|
HC DRAW VENIPUNCTURE
|
Facility
|
IP
|
$15.61
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
30000001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Aetna Commercial |
$13.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.15
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$10.93
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$14.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: PHP Commercial |
$13.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health SBD |
$9.83
|
|
|
HC DRAW VENIPUNCTURE
|
Facility
|
OP
|
$15.61
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
30000001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$13.27
|
| Rate for Payer: Aetna Medicare |
$9.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.36
|
| Rate for Payer: BCBS Complete |
$5.12
|
| Rate for Payer: BCBS MAPPO |
$9.09
|
| Rate for Payer: BCN Medicare Advantage |
$9.09
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: City of Battle Creek Police Dept Commercial |
$50.00
|
| Rate for Payer: Cofinity Commercial |
$10.93
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.09
|
| Rate for Payer: Healthscope Commercial |
$14.05
|
| Rate for Payer: Mclaren Medicaid |
$4.87
|
| Rate for Payer: Mclaren Medicare |
$9.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.54
|
| Rate for Payer: Meridian Medicaid |
$5.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.45
|
| Rate for Payer: Michigan State Police Michigan State Police |
$50.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: PACE Medicare |
$8.64
|
| Rate for Payer: PACE SWMI |
$9.09
|
| Rate for Payer: PHP Commercial |
$13.27
|
| Rate for Payer: PHP Medicare Advantage |
$9.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health Medicare |
$9.09
|
| Rate for Payer: Priority Health SBD |
$9.83
|
| Rate for Payer: Railroad Medicare Medicare |
$9.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.09
|
| Rate for Payer: UHC Medicare Advantage |
$9.09
|
| Rate for Payer: UHCCP Medicaid |
$5.12
|
| Rate for Payer: VA VA |
$9.09
|
|
|
HC DRSG MEPILEX AG FOAM 8X20
|
Facility
|
IP
|
$370.40
|
|
|
Service Code
|
HCPCS A6214
|
| Hospital Charge Code |
27000065
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$233.35 |
| Max. Negotiated Rate |
$333.36 |
| Rate for Payer: Aetna Commercial |
$314.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.76
|
| Rate for Payer: Cash Price |
$296.32
|
| Rate for Payer: Cofinity Commercial |
$259.28
|
| Rate for Payer: Cofinity Commercial |
$318.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$259.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.32
|
| Rate for Payer: Healthscope Commercial |
$333.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.84
|
| Rate for Payer: PHP Commercial |
$314.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.76
|
| Rate for Payer: Priority Health SBD |
$233.35
|
|
|
HC DRSG MEPILEX AG FOAM 8X20
|
Facility
|
OP
|
$370.40
|
|
|
Service Code
|
HCPCS A6214
|
| Hospital Charge Code |
27000065
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$148.16 |
| Max. Negotiated Rate |
$333.36 |
| Rate for Payer: Aetna Commercial |
$314.84
|
| Rate for Payer: Aetna Medicare |
$185.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.76
|
| Rate for Payer: BCBS Complete |
$148.16
|
| Rate for Payer: Cash Price |
$296.32
|
| Rate for Payer: Cofinity Commercial |
$259.28
|
| Rate for Payer: Cofinity Commercial |
$318.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$259.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.32
|
| Rate for Payer: Healthscope Commercial |
$333.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.84
|
| Rate for Payer: PHP Commercial |
$314.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.76
|
| Rate for Payer: Priority Health SBD |
$233.35
|
|
|
HC DRSG MEPILEX BORDER LITE 4X5 EA
|
Facility
|
IP
|
$5.64
|
|
|
Service Code
|
HCPCS A6213
|
| Hospital Charge Code |
62300221
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$5.08 |
| Rate for Payer: Aetna Commercial |
$4.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.67
|
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Cofinity Commercial |
$4.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.51
|
| Rate for Payer: Healthscope Commercial |
$5.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.79
|
| Rate for Payer: PHP Commercial |
$4.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.67
|
| Rate for Payer: Priority Health SBD |
$3.55
|
|
|
HC DRSG MEPILEX BORDER LITE 4X5 EA
|
Facility
|
OP
|
$5.64
|
|
|
Service Code
|
HCPCS A6213
|
| Hospital Charge Code |
62300221
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$5.08 |
| Rate for Payer: Aetna Commercial |
$4.79
|
| Rate for Payer: Aetna Medicare |
$2.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.67
|
| Rate for Payer: BCBS Complete |
$2.26
|
