|
HC DIP, TET TOX, HAEMO INFLU TYPE B, INACTIV POLIO VAC, (DTAP-IPV/HIB) IM
|
Facility
|
IP
|
$123.60
|
|
|
Service Code
|
CPT 90698
|
| Hospital Charge Code |
63600080
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.87 |
| Max. Negotiated Rate |
$111.24 |
| Rate for Payer: Aetna Commercial |
$105.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.34
|
| Rate for Payer: Cash Price |
$98.88
|
| Rate for Payer: Cofinity Commercial |
$106.30
|
| Rate for Payer: Cofinity Commercial |
$86.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.88
|
| Rate for Payer: Healthscope Commercial |
$111.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.06
|
| Rate for Payer: PHP Commercial |
$105.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.34
|
| Rate for Payer: Priority Health SBD |
$77.87
|
|
|
HC DIP, TET TOX, HAEMO INFLU TYPE B, INACTIV POLIO VAC, (DTAP-IPV/HIB) IM
|
Facility
|
OP
|
$123.60
|
|
|
Service Code
|
CPT 90698
|
| Hospital Charge Code |
63600080
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.44 |
| Max. Negotiated Rate |
$325.82 |
| Rate for Payer: Aetna Commercial |
$105.06
|
| Rate for Payer: Aetna Medicare |
$61.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.34
|
| Rate for Payer: BCBS Complete |
$49.44
|
| Rate for Payer: BCBS Trust/PPO |
$325.82
|
| Rate for Payer: BCN Commercial |
$325.82
|
| Rate for Payer: Cash Price |
$98.88
|
| Rate for Payer: Cash Price |
$98.88
|
| Rate for Payer: Cofinity Commercial |
$106.30
|
| Rate for Payer: Cofinity Commercial |
$86.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.88
|
| Rate for Payer: Healthscope Commercial |
$111.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.06
|
| Rate for Payer: PHP Commercial |
$105.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.34
|
| Rate for Payer: Priority Health SBD |
$77.87
|
|
|
HC DIPTH, TET TOX, AND ACELLUEAR PERTUSSIS VAC (DTAP), LESS THAN 7 YRS IM
|
Facility
|
IP
|
$53.78
|
|
|
Service Code
|
CPT 90700
|
| Hospital Charge Code |
63600081
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$48.40 |
| Rate for Payer: Aetna Commercial |
$45.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.96
|
| Rate for Payer: Cash Price |
$43.02
|
| Rate for Payer: Cofinity Commercial |
$37.65
|
| Rate for Payer: Cofinity Commercial |
$46.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.02
|
| Rate for Payer: Healthscope Commercial |
$48.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.71
|
| Rate for Payer: PHP Commercial |
$45.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.96
|
| Rate for Payer: Priority Health SBD |
$33.88
|
|
|
HC DIPTH, TET TOX, AND ACELLUEAR PERTUSSIS VAC (DTAP), LESS THAN 7 YRS IM
|
Facility
|
OP
|
$53.78
|
|
|
Service Code
|
CPT 90700
|
| Hospital Charge Code |
63600081
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.51 |
| Max. Negotiated Rate |
$81.87 |
| Rate for Payer: Aetna Commercial |
$45.71
|
| Rate for Payer: Aetna Medicare |
$26.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.96
|
| Rate for Payer: BCBS Complete |
$21.51
|
| Rate for Payer: BCBS Trust/PPO |
$81.87
|
| Rate for Payer: BCN Commercial |
$81.87
|
| Rate for Payer: Cash Price |
$43.02
|
| Rate for Payer: Cash Price |
$43.02
|
| Rate for Payer: Cofinity Commercial |
$37.65
|
| Rate for Payer: Cofinity Commercial |
$46.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.02
|
| Rate for Payer: Healthscope Commercial |
$48.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.71
|
| Rate for Payer: PHP Commercial |
$45.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.96
|
| Rate for Payer: Priority Health SBD |
$33.88
|
|
|
HC DIRECT ADMIT TO OBS
|
Facility
|
OP
|
$154.83
|
|
|
Service Code
|
HCPCS G0379
|
| Hospital Charge Code |
76200001
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$97.54 |
| Max. Negotiated Rate |
$1,888.00 |
| Rate for Payer: Aetna Commercial |
$131.61
|
| Rate for Payer: Aetna Medicare |
$624.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$750.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$750.88
