchange |
$13.39
|
| Rate for Payer: UHC Medicare Advantage |
$13.79
|
| Rate for Payer: VA VA |
$13.39
|
|
|
HC LIPID PANEL
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
30100015
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health SBD |
$32.13
|
|
|
HC LIPOPROTEIN A
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
30100280
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.70 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health SBD |
$25.70
|
|
|
HC LIPOPROTEIN A
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
30100280
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.83 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna Medicare |
$14.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.90
|
| Rate for Payer: BCBS Complete |
$8.23
|
| Rate for Payer: BCBS MAPPO |
$14.32
|
| Rate for Payer: BCBS Trust/PPO |
$11.21
|
| Rate for Payer: BCN Medicare Advantage |
$14.32
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.32
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Mclaren Medicaid |
$7.83
|
| Rate for Payer: Mclaren Medicare |
$14.32
|
| Rate for Payer: Meridian Medicaid |
$8.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PACE Medicare |
$13.60
|
| Rate for Payer: PACE SWMI |
$14.32
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: PHP Medicare Advantage |
$14.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health Medicare |
$14.32
|
| Rate for Payer: Priority Health SBD |
$25.70
|
| Rate for Payer: Railroad Medicare Medicare |
$14.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.18
|
| Rate for Payer: UHC Core |
$22.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.32
|
| Rate for Payer: UHC Exchange |
$14.32
|
| Rate for Payer: UHC Medicare Advantage |
$14.75
|
| Rate for Payer: VA VA |
$14.32
|
|
|
HC LIQUID PLASMA IRRADIATED
|
Facility
|
OP
|
$357.89
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000096
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$40.84 |
| Max. Negotiated Rate |
$322.10 |
| Rate for Payer: Aetna Commercial |
$304.21
|
| Rate for Payer: Aetna Medicare |
$77.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.34
|
| Rate for Payer: BCBS Complete |
$42.89
|
| Rate for Payer: BCBS MAPPO |
$74.67
|
| Rate for Payer: BCBS Trust/PPO |
$248.35
|
| Rate for Payer: BCN Medicare Advantage |
$74.67
|
| Rate for Payer: Cash Price |
$286.31
|
| Rate for Payer: Cash Price |
$286.31
|
| Rate for Payer: Cofinity Commercial |
$307.79
|
| Rate for Payer: Cofinity Commercial |
$250.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.67
|
| Rate for Payer: Healthscope Commercial |
$322.10
|
| Rate for Payer: Mclaren Medicaid |
$40.84
|
| Rate for Payer: Mclaren Medicare |
$74.67
|
| Rate for Payer: Meridian Medicaid |
$42.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$78.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$304.21
|
| Rate for Payer: PACE Medicare |
$70.94
|
| Rate for Payer: PACE SWMI |
$74.67
|
| Rate for Payer: PHP Commercial |
$304.21
|
| Rate for Payer: PHP Medicare Advantage |
$74.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$256.27
|
| Rate for Payer: Priority Health Medicare |
$74.67
|
| Rate for Payer: Priority Health Narrow Network |
$205.02
|
| Rate for Payer: Priority Health SBD |
$225.47
|
| Rate for Payer: Railroad Medicare Medicare |
$74.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.67
|
| Rate for Payer: UHC Medicare Advantage |
$76.91
|
| Rate for Payer: VA VA |
$74.67
|
|
|
HC LIQUID PLASMA IRRADIATED
|
Facility
|
IP
|
$357.89
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000096
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$225.47 |
| Max. Negotiated Rate |
$322.10 |
| Rate for Payer: Aetna Commercial |
$304.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.63
|
| Rate for Payer: Cash Price |
$286.31
|
| Rate for Payer: Cofinity Commercial |