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Cofinity Commercial |
$4.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.51
|
| Rate for Payer: Healthscope Commercial |
$5.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.79
|
| Rate for Payer: PHP Commercial |
$4.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.67
|
| Rate for Payer: Priority Health SBD |
$3.55
|
|
|
HC DRSG MEPILEX BORDER SACRUM 9X9 EA
|
Facility
|
IP
|
$27.35
|
|
|
Service Code
|
HCPCS A6214
|
| Hospital Charge Code |
62300222
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$17.23 |
| Max. Negotiated Rate |
$24.61 |
| Rate for Payer: Aetna Commercial |
$23.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.78
|
| Rate for Payer: Cash Price |
$21.88
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$23.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.88
|
| Rate for Payer: Healthscope Commercial |
$24.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.25
|
| Rate for Payer: PHP Commercial |
$23.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.78
|
| Rate for Payer: Priority Health SBD |
$17.23
|
|
|
HC DRSG MEPILEX BORDER SACRUM 9X9 EA
|
Facility
|
OP
|
$27.35
|
|
|
Service Code
|
HCPCS A6214
|
| Hospital Charge Code |
62300222
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$24.61 |
| Rate for Payer: Aetna Commercial |
$23.25
|
| Rate for Payer: Aetna Medicare |
$13.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.78
|
| Rate for Payer: BCBS Complete |
$10.94
|
| Rate for Payer: Cash Price |
$21.88
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$23.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.88
|
| Rate for Payer: Healthscope Commercial |
$24.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.25
|
| Rate for Payer: PHP Commercial |
$23.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.78
|
| Rate for Payer: Priority Health SBD |
$17.23
|
|
|
HC DRUG SCREEN 10 URINE
|
Facility
|
OP
|
$104.04
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000134
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$174.92 |
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: BCBS Complete |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Cofinity Commercial |
$72.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Mclaren Medicaid |
$33.31
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.63
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$65.55
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$34.98
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC DRUG SCREEN 10 URINE
|
Facility
|
IP
|
$104.04
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000134
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.55 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.63
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$72.83
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.63
|
| Rate for Payer: Priority Health SBD |
$65.55
|
|
|
HC DRUG SCREEN COLLECT-OUTSIDE SVC
|
Facility
|
IP
|
$24.48
|
|
|
Service Code
|
CPT 99000
|
| Hospital Charge Code |
98300005
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$15.42 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.91
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.81
|
| Rate for Payer: PHP Commercial |
$20.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.91
|
| Rate for Payer: Priority Health SBD |
$15.42
|
|
|
HC DRUG SCREEN COLLECT-OUTSIDE SVC
|
Facility
|
OP
|
$24.48
|
|
|
Service Code
|
CPT 99000
|
| Hospital Charge Code |
98300005
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: Aetna Medicare |
$12.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.91
|
| Rate for Payer: BCBS Complete |
$9.79
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.81
|
| Rate for Payer: PHP Commercial |
$20.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.91
|
| Rate for Payer: Priority Health SBD |
$15.42
|
|
|
HC DRUG SCREEN QUAL EA PROC
|
Facility
|
IP
|
$48.23
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30100652
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.38 |
| Max. Negotiated Rate |
$43.41 |
| Rate for Payer: Aetna Commercial |
$41.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.35
|
| Rate for Payer: Cash Price |
$38.58
|
| Rate for Payer: Cofinity Commercial |
$33.76
|
| Rate for Payer: Cofinity Commercial |
$41.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.58
|
| Rate for Payer: Healthscope Commercial |
$43.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.00
|
| Rate for Payer: PHP Commercial |
$41.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.35
|
| Rate for Payer: Priority Health SBD |
$30.38
|
|
|
HC DRUG SCREEN QUAL EA PROC
|
Facility
|
OP
|
$48.23
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30100652
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$43.41 |
| Rate for Payer: Aetna Commercial |
$41.00
|
| Rate for Payer: Aetna Medicare |