|
| Rate for Payer: BCBS Complete |
$338.07
|
| Rate for Payer: BCBS MAPPO |
$600.70
|
| Rate for Payer: BCBS Trust/PPO |
$108.07
|
| Rate for Payer: BCN Commercial |
$108.07
|
| Rate for Payer: BCN Medicare Advantage |
$600.70
|
| Rate for Payer: Cash Price |
$123.86
|
| Rate for Payer: Cash Price |
$123.86
|
| Rate for Payer: Cash Price |
$123.86
|
| Rate for Payer: Cofinity Commercial |
$108.38
|
| Rate for Payer: Cofinity Commercial |
$133.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$600.70
|
| Rate for Payer: Healthscope Commercial |
$139.35
|
| Rate for Payer: Mclaren Medicaid |
$321.98
|
| Rate for Payer: Mclaren Medicare |
$600.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$630.74
|
| Rate for Payer: Meridian Medicaid |
$1,000.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$690.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.61
|
| Rate for Payer: Nomi Health Commercial |
$1,802.10
|
| Rate for Payer: PACE Medicare |
$570.66
|
| Rate for Payer: PACE SWMI |
$600.70
|
| Rate for Payer: PHP Commercial |
$131.61
|
| Rate for Payer: PHP Medicare Advantage |
$600.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,888.00
|
| Rate for Payer: Priority Health Medicare |
$600.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,510.40
|
| Rate for Payer: Priority Health SBD |
$97.54
|
| Rate for Payer: Railroad Medicare Medicare |
$600.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,690.91
|
| Rate for Payer: UHC Core |
$114.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$600.70
|
| Rate for Payer: UHC Exchange |
$114.57
|
| Rate for Payer: UHC Medicare Advantage |
$600.70
|
| Rate for Payer: UHCCP Medicaid |
$338.19
|
| Rate for Payer: VA VA |
$600.70
|
|
|
HC DIRECT ADMIT TO OBS
|
Facility
|
IP
|
$154.83
|
|
|
Service Code
|
HCPCS G0379
|
| Hospital Charge Code |
76200001
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$97.54 |
| Max. Negotiated Rate |
$139.35 |
| Rate for Payer: Aetna Commercial |
$131.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.64
|
| Rate for Payer: Cash Price |
$123.86
|
| Rate for Payer: Cofinity Commercial |
$108.38
|
| Rate for Payer: Cofinity Commercial |
$133.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.86
|
| Rate for Payer: Healthscope Commercial |
$139.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.61
|
| Rate for Payer: PHP Commercial |
$131.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.64
|
| Rate for Payer: Priority Health SBD |
$97.54
|
|
|
HC DIRECT COOMBS
|
Facility
|
IP
|
$65.65
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
30200343
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.36 |
| Max. Negotiated Rate |
$59.08 |
| Rate for Payer: Aetna Commercial |
$55.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.67
|
| Rate for Payer: Cash Price |
$52.52
|
| Rate for Payer: Cofinity Commercial |
$45.96
|
| Rate for Payer: Cofinity Commercial |
$56.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.52
|
| Rate for Payer: Healthscope Commercial |
$59.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.80
|
| Rate for Payer: PHP Commercial |
$55.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.67
|
| Rate for Payer: Priority Health SBD |
$41.36
|
|
|
HC DIRECT COOMBS
|
Facility
|
OP
|
$65.65
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
30200343
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$182.90 |
| Rate for Payer: Aetna Commercial |
$55.80
|
| Rate for Payer: Aetna Medicare |
$60.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.75
|
| Rate for Payer: BCBS Complete |
$32.75
|
| Rate for Payer: BCBS MAPPO |
$58.20
|
| Rate for Payer: BCBS Trust/PPO |
$4.77
|
| Rate for Payer: BCN Commercial |
$4.77
|
| Rate for Payer: BCN Medicare Advantage |
$58.20
|
| Rate for Payer: Cash Price |
$52.52
|
| Rate for Payer: Cash Price |
$52.52
|
| Rate for Payer: Cofinity Commercial |
$56.46
|
| Rate for Payer: Cofinity Commercial |
$45.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.20