$250.52
|
| Rate for Payer: Cofinity Commercial |
$307.79
|
| Rate for Payer: Healthscope Commercial |
$322.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$304.21
|
| Rate for Payer: PHP Commercial |
$304.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.52
|
| Rate for Payer: Priority Health SBD |
$225.47
|
|
|
HC LISTERIA MONOCYTOGENES
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600274
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health SBD |
$32.13
|
|
|
HC LISTERIA MONOCYTOGENES
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600274
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$59.65 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| 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 |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$27.48
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$59.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC LITHIUM LEVEL
|
Facility
|
OP
|
$53.86
|
|
|
Service Code
|
CPT 80178
|
| Hospital Charge Code |
30100034
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$48.47 |
| Rate for Payer: Aetna Commercial |
$45.78
|
| Rate for Payer: Aetna Medicare |
$6.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.26
|
| Rate for Payer: BCBS Complete |
$3.80
|
| Rate for Payer: BCBS MAPPO |
$6.61
|
| Rate for Payer: BCBS Trust/PPO |
$5.18
|
| Rate for Payer: BCN Medicare Advantage |
$6.61
|
| Rate for Payer: Cash Price |
$43.09
|
| Rate for Payer: Cash Price |
$43.09
|
| Rate for Payer: Cofinity Commercial |
$46.32
|
| Rate for Payer: Cofinity Commercial |
$37.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.61
|
| Rate for Payer: Healthscope Commercial |
$48.47
|
| Rate for Payer: Mclaren Medicaid |
$3.62
|
| Rate for Payer: Mclaren Medicare |
$6.61
|
| Rate for Payer: Meridian Medicaid |
$3.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.78
|
| Rate for Payer: PACE Medicare |
$6.28
|
| Rate for Payer: PACE SWMI |
$6.61
|
| Rate for Payer: PHP Commercial |
$45.78
|
| Rate for Payer: PHP Medicare Advantage |
$6.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.70
|
| Rate for Payer: Priority Health Medicare |
$6.61
|
| Rate for Payer: Priority Health SBD |
$33.93
|
| Rate for Payer: Railroad Medicare Medicare |
$6.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.93
|
| Rate for Payer: UHC Core |
$11.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.61
|
| Rate for Payer: UHC Exchange |
$6.61
|
| Rate for Payer: UHC Medicare Advantage |
$6.81
|
| Rate for Payer: VA VA |
$6.61
|
|
|
HC LITHIUM LEVEL
|
Facility
|
IP
|
$53.86
|
|
|
Service Code
|
CPT 80178
|
| Hospital Charge Code |
30100034
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$48.47 |
| Rate for Payer: Aetna Commercial |
$45.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.01
|
| Rate for Payer: Cash Price |
$43.09
|
| Rate for Payer: Cofinity Commercial |
$37.70
|
| Rate for Payer: Cofinity Commercial |
$46.32
|
| Rate for Payer: Healthscope Commercial |
$48.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.78
|
| Rate for Payer: PHP Commercial |
$45.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.70
|
| Rate for Payer: Priority Health SBD |
$33.93
|
|
|
HC LITHOTRIPSY
|
Facility
|
OP
|
$2,796.13
|
|
| Hospital Charge Code |
36000072
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,118.45 |
| Max. Negotiated Rate |
$2,516.52 |
| Rate for Payer: Aetna Commercial |
$2,376.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,817.48
|
| Rate for Payer: BCBS Complete |
$1,118.45
|
| Rate for Payer: Cash Price |
$2,236.90
|
| Rate for Payer: Cofinity Commercial |
$1,957.29
|
| Rate for Payer: Cofinity Commercial |
$2,404.67
|
| Rate for Payer: Healthscope Commercial |
$2,516.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,376.71
|
| Rate for Payer: PHP Commercial |
$2,376.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,957.29