$13.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.75
|
| Rate for Payer: BCBS Complete |
$7.09
|
| Rate for Payer: BCBS MAPPO |
$12.60
|
| Rate for Payer: BCN Medicare Advantage |
$12.60
|
| Rate for Payer: Cash Price |
$38.58
|
| Rate for Payer: Cash Price |
$38.58
|
| Rate for Payer: Cofinity Commercial |
$41.48
|
| Rate for Payer: Cofinity Commercial |
$33.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$43.41
|
| Rate for Payer: Mclaren Medicaid |
$6.75
|
| Rate for Payer: Mclaren Medicare |
$12.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.23
|
| Rate for Payer: Meridian Medicaid |
$7.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.00
|
| Rate for Payer: PACE Medicare |
$11.97
|
| Rate for Payer: PACE SWMI |
$12.60
|
| Rate for Payer: PHP Commercial |
$41.00
|
| Rate for Payer: PHP Medicare Advantage |
$12.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.35
|
| Rate for Payer: Priority Health Medicare |
$12.60
|
| Rate for Payer: Priority Health SBD |
$30.38
|
| Rate for Payer: Railroad Medicare Medicare |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.60
|
| Rate for Payer: UHC Medicare Advantage |
$12.60
|
| Rate for Payer: UHCCP Medicaid |
$7.09
|
| Rate for Payer: VA VA |
$12.60
|
|
|
HC DRUG SCREEN QUANTALCOHOLS
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100732
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.20 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.73
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.03
|
| Rate for Payer: PHP Commercial |
$65.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.73
|
| Rate for Payer: Priority Health SBD |
$48.20
|
|
|
HC DRUG SCREEN QUANTALCOHOLS
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100732
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.03
|
| Rate for Payer: Aetna Medicare |
$38.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.73
|
| Rate for Payer: BCBS Complete |
$30.60
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.03
|
| Rate for Payer: PHP Commercial |
$65.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.73
|
| Rate for Payer: Priority Health SBD |
$48.20
|
|
|
HC DSDNA AB WITH REFLEX, IGG, S
|
Facility
|
IP
|
$39.51
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
30200505
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.89 |
| Max. Negotiated Rate |
$35.56 |
| Rate for Payer: Aetna Commercial |
$33.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.68
|
| Rate for Payer: Cash Price |
$31.61
|
| Rate for Payer: Cofinity Commercial |
$27.66
|
| Rate for Payer: Cofinity Commercial |
$33.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.61
|
| Rate for Payer: Healthscope Commercial |
$35.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.58
|
| Rate for Payer: PHP Commercial |
$33.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.68
|
| Rate for Payer: Priority Health SBD |
$24.89
|
|
|
HC DSDNA AB WITH REFLEX, IGG, S
|
Facility
|
OP
|
$39.51
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
30200505
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$38.68 |
| Rate for Payer: Aetna Commercial |
$33.58
|
| Rate for Payer: Aetna Medicare |
$14.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.68
|
| 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: BCN Medicare Advantage |
$13.74
|
| Rate for Payer: Cash Price |
$31.61
|
| Rate for Payer: Cash Price |
$31.61
|
| Rate for Payer: Cofinity Commercial |
$33.98
|
| Rate for Payer: Cofinity Commercial |
$27.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.74
|
| Rate for Payer: Healthscope Commercial |
$35.56
|
| 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 |
$33.58
|
| Rate for Payer: PACE Medicare |
$13.05
|
| Rate for Payer: PACE SWMI |
$13.74
|
| Rate for Payer: PHP Commercial |
$33.58
|
| 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 |
$25.68
|
| Rate for Payer: Priority Health Medicare |
$13.74
|
| Rate for Payer: Priority Health SBD |
$24.89
|
| Rate for Payer: Railroad Medicare Medicare |
$13.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.68
|
| 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 DSMA TC 99M PER STUDY
|
Facility
|
IP
|
$388.71
|
|
|
Service Code
|
HCPCS A9551
|
| Hospital Charge Code |
34300004
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$244.89 |
| Max. Negotiated Rate |
$349.84 |
| Rate for Payer: Aetna Commercial |
$330.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.66
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$272.10
|
| Rate for Payer: Cofinity Commercial |
$334.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$272.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Healthscope Commercial |
$349.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: PHP Commercial |
$330.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.66
|
| Rate for Payer: Priority Health SBD |