|
| Rate for Payer: Healthscope Commercial |
$59.08
|
| Rate for Payer: Mclaren Medicaid |
$31.20
|
| Rate for Payer: Mclaren Medicare |
$58.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.11
|
| Rate for Payer: Meridian Medicaid |
$32.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.80
|
| Rate for Payer: Nomi Health Commercial |
$174.60
|
| Rate for Payer: PACE Medicare |
$55.29
|
| Rate for Payer: PACE SWMI |
$58.20
|
| Rate for Payer: PHP Commercial |
$55.80
|
| Rate for Payer: PHP Medicare Advantage |
$58.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.90
|
| Rate for Payer: Priority Health Medicare |
$58.20
|
| Rate for Payer: Priority Health Narrow Network |
$146.32
|
| Rate for Payer: Priority Health SBD |
$41.36
|
| Rate for Payer: Railroad Medicare Medicare |
$58.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.20
|
| Rate for Payer: UHC Medicare Advantage |
$58.20
|
| Rate for Payer: UHCCP Medicaid |
$32.77
|
| Rate for Payer: VA VA |
$58.20
|
|
|
HC DISACCHARIDASE ANALYSIS
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
30100755
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$96.39 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.45
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$107.10
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health SBD |
$96.39
|
|
|
HC DISACCHARIDASE ANALYSIS
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
30100755
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.88 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna Medicare |
$23.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.71
|
| Rate for Payer: BCBS Complete |
$12.48
|
| Rate for Payer: BCBS MAPPO |
$22.17
|
| Rate for Payer: BCBS Trust/PPO |
$19.63
|
| Rate for Payer: BCN Commercial |
$19.63
|
| Rate for Payer: BCN Medicare Advantage |
$22.17
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Cofinity Commercial |
$107.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.17
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Mclaren Medicaid |
$11.88
|
| Rate for Payer: Mclaren Medicare |
$22.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.28
|
| Rate for Payer: Meridian Medicaid |
$12.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: Nomi Health Commercial |
$33.26
|
| Rate for Payer: PACE Medicare |
$21.06
|
| Rate for Payer: PACE SWMI |
$22.17
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: PHP Medicare Advantage |
$22.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.17
|
| Rate for Payer: Priority Health Medicare |
$22.17
|
| Rate for Payer: Priority Health Narrow Network |
$17.74
|
| Rate for Payer: Priority Health SBD |
$96.39
|
| Rate for Payer: Railroad Medicare Medicare |
$22.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.17
|
| Rate for Payer: UHC Medicare Advantage |
$22.17
|
| Rate for Payer: UHCCP Medicaid |
$12.48
|
| Rate for Payer: VA VA |
$22.17
|
|
|
HC DISASTER COVERAGE
|
Facility
|
OP
|
$144.84
|
|
| Hospital Charge Code |
27000704
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.94 |
| Max. Negotiated Rate |
$130.36 |
| Rate for Payer: Aetna Commercial |
$123.11
|
| Rate for Payer: Aetna Medicare |
$72.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.15
|
| Rate for Payer: BCBS Complete |
$57.94
|
| Rate for Payer: Cash Price |
$115.87
|
| Rate for Payer: Cofinity Commercial |
$101.39
|
| Rate for Payer: Cofinity Commercial |
$124.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.87
|
| Rate for Payer: Healthscope Commercial |
$130.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.11
|
| Rate for Payer: PHP Commercial |
$123.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.15
|
| Rate for Payer: Priority Health SBD |
$91.25
|
|
|
HC DISASTER COVERAGE
|
Facility
|
IP
|
$144.84
|
|
| Hospital Charge Code |
27000704
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$91.25 |
| Max. Negotiated Rate |
$130.36 |
| Rate for Payer: Aetna Commercial |
$123.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.15