|
| Rate for Payer: Priority Health SBD |
$1,761.56
|
|
|
HC LITHOTRIPSY
|
Facility
|
IP
|
$2,796.13
|
|
| Hospital Charge Code |
36000072
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,761.56 |
| Max. Negotiated Rate |
$2,516.52 |
| Rate for Payer: Aetna Commercial |
$2,376.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,817.48
|
| Rate for Payer: Cash Price |
$2,236.90
|
| Rate for Payer: Cofinity Commercial |
$1,957.29
|
| Rate for Payer: Cofinity Commercial |
$2,404.67
|
| Rate for Payer: Healthscope Commercial |
$2,516.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,376.71
|
| Rate for Payer: PHP Commercial |
$2,376.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,957.29
|
| Rate for Payer: Priority Health SBD |
$1,761.56
|
|
|
HC LIVER BIOPSY
|
Facility
|
OP
|
$1,449.99
|
|
| Hospital Charge Code |
36000073
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$580.00 |
| Max. Negotiated Rate |
$1,304.99 |
| Rate for Payer: Aetna Commercial |
$1,232.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$942.49
|
| Rate for Payer: BCBS Complete |
$580.00
|
| Rate for Payer: Cash Price |
$1,159.99
|
| Rate for Payer: Cofinity Commercial |
$1,014.99
|
| Rate for Payer: Cofinity Commercial |
$1,246.99
|
| Rate for Payer: Healthscope Commercial |
$1,304.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,232.49
|
| Rate for Payer: PHP Commercial |
$1,232.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,014.99
|
| Rate for Payer: Priority Health SBD |
$913.49
|
|
|
HC LIVER BIOPSY
|
Facility
|
IP
|
$1,449.99
|
|
| Hospital Charge Code |
36000073
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$913.49 |
| Max. Negotiated Rate |
$1,304.99 |
| Rate for Payer: Aetna Commercial |
$1,232.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$942.49
|
| Rate for Payer: Cash Price |
$1,159.99
|
| Rate for Payer: Cofinity Commercial |
$1,014.99
|
| Rate for Payer: Cofinity Commercial |
$1,246.99
|
| Rate for Payer: Healthscope Commercial |
$1,304.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,232.49
|
| Rate for Payer: PHP Commercial |
$1,232.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,014.99
|
| Rate for Payer: Priority Health SBD |
$913.49
|
|
|
HC LIVER KIDNEY MICROSOME ANTIBODY
|
Facility
|
OP
|
$55.49
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
30200208
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$49.94 |
| Rate for Payer: Aetna Commercial |
$47.17
|
| Rate for Payer: Aetna Medicare |
$15.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.19
|
| Rate for Payer: BCBS Complete |
$8.36
|
| Rate for Payer: BCBS MAPPO |
$14.55
|
| Rate for Payer: BCBS Trust/PPO |
$11.39
|
| Rate for Payer: BCN Medicare Advantage |
$14.55
|
| Rate for Payer: Cash Price |
$44.39
|
| Rate for Payer: Cash Price |
$44.39
|
| Rate for Payer: Cofinity Commercial |
$47.72
|
| Rate for Payer: Cofinity Commercial |
$38.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.55
|
| Rate for Payer: Healthscope Commercial |
$49.94
|
| Rate for Payer: Mclaren Medicaid |
$7.96
|
| Rate for Payer: Mclaren Medicare |
$14.55
|
| Rate for Payer: Meridian Medicaid |
$8.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.17
|
| Rate for Payer: PACE Medicare |
$13.82
|
| Rate for Payer: PACE SWMI |
$14.55
|
| Rate for Payer: PHP Commercial |
$47.17
|
| Rate for Payer: PHP Medicare Advantage |
$14.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.84
|
| Rate for Payer: Priority Health Medicare |
$14.55
|
| Rate for Payer: Priority Health SBD |
$34.96
|
| Rate for Payer: Railroad Medicare Medicare |
$14.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.46
|
| Rate for Payer: UHC Core |
$24.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.55
|
| Rate for Payer: UHC Exchange |
$14.55
|
| Rate for Payer: UHC Medicare Advantage |
$14.99
|
| Rate for Payer: VA VA |
$14.55
|
|