$244.89
|
|
|
HC DSMA TC 99M PER STUDY
|
Facility
|
OP
|
$388.71
|
|
|
Service Code
|
HCPCS A9551
|
| Hospital Charge Code |
34300004
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$155.48 |
| Max. Negotiated Rate |
$349.84 |
| Rate for Payer: Aetna Commercial |
$330.40
|
| Rate for Payer: Aetna Medicare |
$194.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.66
|
| Rate for Payer: BCBS Complete |
$155.48
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$272.10
|
| Rate for Payer: Cofinity Commercial |
$334.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$272.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Healthscope Commercial |
$349.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: PHP Commercial |
$330.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.66
|
| Rate for Payer: Priority Health SBD |
$244.89
|
|
|
HC DTAP HEPB IPV VACCINE INTRAMUSCULAR
|
Facility
|
OP
|
$176.19
|
|
|
Service Code
|
CPT 90723
|
| Hospital Charge Code |
63600137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.48 |
| Max. Negotiated Rate |
$158.57 |
| Rate for Payer: Aetna Commercial |
$149.76
|
| Rate for Payer: Aetna Medicare |
$88.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.52
|
| Rate for Payer: BCBS Complete |
$70.48
|
| Rate for Payer: Cash Price |
$140.95
|
| Rate for Payer: Cofinity Commercial |
$123.33
|
| Rate for Payer: Cofinity Commercial |
$151.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.95
|
| Rate for Payer: Healthscope Commercial |
$158.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.76
|
| Rate for Payer: PHP Commercial |
$149.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.52
|
| Rate for Payer: Priority Health SBD |
$111.00
|
|
|
HC DTAP HEPB IPV VACCINE INTRAMUSCULAR
|
Facility
|
IP
|
$176.19
|
|
|
Service Code
|
CPT 90723
|
| Hospital Charge Code |
63600137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.00 |
| Max. Negotiated Rate |
$158.57 |
| Rate for Payer: Aetna Commercial |
$149.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.52
|
| Rate for Payer: Cash Price |
$140.95
|
| Rate for Payer: Cofinity Commercial |
$123.33
|
| Rate for Payer: Cofinity Commercial |
$151.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.95
|
| Rate for Payer: Healthscope Commercial |
$158.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.76
|
| Rate for Payer: PHP Commercial |
$149.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.52
|
| Rate for Payer: Priority Health SBD |
$111.00
|
|
|
HC DTAP-IPV VACCINE 4-6 YEARS IM
|
Facility
|
OP
|
$76.67
|
|
|
Service Code
|
CPT 90696
|
| Hospital Charge Code |
63600120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.67 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna Commercial |
$65.17
|
| Rate for Payer: Aetna Medicare |
$38.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.84
|
| Rate for Payer: BCBS Complete |
$30.67
|
| Rate for Payer: Cash Price |
$61.34
|
| Rate for Payer: Cofinity Commercial |
$53.67
|
| Rate for Payer: Cofinity Commercial |
$65.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.34
|
| Rate for Payer: Healthscope Commercial |
$69.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.17
|
| Rate for Payer: PHP Commercial |
$65.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.84
|
| Rate for Payer: Priority Health SBD |
$48.30
|
|
|
HC DTAP-IPV VACCINE 4-6 YEARS IM
|
Facility
|
IP
|
$76.67
|
|
|
Service Code
|
CPT 90696
|
| Hospital Charge Code |
63600120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.30 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna Commercial |
$65.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.84
|
| Rate for Payer: Cash Price |
$61.34
|
| Rate for Payer: Cofinity Commercial |
$53.67
|
| Rate for Payer: Cofinity Commercial |
$65.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.34
|
| Rate for Payer: Healthscope Commercial |
$69.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.17
|
| Rate for Payer: PHP Commercial |
$65.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.84
|
| Rate for Payer: Priority Health SBD |
$48.30
|
|
|
HC DTAP-IVP-HIB-HEPB INTRAMUSCULAR
|
Facility
|
IP
|
$166.46
|
|
|
Service Code
|
CPT 90697
|
| Hospital Charge Code |
63600207
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.87 |
| Max. Negotiated Rate |
$149.81 |
| Rate for Payer: Aetna Commercial |
$141.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.20
|
| Rate for Payer: Cash Price |
$133.17
|
| Rate for Payer: Cofinity Commercial |
$116.52
|
| Rate for Payer: Cofinity Commercial |
$143.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.17
|
| Rate for Payer: Healthscope Commercial |
$149.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.49
|
| Rate for Payer: PHP Commercial |
$141.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.20
|
| Rate for Payer: Priority Health SBD |
$104.87
|
|