|
| Rate for Payer: Cash Price |
$115.87
|
| Rate for Payer: Cofinity Commercial |
$101.39
|
| Rate for Payer: Cofinity Commercial |
$124.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.87
|
| Rate for Payer: Healthscope Commercial |
$130.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.11
|
| Rate for Payer: PHP Commercial |
$123.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.15
|
| Rate for Payer: Priority Health SBD |
$91.25
|
|
|
HC DISP FEE CONTRALATERAL BINAURAL
|
Facility
|
OP
|
$484.50
|
|
|
Service Code
|
CPT V5240
|
| Hospital Charge Code |
27100022
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$193.80 |
| Max. Negotiated Rate |
$436.05 |
| Rate for Payer: Aetna Commercial |
$411.82
|
| Rate for Payer: Aetna Medicare |
$242.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$314.92
|
| Rate for Payer: BCBS Complete |
$193.80
|
| Rate for Payer: Cash Price |
$387.60
|
| Rate for Payer: Cofinity Commercial |
$339.15
|
| Rate for Payer: Cofinity Commercial |
$416.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$339.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.60
|
| Rate for Payer: Healthscope Commercial |
$436.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$411.82
|
| Rate for Payer: PHP Commercial |
$411.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.92
|
| Rate for Payer: Priority Health SBD |
$305.24
|
|
|
HC DISP FEE CONTRALATERAL BINAURAL
|
Facility
|
IP
|
$484.50
|
|
|
Service Code
|
CPT V5240
|
| Hospital Charge Code |
27100022
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$305.24 |
| Max. Negotiated Rate |
$436.05 |
| Rate for Payer: Aetna Commercial |
$411.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$314.92
|
| Rate for Payer: Cash Price |
$387.60
|
| Rate for Payer: Cofinity Commercial |
$339.15
|
| Rate for Payer: Cofinity Commercial |
$416.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$339.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.60
|
| Rate for Payer: Healthscope Commercial |
$436.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$411.82
|
| Rate for Payer: PHP Commercial |
$411.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.92
|
| Rate for Payer: Priority Health SBD |
$305.24
|
|
|
HC DISP FEE CONTRALATERAL MONAURAL
|
Facility
|
IP
|
$280.50
|
|
|
Service Code
|
CPT V5200
|
| Hospital Charge Code |
27100021
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$176.72 |
| Max. Negotiated Rate |
$252.45 |
| Rate for Payer: Aetna Commercial |
$238.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.32
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$196.35
|
| Rate for Payer: Cofinity Commercial |
$241.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Healthscope Commercial |
$252.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.42
|
| Rate for Payer: PHP Commercial |
$238.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.32
|
| Rate for Payer: Priority Health SBD |
$176.72
|
|
|
HC DISP FEE CONTRALATERAL MONAURAL
|
Facility
|
OP
|
$280.50
|
|
|
Service Code
|
CPT V5200
|
| Hospital Charge Code |
27100021
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$112.20 |
| Max. Negotiated Rate |
$252.45 |
| Rate for Payer: Aetna Commercial |
$238.42
|
| Rate for Payer: Aetna Medicare |
$140.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.32
|
| Rate for Payer: BCBS Complete |
$112.20
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$196.35
|
| Rate for Payer: Cofinity Commercial |
$241.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Healthscope Commercial |
$252.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.42
|
| Rate for Payer: PHP Commercial |
$238.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.32
|
| Rate for Payer: Priority Health SBD |
$176.72
|
|
|
HC DNA DOUBLE STRANDED AB
|
Facility
|
IP
|
$28.41
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
30200158
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$25.57 |
| Rate for Payer: Aetna Commercial |
$24.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.47
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cofinity Commercial |
$19.89
|
| Rate for Payer: Cofinity Commercial |
$24.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.73
|
| Rate for Payer: Healthscope Commercial |
$25.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.15
|
| Rate for Payer: PHP Commercial |
$24.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.47
|
| Rate for Payer: Priority Health SBD |
$17.90
|
|
|
HC DNA DOUBLE STRANDED AB
|
Facility
|
OP
|
$28.41
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
30200158
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$25.57 |
| Rate for Payer: Aetna Commercial |
$24.15
|
| Rate for Payer: Aetna Medicare |
$14.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.18
|
| Rate for Payer: BCBS Complete |
$7.73
|
| Rate for Payer: BCBS MAPPO |
$13.74
|
| Rate for Payer: BCBS Trust/PPO |
$12.17
|
| Rate for Payer: BCN Commercial |
$12.17
|
| Rate for Payer: BCN Medicare Advantage |
$13.74
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cofinity Commercial |
$24.43
|
| Rate for Payer: Cofinity Commercial |
$19.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.74
|
| Rate for Payer: Healthscope Commercial |
$25.57
|
| Rate for Payer: Mclaren Medicaid |
$7.36
|
| Rate for Payer: Mclaren Medicare |
$13.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.43
|
| Rate for Payer: Meridian Medicaid |
$7.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.15
|
| Rate for Payer: Nomi Health Commercial |
$20.61
|
| Rate for Payer: PACE Medicare |
$13.05
|
| Rate for Payer: PACE SWMI |
$13.74
|
| Rate for Payer: PHP Commercial |
$24.15
|
| Rate for Payer: PHP Medicare Advantage |
$13.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.74
|
| Rate for Payer: Priority Health Medicare |
$13.74
|
| Rate for Payer: Priority Health Narrow Network |
$10.99
|
| Rate for Payer: Priority Health SBD |
$17.90
|
| Rate for Payer: Railroad Medicare Medicare |
$13.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.74
|
| Rate for Payer: UHC Medicare Advantage |
$13.74
|
| Rate for Payer: UHCCP Medicaid |
$7.74
|
| Rate for Payer: VA VA |
$13.74
|
|
|
HC DNA PROBES CMPT2
|
Facility
|
OP
|
$77.87
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000043
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.44 |
| Max. Negotiated Rate |
$76.78 |
| Rate for Payer: Aetna Commercial |
$66.19
|
| Rate for Payer: Aetna Medicare |
$53.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.99
|
| Rate for Payer: BCBS Complete |
$28.81
|
| Rate for Payer: BCBS MAPPO |
$51.19
|
| Rate for Payer: BCBS Trust/PPO |
$45.31
|
| Rate for Payer: BCN Commercial |
$45.31
|
| Rate for Payer: BCN Medicare Advantage |
$51.19
|
| Rate for Payer: Cash Price |
$62.30
|
| Rate for Payer: Cash Price |
$62.30
|
| Rate for Payer: Cofinity Commercial |
$66.97
|
| Rate for Payer: Cofinity Commercial |
$54.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.19
|
| Rate for Payer: Healthscope Commercial |
$70.08
|
| Rate for Payer: Mclaren Medicaid |
$27.44
|
| Rate for Payer: Mclaren Medicare |
$51.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.75
|
| Rate for Payer: Meridian Medicaid |
$28.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.19
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: PACE Medicare |
$48.63
|
| Rate for Payer: PACE SWMI |
$51.19
|
| Rate for Payer: PHP Commercial |
$66.19
|
| Rate for Payer: PHP Medicare Advantage |
$51.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.19
|
| Rate for Payer: Priority Health Medicare |
$51.19
|
| Rate for Payer: Priority Health Narrow Network |
$40.95
|
| Rate for Payer: Priority Health SBD |
$49.06
|
| Rate for Payer: Railroad Medicare Medicare |
$51.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.19
|
| Rate for Payer: UHC Medicare Advantage |
$51.19
|
| Rate for Payer: UHCCP Medicaid |
$28.82
|
| Rate for Payer: VA VA |
$51.19
|
|
|
HC DNA PROBES CMPT2
|
Facility
|
IP
|
$77.87
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000043
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$49.06 |
| Max. Negotiated Rate |
$70.08 |
| Rate for Payer: Aetna Commercial |
$66.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.62
|
| Rate for Payer: Cash Price |
$62.30
|
| Rate for Payer: Cofinity Commercial |
$54.51
|
| Rate for Payer: Cofinity Commercial |
$66.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.30
|
| Rate for Payer: Healthscope Commercial |
$70.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.19
|
| Rate for Payer: PHP Commercial |
$66.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.62
|
| Rate for Payer: Priority Health SBD |
$49.06
|
|
|
HC DOG IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200038
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.63
|
| Rate for Payer: BCN Commercial |
$4.63
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.37
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$4.30
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC DOG IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200038
|
|
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 DOPPLER COLOR FLOW
|
Facility
|
OP
|
$440.60
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
48000007
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$23.19 |
| Max. Negotiated Rate |
$396.54 |
| Rate for Payer: Aetna Commercial |
$374.51
|
| Rate for Payer: Aetna Medicare |
$220.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$286.39
|
| Rate for Payer: BCBS Complete |
$176.24
|
| Rate for Payer: BCBS Trust/PPO |
$90.08
|
| Rate for Payer: BCN Commercial |
$90.08
|
| Rate for Payer: Cash Price |
$352.48
|
| Rate for Payer: Cash Price |
$352.48
|
| Rate for Payer: Cofinity Commercial |
$308.42
|
| Rate for Payer: Cofinity Commercial |
$378.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$308.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.48
|
| Rate for Payer: Healthscope Commercial |
$396.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.51
|
| Rate for Payer: PHP Commercial |
$374.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.39
|
| Rate for Payer: Priority Health SBD |
$277.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.19
|
| Rate for Payer: UHC Exchange |
$326.04
|
|
|
HC DOPPLER COLOR FLOW
|
Facility
|
IP
|
$440.60
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
48000007
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$277.58 |
| Max. Negotiated Rate |
$396.54 |
| Rate for Payer: Aetna Commercial |
$374.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$286.39
|
| Rate for Payer: Cash Price |
$352.48
|
| Rate for Payer: Cofinity Commercial |
$308.42
|
| Rate for Payer: Cofinity Commercial |
$378.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$308.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.48
|
| Rate for Payer: Healthscope Commercial |
$396.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.51
|
| Rate for Payer: PHP Commercial |
$374.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.39
|
| Rate for Payer: Priority Health SBD |
$277.58
|
|
|
HC DOXYCYCLINE HYCLATE 100 MG
|
Facility
|
OP
|
$225.72
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600189
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$90.29 |
| Max. Negotiated Rate |
$203.15 |
| Rate for Payer: Aetna Commercial |
$191.86
|
| Rate for Payer: Aetna Medicare |
$112.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.72
|
| Rate for Payer: BCBS Complete |
$90.29
|
| Rate for Payer: Cash Price |
$180.58
|
| Rate for Payer: Cofinity Commercial |
$158.00
|
| Rate for Payer: Cofinity Commercial |
$194.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$158.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.58
|
| Rate for Payer: Healthscope Commercial |
$203.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.86
|
| Rate for Payer: PHP Commercial |
$191.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.72
|
| Rate for Payer: Priority Health SBD |
$142.20
|
|
